In part one of this “Fat is magic” series, we learned about the history of fat and the societal perspectives, but also about the intrinsic value of fat itself. Then for our second installment, we focused on the technical aspects of fat transfer - what some in the plastic surgery field have dubbed “procurement, processing, and placement” - an insider’s peek into what goes on behind the sterile blue drapes of the operating room.
For our third and final part of this series, we will explore two of the most popular surgical procedures utilizing this technique: fat grafting to the breasts and buttocks, otherwise known as breast augmentation with fat transfer and the famous (or infamous?) “Brazilian butt lift”.
The breasts and buttocks have long been the focus of the sexual and erotic gaze. Social scientists have studied what makes a pleasing female proportion, which may have been an indication of health and fertility to our ancient predecessors. Today with omnipresent technology able to flood our senses with celebrity and popular culture, the trends seem to be both larger than life and completely achievable at the same time. The big boobs of Baywatch in the late 1980’s through the 1990’s followed by the bodacious booty that burst onto the scene with J. Lo’s infamous Grammy dress may be the markers of a cultural sea change in American perception of the female figure.
Both areas have long been targeted for enhancement with artificial implants. Breast augmentation with saline or silicone-gel filled implants is one of the most popular plastic surgical procedures in the United States today, and the number of enhancements using silicone buttock implants to provide shape and volume to the derriere has remained steady over the last few years.
Although both procedures remain popular and have legions of very satisfied patients, placing artificial materials into the body can have issues. Implants are man-made devices that eventually wear out with use and time. More surgery is inevitable to maintain health and appearance. As plastic surgeons have become more adept in the science and skill of fat grafting, their patients have benefited from having this additional technique in the plastic surgical arsenal.
With fat transfer to the breasts, patients can get more shape and fullness with minimal scarring and the “bonus” of selectively slimming down other areas. Recovery can be comfortable and quick, and as long as patients maintain their weight and health, the results can be long-lasting. If you are looking for a modest size-increase (generally a maximum of ½ to 1 cup size more) and a very natural feel/look (a gentle slope from the top of the breast to moderate fullness of the bottom half), this is a nice option for a “natural” breast augmentation.
The Brazilian butt lift is a bit of a misnomer - it’s not so much a lift but more of a reshaping and redistribution of curves and fullness. Similar to the art of sculpture, the BBL is manipulation of both positive and negative space to create a beautiful three-dimensional shape. With liposuction, plastic surgeons can better define the waistline (going back to those waist-to-hip ratios), contour away the dreaded “muffin top”, and essentially move that fat into the butt to create a more youthful and traditionally feminine shape.
Papers have been written describing the regional differences between preferred buttock size, and yes, surgeons in Latin America do seem inclined towards the “bigger is better” aesthetic(1). But not everyone chooses to go full Kardashian; even a slightly more demure approach (transferring not 6000 cc of fat, but more like 600 cc) can banish the dreaded “mom butt.”
Again, the scars from this procedure are small, and recovery from a “BBL” can be fairly tolerable, other than avoiding sitting or lying on your newly enhanced backside for a few weeks. The results can last as long as your weight and health are stable.
There are some important issues with each of these fat transfer procedures that should be understood before signing up for “the magic”. With fat grafting to the breast, there can be some complexity added to future mammograms. Because of the nature of fat grafting - trying to precisely place fat cell by fat cell into a favorable home in the breast space - not every fat cell thrives. Some inevitably fail to survive in their new place, and the human body will sometimes calcify these bunches of dead fat cells. This can be an issue with breast cancer screening, as microcalcifications are a major red flag on mammograms. But as fat transfer to the breasts becomes more popular, radiologists have become much more adept at distinguishing the benign calcifications associated with fat grafting from the concerning calcifications associated with breast cancer (2).
The dramatic rise in popularity of the BBL in the last several years has brought a number of tragedies to national attention. A serious risk of fat transfer to the buttocks in particular is accidental injection of fat into a large vein, called a fat embolus, which can cause severe cardiopulmonary issues, and as seen recently with one clinic in Florida, even death.
The major plastic and aesthetic surgical societies have convened committees to evaluate these tragic outcomes. In general, the task forces advise caution to both surgeons and patients (3). Surgeons performing BBL can adjust their technique and tools to reduce risk during the procedure. If you are a patient interested in BBL, as with all elective aesthetic or cosmetic surgical procedures, make sure that your surgeon is experienced and credentialed, confirm that your procedure will be performed in an accredited operating room (i.e. a hospital or certified ambulatory surgery center), and if your gut tells you that something is not right, follow your instincts.
Fat grafting is a remarkable and powerful technique that can achieve natural and lasting results. We can remove fat from places we do not want it and transfer it to places where we do, resulting in fuller breasts, trimmer waists, and curvier backsides. Is it magic? Maybe not exactly, but it may be as close as we can get by combining art and science in plastic surgery.
1. Heidekrueger PI, et al. The ideal buttock size: a sociodemographic morphometric evaluation. Plastic & Reconstructive Surgery. July 2017; 140(1): 20e–32e.
2. Rubin JP, et al. Mammographic changes after fat transfer to the breast compared with changes after breast reduction: a blinded study. Plastic & Reconstructive Surgery. May 2012;129(5):1029-38.
3. Mofid MM et al. Report on mortality from gluteal fat grafting: recommendations from the ASERF Task Force. Aesthetic Surgery Journal. 37(7) 796–806.
By Dr. Angeline Lim of Duet Plastic Surgery - Expert Plastic Surgeons
Angeline Lim, M.D. and Jennifer Weintraub, M.D. are the board-certified plastic surgeons of Duet Plastic Surgery, an all-women boutique-style practice in Palo Alto, California. When not guiding her patients through their health and beauty journeys in the operating room, Dr. Lim is hard at work at home, getting her holiday baking into gear (So. Many. Cookies.).