Science does not allow us to talk about something that is not proven. The difference between science with myth or religion is that science only talks about things that have been confirmed. Medical sector is a part of science therefore, the doctor should only communicate about scientific truth as well.



However, the medical field has a lot of technical and professional terminologies that cannot be understood without any basic knowledge. Therefore, it is important to change these terms to what the patients can understand. We need to use some daily life words or terminologies when we treat the patients.

In the internet, we see contents that both professionals and nonprofessionals have written. We do not know what is scientific or not, and we do not know what is for marketing purpose or not. I think that as a doctor, it is important to let the patients know what contents are reliable or not.

This applies to fat / stem cell transplant as well.

In this era of capitalism, people are excited and concentrate on new products and want to purchase these products. The professionals need to provide evidence that these products are effective and safe to use. The patients should listen to these evidence and make decision on the purchase. However, there are millions of false information on the internet with marketing purposes.



Fat transplant in exact terminology is called ‘Free fat graft operation by injection’. As soon as the fat is removed from the donor site, the supply of oxygen/nutrition is stopped. The core question then would be how long this fat can last without oxygen/nutrition until it is transplanted to a new site.

If we conduct the surgery in a quite, stable and ready environment, there would be less trauma on the patient and the overall transplant process would be quick with high success rate. The fat that has been transplanted does not grow its vessels but gets oxygen/nutrition from the surrounding areas. So engrafting large amount of fat would not be meaningful. Small amount of fat transplanted in a large area would lead to better success rate.




But if this is applied, there would be many complaints from patients. They would think that there is no effect with the given cost. In order to satisfy the patients, the hospital now puts much more fat than necessary and also provide 2nd, 3rd, and 4th revision if necessary.

There still is a problem with the graft success rate. In order to improve on this, stem cell transplant has been carried out simultaneously. We also provide an explanation to the patients that this simultaneous activity increases the success rate.

In 2013 during the US Plastic Surgery Association Meeting, it was notified that stem cell transplant is still not reliable as there are not enough related data, findings and complications that may arise. Also it was notified that stem cell transplant should not be used as a marketing tool to gather the patients. However, not much has changed since.



The studies on the stem cell transplant are still under say and there is no concrete finding that we can share. We only presume that something would happen with a few concrete facts. We derive preadipocyte and enrich it to put into an area such as your wrinkles on the face. The preadipocyte are young compared to other cells therefore one can presume that they can last longer and result in higher success rate. It is still believed that minimum of 5 to 10 years are required for us to find if the stem cell transplant is safe and has no complications.



I do not recommend stem cell transplant unless it is really necessary (for example, when you need a revision, have a severe scar, or if there are no other choices). I hope that the patients too ,would give much thought into fat and stem cell transplant.

This is all for today. Thank you.

Breast fat transfer [KIES-U Korea]

Q. Is it effective to do fat transfer for the breast augmentation?
A. Yes, it is.
Q. Is the breast fat transfer safe?
A. Yes, it has been determined that it is safe.
Q. Which is the better method? Breast fat transfer or the implant?
A. It is difficult to say which is the better of the two. It depends.





The questions above are the frequently asked questions. Today, we will talk about the fat transfer breast augmetation.

When did the fat transfer breast augmentation start?

First, let’s talk about the history. Some people would be bored with this term, “history”, but you would be surprised to know this history of beauty surgery. You will be able to know that a lot of what we do today, has already been done in the past.
 
People do not think much differently.
In 1890, somebody started a surgery that required the usage of liquid paraffin. This was the beginning of the breast augmentation surgery.

Of course, there were a lot of problems. Infection caused inflammation and necrosis. People said that none of such this happened, but you could feel lumps on the body.
This method disappeared after the 1920’s.



 
Fat transfer breast augmentation started in the 1920’s. It was not much different from what it is today. You take the fat from the abdomen or the buttocks and transfer the fat to the breast. This fat did not cause infection like the paraffin but the problem was that the fat dissolved quickly. The result looked good however, the result was not maintainable. The number of people who wanted fat transfer decreased after the 1920’s, but this number started to increase as those patients who needed reconstructive surgery after the breast cancer surgery increased.

In 1987, US Cosmetic Surgery Association objected breast fat transfer because it perceived that the scar tissue caused from the breast fat transfer and calcification caused difficulty in examining the breast cancer through x-ray. There were many doctors / surgeon who are concerned about this, therefore, agreed to the objection.

Introduction of structural fat transfer

Then in 1990’s NYU’s Dr. Sidney Coleman introduced a new idea of “Structural Fat Grafting” and stated that the newly transferred fat with good technique would lead to good grafting and longer maintaining period of the fat.

Also, Dr. Coleman proved that the fat transfer did not cause any problem in examining the breast cancer.

There was no problem with this theory and many doctors agreed to the theory as well, leading to a big expansion of fat transfer. US Cosmetic Surgery Association backed off from its objection and accepted the fat transfer as a good method. (This happened in 2007)

Dr. Coleman is perceived to be an expert in the fat transfer sector. Most of the fat transfer originated from this “Coleman technique”.

Dr. Coleman stated that each surgery requires about 300 cc of fat. If more fat is used then this would lead to necrosis and he also stated that the fat transfer is a good alternative to solving breast size and form problems.

Limitation on fat transfer
 

Then, let’s look at some limitation on Dr. Coleman’s breast fat transfer.

"For those who want very big breast, it is recommended to use the breast implants rather than doing the fat transfer". This means that the fat transfer breast augmentation is not effective to product a large volume on the breasts.

Another limitation is the body type. Those with thin body would not have enough fat to transfer to have large breasts.
Usually, we would need to transfer 250~400cc of fat on each breast for other people to visually recognize that the breast has become bigger.
So, approximately, 800cc of fat would be needed for both breasts.
In order to get 800 cc of fat, we would need 1600 cc of fat from the abdomen or thighs.
This much amount of fat is not possible from a thin person. Also, fat transfer is not a one-time procedure. It requires 2 or 3 procedures.
If you take the fat from the stomach or thigh that do not have enough fat, it would lead to uneven shape of the stomach or the thigh.



It is important that the breasts become bigger. The fat that has been transferred properly to the breast leads to better feel than any other implants that have been used and also there are no problems with shape or structure. But, if you compromise on your thigh or abdomen to make the breast look better, you might want to reconsider this.

This is the biggest limitation of breast fat transfer. This is only recommendable to those patients who have enough fat.

To whom is the fat transfer breast augmentation applicable?

If there is a limitation on the amount of fat used in one procedure, then you might need a second one.
There must be about 4 month term between the first and the second procedures. We must check if the fat transferred remains or not after 4 months.
Therefore, fat transfer requires patience.

All the surgeries that have originated from Coleman technique must be done 100% by hands. There are many advertisements that the clinics have certain tools or products that lead to better results but these tools or products have not been verified. Fat transfer takes about 4 to 5 hours therefore, requiring a lot of labor.
You might think that your breast look larger after the long surgery, but this could be a hallucination. About 50% of the fat disappears at that moment.
Most of the patients are not satisfied with the loss of volume after 4 months. Most patients give up rather than asking for the second fat transfer.



There are some requirements for those who want breast fat transfer.
First, do not expect to have large breasts
Second, you need to have the patience to do this 2~3 times for a period of 6 months or more
Third, you need to have enough fat on your body. Your weight needs to be more than a certain level.

You need to be familiar with these three points and find an appropriate method. Breast fat transfer is a very good method but this does not apply to all patients.
Thank you for reading.