Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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The first phase of the procedure involves harvesting the fat. Traditional liposuction can be too harsh, damaging the fragile fat cells. Hydrodynamic or water-jet-assisted liposuction is a common technique for gently dislodging fat cells. A fan-shaped jet of fluid separates the fat from the connective tissue.
This method minimizes trauma to adipocytes, thereby increasing viability. It washes the fat cells out of the body rather than scraping them out. This gentle harvest is critical to the graft’s ultimate survival.
Many surgeons prefer manual syringe aspiration over machine suction. This involves using a handheld syringe with a low-pressure vacuum to extract the fat. This gives the surgeon tactile feedback and precise control over the negative pressure applied to the cells.
By keeping the suction pressure low, the structural integrity of the fat cell wall is preserved. High-pressure suction can rupture cells, rendering them useless for grafting. This manual technique is labor-intensive but yields high-quality fat.
Once harvested, the fat must be processed to remove oil, blood, and tumescent fluid. Closed-system processing keeps the fat within a sterile circuit, preventing exposure to air. This significantly reduces the risk of contamination and infection.
Devices in this category often use filtration or gravity-based separation within a sealed bag or canister. This ensures that only the purest, most viable fat is prepared for reinjection while maintaining the strictest sterility standards.
Centrifugation is a widely used method for purifying harvested fat. The syringes of fat are spun at high speed to separate the components by density. This creates distinct layers: oil on top, pure fat in the middle, and blood/fluid on the bottom.
The surgeon then discards the oil and fluid, keeping only the concentrated fat cells and stem cells. While effective, care must be taken not to spin the fat too quickly, as this could damage delicate cells. This method concentrates the growth factors.
Expansion Vibration Lipofilling, or EVL, is a technique used during the injection phase. The surgeon uses a rapidly oscillating vibrating cannula. This vibration helps the cannula glide through the breast tissue without tearing it.
The vibration also helps to scatter the fat cells more evenly, preventing clumps. It expands the recipient tissue matrix, allowing for a larger volume of fat to be injected safely and smoothly. This reduces the physical effort required and improves patient comfort.
To ensure the fat survives, it cannot be injected into a single large pocket. Surgeons use a multiplanar technique, depositing tiny fat trails at different levels within the breast.
Fat is placed in the subcutaneous plane (under the skin), the intraglandular plane (within the breast tissue), and the prepectoral plane (over the muscle). This layering ensures that every droplet of fat is surrounded by healthy, blood-rich tissue, which supports its survival.
For patients with very tight skin or small breasts, a device called BRAVA may be used weeks before surgery. This external suction device consists of two domes worn over the breasts. It applies gentle negative pressure to stretch the skin and create space.
This pre-expansion process essentially primes the breast, creating a larger matrix to receive the fat. It also increases blood flow to the area. While it requires significant patient compliance, it can double the amount of fat that can be successfully grafted.
This procedure combines a breast implant with fat grafting. The implant provides the core projection and volume, while the fat is layered over the top. This is particularly useful for camouflaging the edges of the implant in thin patients.
The fat is often injected into the cleavage area and the upper pole to create a soft, natural transition. This technique allows for the use of smaller implants while still achieving the desired size, reducing the weight burden on the chest wall.
Revision grafting is performed to correct irregularities from prior surgeries, whether from implants or prior fat transfers. It is a precise, targeted procedure used to fill dents, ripples, or asymmetries.
This often involves smaller volumes of fat injected into specific defects. It acts as a biological “spackle” to smooth out the breast contour. It is a standard secondary procedure to perfect the aesthetic result.
Some advanced procedures involve enriching the fat graft with additional stem cells. This can be done by harvesting extra fat, isolating the stromal vascular fraction (SVF), which contains the stem cells, and mixing it with the fat to be grafted.
This cell-assisted lipotransfer (CAL) aims to improve the survival rate of the fat and enhance the skin rejuvenating effects. While more time-consuming and costly, it is an option for patients with poor tissue quality or radiation damage.
In cases where the nipple blood supply is compromised or thin, fat grafting can be used to improve the vascular bed. By injecting fat deep around the nipple areola complex, the surgeon can thicken the supporting tissue.
This creates a more robust cushion for the nipple, potentially improving projection. It is a delicate procedure requiring precise placement to avoid damaging the existing ducts or neurovascular bundles.
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There is no single “best” method, but gentle techniques like water-jet or low-pressure manual aspiration are generally preferred. The key is to avoid high-suction machines that can shred the fat cells. The surgeon’s skill in handling the fat is more important than the specific brand of machine.
Yes, for the right patient. If you have tiny, tight breasts (A cup or smaller), the BRAVA device can significantly increase the amount of fat that survives by creating space and improving blood flow. However, it requires wearing the device for 10+ hours a day for weeks, which is a significant commitment.
Both methods work well when done correctly. Centrifugation (spinning) concentrates the fat, resulting in a denser volume. Filtration (washing) is gentler and keeps the fat more hydrated. Surgeons choose based on their experience and the patient’s specific tissue quality.
Yes, this is one of the best uses for fat grafting. Injecting a layer of fat over the rippled area of an implant thickens the skin and hides the wrinkles, creating a smooth surface. It is a ubiquitous part of breast revision surgery.
Most patients are satisfied after one session if they have realistic expectations (a 0.5 to 1 cup-size increase). If you want a larger increase or have very tight skin, plan a second session 3 to 6 months later to build volume in layers.
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