Breast Augmentation

Breast augmentation is the enlargement of the breasts. It's most commonly performed using an implant that's placed in a pocket made behind the breast or under the pectoral muscle.

There are two main types of implants for breast augmentation. Saline implants are made of a silicone shell that's filled with a solution of saline (sterile salt water). The size of some saline implants can be adjusted by injecting or removing saline. Silicone implants are filled with a silicone gel. Several years ago, silicone breast implants were pulled from the market because of safety concerns. After more thorough studies, the FDA approved the use of silicone breast implants again in November 2006.

Breast augmentation is the second most popular surgical cosmetic procedure in the U.S. In 2006, the American Society for Aesthetic Plastic Surgery estimates more than 383,800 procedures were performed in this country.

A "Natural" Alternative to Breast Implants

While breast implants remain very popular, some women are still reluctant to get them. Surgery is required to place the implant, increasing the risk of infection and bleeding. And though implants are generally considered to be safe, some women experience scarring, breast tightening (capsular contracture), rippling or wrinkling of the implant. There is also a risk the implant will rupture.

A more natural option to breast implants is fat grafting, or transplanting fat from one area of the body to another. First, the fat is taken from the patient's own body using liposuction techniques. Then, the fat cells are harvested and injected into the breast. The procedure is touted as a way for women to lose fat in unwanted areas of the bodies and gain volume and shape in the breasts.

Research shows transplanted fat is a good filler and readily incorporated into the tissues. When taken from the patient's own body, the fat is completely biocompatible and won't be rejected. Most patients have more than a sufficient supply of donor fat.

Early attempts at fat grafting for the breast were often not very successful. In many cases, the transplanted fat cells died and were absorbed back into the body, erasing the results of the augmentation. There were also concerns about the development of cysts or calcifications that could mimic breast cancer or interfere with the ability to detect the cancer.

Now, using refined techniques, some surgeons are having more successful results. Plastic Surgeon Roger Khouri, M.D., is offering fat grafting for breast augmentation to his patients. He recommends that prior to the transplant, the breasts be prepared with a device called the BRAVA® Breast Enhancement and Shaping System. BRAVA consists of two dome-shaped bra cups connected to a small computerized battery pack. The system, worn for 10 hours a day, gently and rhythmically tugs or pulls on the breasts. Khouri explains the process creates extra space for the transplanted fat.

After two weeks of wearing the BRAVA device, the patient comes into the office for the fat grafting. Khouri removes the fat. Then using syringes, he injects small amounts of fat into the space created by BRAVA therapy - under the breast tissue or into the space between the breast and the skin. With time, some of the fat cells die. However, with the refined techniques, doctors are seeing much higher rates of graft survival, often as much as 80 to 90 percent. Final results of the procedure can be seen after about three to four months.

Khouri says fat grafting won't provide the same amount of enlargement as breast implants. In most cases, the procedure will enhance the breasts by only one or two cup sizes. So women who are looking for larger breasts will still need to use breast implants.

While more physicians are reporting successful use of fat grafting, experts are divided over its use. The American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery still advise against fat grafting for breast enhancement until safety of the procedure can be better established.

For information about the BRAVA® Breast Enhancement and Shaping System: http://www.brava.com/home.asp

For general information on breast augmentation: American Society for Aesthetic Plastic SurgeryAmerican Society of Plastic Surgeons