Breast Fat Grafting Comes Of Age

The search for the ideal breast implant material has spanned everything from soy oil to paraffin. 

The current generation of silicone implants are one of the most studied medical implants in the world.  Despite the favorable safety profile, a sizeable percentage of women interested in augmentation surgery have sat on the sidelines.  There most cited concern is having something they consider unnatural in their body. 

At the recent American of Society Plastic Surgeons meeting in New Orleans,  fat grafting to the breast seems to have come of age.  Plastic surgeons have been using fat grafting to the breast for patients undergoing reconstructive breast surgery for several years now.  The original hesitations of using fat grafts for breast augmentation purposes have to do with the number of procedures necessary and the ability to read subsequent mammograms.  Both these issues are slowly being resolved.

Who is a candidate?

Most patients would prefer to have this procedure in one surgical procedure with one recovery.  Ideally, a perfect patient would want to increase their breast size from 1 to 1 1/2 cup sizes larger.  They would need to have a sufficient fat volume to be liposuctioned to provide enough material to graft.  People that are very athletic often would not have enough donor fat to be used. 

Who is not an ideal candidate?

Traditional augmentation is still best utilized for the very slim patient who wants to increase her breast size 1 1/2 to 2 cup sizes or more.  A breast implant would allow more shaping options to the breast particularly giving a patient more fullness in the superior portions of the breast.

There are still are remaining issues of the effectiveness of mammograms in patients that have had fat grafting to the breast.  Newer imaging technologies, or CT/MRI, may help resolve these issues.

Cosmetic Breast Surgery By Age & Clinic Type Infographic

Aesthetic breast plastic surgery procedures in the US in 2011.

US cosmetic breast procedures by age and clinic type in 2011.

In looking at this infographic, I'm somewhat surprised that 34% of the procedures are on women over 55. I would have thought that number would be somewhere in the 20% range and the 30-39 year range much higher than 12%.

Dr. An Po Chung, Plastic Surgeon Performing Fat Transfer In Taiwan

Dr. An Po Chung Taiwan Plastic Surgeon

Name: An Po Chung M.D., MSC
Location: Taipei, Taiwan
Website: 4flower.com.tw

Dr. An Po Chung is a professional member of Taiwan Surgical Society of Specialist, Taiwan Plastic Surgery Medical Association, Physicians Cosmetic Surgery in Taiwan Medical Association specialist Deputy Secretary-General of facial plastic surgery Medical Association and International Cosmetic Surgery Medical Association.

Can you tell us what is it like practicing cosmetic surgery in Taiwan in comparison with what you see in other countries?

From my experience of attending several international conferences, I noticed that cosmetic surgery in Taiwan is not so different from the other countries. However, the patients in Taiwan prefer minimal invasive cosmetic surgery. Some of them have unrealistic high expectations of non-invasive treatment such as filler and Botox.

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Georgios Hristopoulos MD: Plastic & Aesthetic Surgery In Germany

Georgios Hristopoulos M.D., Specialist in Plastic and Aesthetic Surgery in Germany

Cosmetic medical technologies offered in Germany are attracting medical tourists. 

Name: Dr. Georgios Hristopoulos
Clinic: Pantheon Aesthetic Center
Location: Cologne, Germany
Website: pantheon-aesthetic-center.de, beethoven-klinik-koeln.de

That's interesting: Dr. Georgios Hristopoulos is employed as Head of the Department of Aesthetic Plastic Surgery of the Beethoven Klinik in Cologne, Germany and at the same time runs his private office, named Pantheon Aesthetic Center. His surgical focus is the Breast Surgery and specifically the complete sub muscular Breast Augmentation (inner Bra) as well as the Dermolipectomies on trunk and extremities.

He speaks German, Greek, English and Spanish. 

How does your surgical practice function? How is it organized? 

I am the Chief of the Department of Aesthetic Plastic Surgery of a small private clinic in Cologne / Germany called Beethoven-Klinik. The clinic is one of the oldest and biggest private Clinics of Plastic and Aesthetic Surgery with government concession in the North Rhine Region and maybe in whole Germany. We have an interdisciplinary occupation with Orthopaedists, Trauma-Surgeons and a Dermatologist.

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Dr. Sufan Wu, Plastic Surgeon In China

Chinese Plastic and Reconstructive Surgeon Sufan Wu, M.D., Ph.DPlastic surgery is gaining momentum in China, but in different ways than in the West.

Name: Sufan Wu, M.D., Ph.D
Location: Zhejiang, China
Website: prschina.com

Dr. Sufan Wu is the Chief of Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People's Hospital, China. Chairman of the Association of Plastic Surgery of Zhejiang Province. Committee members of Chinese national Association of Plastic Surgery, Association of Aesthetic Medicine. Active member and faculty member of ISAPS.

Can you tell us what is it like practicing cosmetic surgery in China in comparison with what you see in other countries?

Compared with the other countries – the US and Europe in particular – cosmetic medicine in China has the following differences:

1. The history of cosmetic surgery in China is

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Dr. Alexander E. Handschin, Plastic Surgeon In Germany

Dr. Alexander E. Handschin

With several specializations in surgery, Dr. Alexander E. Handschin shares his practice style changes in Germany.

Name: Dr. Alexander E. Handschin
Location: Hamburg, Germany
Website: drguth.de

That's interesting: Dr. Handschin belongs to the following professional organizations: the Board of General Surgery in Switzerland and Germany, Board of General Surgery in Switzerland and Germany, and Specialisation Board of Hand Surgery. He is also a fellow of the European Board of Plastic, Reconstructive and Aesthetic Surgery (EBOPRAS).

With the advent of Botox therapy and hyaluronic acid fillers, non-surgical options have certainly increased over the past years. I believe that these tools are adding to the possibilities of a plastic surgeon, since their indications do not necessarily interfere with surgical options.

The use of autologous fat-transplants has certainly seen a significant rise, and I believe that additional knowledge will emerge from this technique. Also, the use of stem cells, such as adipose-derived stem cells poses a great potential for plastic surgeons.

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Interview With Serbian Board Certified Plastic Surgeon, Dr. Gorana Kuka.

Gorana Kuka MD, Board Certified Serbian physician

Dr. Gorana Kuka works in private plastic surgery practice at the Colic Hospital with patients coming from around Europe.

Name: Gorana Kuka, MD
Clinic: Colic Hospital
Location: Belgrade, Serbia
Website: dr-colic.com

That's interesting: Dr. Gorana Kuka is board certified by Serbian Medical Society.
She is a member of ISHRS (International Society for Hair Restoration Surgery), IPRAS (International Confederation for Plastic, Reconstructive and Aesthetic Surgery) and a women for women organization that aims to supply help by female surgeons to patients.

Your website is translated in eight different languages including English, German, French, Russian and Italian. Where do your patients come from? Are you seeing 'medical tourism'?

Since around 60% of our patients are coming from abroad, we had to translate our webpage into different languages. Most of our patients come from Switzerland, Germany and Austria. Some of them are of Serbian origin and some of them are foreigners. They have found about us either from their Serbian friends living abroad, or looking through internet for aesthetic surgery of best quality and lower fees.

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Dr. Calvin Lee, Surgical Artistry In Modesto, California

Building and managing a medical spa, vein clinic and cosmetic practice with his plastic surgeon wife is truly a dream come true for this physician.

Dr. Lee, Modesto CA Surgeon

Name: Calvin Lee, MD
Location: Modesto, CA
Clinic: Surgical Artistry
Modesto Plastic Surgery
Websites: SurgeryToday.com, InjectionArtistry.comBigVeins.com

Thats interesting: Dr. Calvin Lee is a regional speaker for Allergan. He has lectured about the Latisse product in Reno, Fresno, Modesto, Santa Rosa, and Napa.

The genesis of Dr. Calvin Lee as an aesthetic physician

I was a busy general surgeon with a heavy load of trauma surgery. Conflicts with my six member general surgery group landed me without a job. This allowed me to reflect upon how I wanted to prioritize my time and my life. I wanted to spend more time growing artistically with my violin. I also wanted to continue making web pages to share information. And most importantly I wanted to spend more time with my wife who is a plastic surgeon. During my phase of soul-searching, I enrolled in a year long Medical Acupuncture course affiliated with Stanford University and added acupuncture to the list of skills that I have.

In 2006, my wife and I started Surgical Artistry which is mainly a plastic surgery practice.

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Dr. Robert Cohen, Breast Enhancement Specialist In Scottsdale, AZ

Dr. Robert Cohen

As a plastic surgeon in Scottsdale, Dr. Rober Cohen specializes in cosmetic surgery of the breast.

Name:Robert Cohen, MD, FACS
Clinic: Scottsdale Center For Plastic Surgery
Location: Scottsdale, AZ
Websites: robertcohenmd.com, cohenbreastsurgery.com

That's interesting: Dr. Cohen published a textbook chapter on technology and robotics in plastic surgery while at Dartmouth.

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Dr. Kevin D. Light: Cosmetic Surgery & Anti-Aging Medicine In Dallas, TX

Kevin D. Light, DO, MBABio-identical hormone therapies, cosmetic surgery, aerospace medicine and battling insurance policies with Dr. Kevin Light.

After meeting Dr. Light at the Medical Fusion Conference last year, we decided that we wanted to know more about this former vet turned cosmetic doc.

Name: Kevin D. Light, DO, MBA
Location: Dallas, TX
Website: tifm.com

That's interesting:  As a board certified General Surgeon, he practiced internationally with the US Air Force for 8 years. He was also lucky enough to be selected to attend the USAF Aerospace Medicine program early in his Air Force career, so he also served as a flight surgeon, that put him in the back seat of T-38, F-15 and F-16 fighter jets for 8 years. He was one of the first medical teams placed in Saudi Arabia during Operation Desert Storm and has received two Air Force Commendation Medals. He was Chief of Surgery during extended assignments in Germany, the Kingdom of Jordan and Guantanamo Bay, Cuba.

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Beverly Hills Plastic Surgeon, Dr. Robin T.W. Yuan

Dr. Robin Yuan is an admittedly 'old-school' plastic surgeon in the heart of Beverly Hills with a staff of one and no marketing.

Dr. Robin Yuan was a founding member of of the Cedars-Sinai Craniofacial Clinic and the Cedars-Sinai Breast Center, and is an active member of the American Society of Plastic Surgeons, the California Society of Plastic Surgeons, the Los Angeles Society of Plastic Surgeons. He was kind enough to sit down and share his thoughts on cosmetic medicine.

Name: Robin T.W. Yuan, M.D.
Location: Beverly Hills, CA
Website: robinyuanmd.com

That's interesting: Dr. Yuan is a member of the newly-formed American Society of Bariatric Plastic Surgeons and was recognized as the Best Plastic Surgeon in Beverly Hills last 2011. His new book, Behind the Mask, Beneath the Glitter: The Deeper Truths About Safe, Smart Cosmetic Surgery is available on Amazon.com. He was one of the original participants in the hit TV show, Extreme Makeover.

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Alex Denes, MD, FACP, A Medical Spa In California

Dr. Alex Denes CaliforniaFrom a start in internal medicine, Dr. Alex Denes has moved to an entirely cosmetic medical spa and practice.

Dr. Denes worked as an assistant surgeon for 30 years before entering the cosmetic field in 2000. We sat down with Dr. Denes to find out what he's learned, and what lessons he has to pass on.

Name: Dr. Alex Denes
Location: Hemet, CA
Website: HiGorgeous.net

That's interesting: Dr. Denes is qualified as an expert witness for the US Department of Justice and the California Medical Board. He's appeared as an expert witness for the defense in hundreds of medical malpractice cases.

He is Medical Director and VP of Medical Affairs of Hemet Community Medical Group, a multispecialty group consisting of 155 physicians, and Corporate Medical Director for KM Strategic Management Group.

How did you transition from Internal Medicine to Cosmetic Medicine?

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Dr. Elan B. Singer, A Plastic Surgeon In Manhattan

Dr. Elan B. SingerNYC plastic surgeon Dr. Elan Singer is in one of the most competitive plastic surgery markets anywhere.

Plastic surgeon and naval reserve officer, Elan Singer MD is practicing on the Upper East Side of Manhattan. We got together with Dr. Singer and asked him what he's going to make sure his practice continues to thrive.

Name: Elan Singer, MD
Location: New York, NY
Website: ebsplasticsurgery.com

That's interesting: Dr. Singer has performed reconstructive surgery on patients from all over the world, including surgical missions to Haiti and Nigeria. Dr. Singer is also an officer in the United States Navy Reserve and performs monthly surgeries at the Walter Reed National Military Medical Center in Bethesda, Maryland.

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Plastic Surgeon Herluf G. Lund Jr., MD, FACS From St. Louis Cosmetic Surgery

With four plastic surgeons and a medical spa, St. Louis Cosmetic Surgery has been around for more than 35 years.

Name: Dr. Herluf Gyde Lund, Jr.
Location: Chesterfield, MO
Website: stlcosmeticsurgery.com

As part of a large cosmetic practice in St. Louis that is one of the largest cosmetic breast surgery practices in the country, Dr. Lund has undoubtedly seen his share of patients and has stories to tell. In this inteview, Dr. Lund shares his clinics compensation structures for staff members, details different types of medical spa business models, and shares his thoughts on building a successful practice.

That's interesting: Dr. Lund chairs and serves on numerous committees for both the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery and is a principle investigator in studies using the next generation, Cohesive Gel Implant. Every summer, Dr. Lund volunteers as the "camp doctor" for Camp Chippewa for Boys in Cass Lake, Minnesota.

What do you think physicians need to know about starting or running a medical spa?

Determine first if you really need a medical spa. If you just want to provide some products and skin care, then you may not need to add a great deal of staffing and services. You may be able to train your nursing staff to provide many of the treatments and the product manufacturers are usually very willing to help train you staff on how to market and sell their product lines. This does not require a big investment in inventory and office space and also lets you “try the water” first. Once you have made the decision to open a medical spa, then you need to decide what you want your medical spa to do. Once you have decided what you want to do, then you need to examine your patient practice mix and the surrounding competition to determine if the goals you have set are achievable given the environment you practice in. For example, there are essentially four types of medical spa models to choose from when setting up a medical spa...

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Dr. David A. Caplin, Plastic Surgeon At Parkcrest Plastic Surgery in St. Louis, MO


Parkcrest Plastic Surgery St. Louis, MOParkcrest Plastic Surgery doctors: Dr. David Caplin second from left.
David Caplin MD is one of four plastic surgeons at Parkcrest Plastic Surgery and draws patients from across all of Eastern Missouri.

In this interview, Dr. Caplin shares his thoughts on training, technology, and even marketing a busy cosmetic practice.

Name: David A. Caplin, M.D., F.A.C.S.
Specialties: Cohesive Gel Implants, SmartLipo laser assisted liposuction
Location: St Louis, Missouri
Website: ParkcrestPlasticSurgery.com

That's interesting: Dr. Caplin is a recipient of the American Society for Aesthetic Plastic Surgery’s "Certificate of Advanced Education in Cosmetic Surgery" and been a principal clinical investigator for the Mentor CPG (gummy bear) Cohesive Gel implant since 2002 with one of the longest and largest clinical experiences with this procedure in North America.

(Cohesive Gel implants have been used with great success in Europe and many other countries for many years but are currently only available to surgeons who are investigators in this study. Cohesive Gel implants have unique qualities including their form-stabilized anatomic shape and their resistance to implant leakage. The distinguishing factor is that the implant is a "soft solid". If the Cohesive implant is cut in half the implant maintains its shape.)

What do you think is most important to train a well rounded plastic surgeon?

In order to be a good aesthetic surgeon I have always felt that a strong background in...

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Breast Reduction Surgeries on the Rise.......for Men

Men feeling self-conscious about the size of their breasts is nothing new—as members of the Seinfeld generation will recall, the episode in which Kramer invents "the Bro," or the "Mansierre" to tame oversized "man boobs" first aired in 1995.

This can't be good.

According to the BBC, in recent years discomfort over what are colloquially known as "moobs," is prompting increasing numbers of men to go under the knife. According to the British Association of Aesthetic Plastic Surgeons, the number of men who underwent breast reduction surgery in the U.K. increased from 323 in 2008 to 581 in 2009, a jump of 80%. Yet, instead of reflecting a surge in gynecomastia, the medical condition in which hormonal changes result in abnormal enlargement, swelling and discomfort in men's breasts, experts suggest that the uptick in cosmetic surgeries is more likely a reflection of both obesity, and increased media scrutiny of "man boobs." (Case and point, several gossip sites have entire photo galleries dedicated to male celebrities' fleshy breasts.)

Of course, for some men, surgery may provide relief from what can be an embarrassing and uncomfortable condition. Yet, as plastic surgeon Rajiv Grover points out to the BBC, for many men, it's not a hormonal imbalance, but simply being overweight, that is the root cause of bigger breasts. "Quite a few cases are caused by obesity, and we often say to men to look at their lifestyles before thinking about the scalpel," Grover said.