The operation is always performed under general anaesthetic and is usually performed as a day surgery procedure.
Harvesting the fat
The area where the fat will be taken from is injected with a large amount of fluid (so-called tumescence solution) usually of normal saline, a local anaesthetic and sometimes adrenaline. Just as in regular liposuction the fat is then aspirated over 2-3 small cuts in the skin, through which a thin cannula is inserted.
Processing the fat
The fat cells are washed and separated from unwanted components such as tumescence solution, blood, oil or connective tissue. This leaves an emulsion which can be drawn up into syringes, allowing it to be injected into the desired area.
Injecting the fat
Through tiny stab incisions in the skin the fat graft is then injected directly into the desired area making sure to distribute it evenly in very small droplets.
The skin incisions are usually closed with self-absorbing sutures.
Pressure on the treated areas should be avoided for at least 2-3 weeks after surgery
If large Volumes of fat are removed wearing a compression garment is usually recommended for a few weeks after surgery to reduce swelling.
You will be able to resume most every-day activities within a few days after surgery. We recommend refraining from sport or any strenuous upper body activities for at least 6 weeks after surgery.
What to expect after surgery
It is to be expected that at least 30% of the injected volume of fat will be absorbed by the body over the first couple of weeks after surgery. Taking this and normal postoperative tissue swelling into account, one cannot assess the result of the procedure until at least three months afterwards.
The site where the fat was taken will become swollen and look quite bruised immediately after surgery. This will subside within a few weeks.
Sometimes remnants of tumescence fluid can leak out of the incision sites. This can be slightly tiresome, but is not dangerous and usually only persists for a few days.
Regular follow-up appointments with your surgeon will be scheduled at 1-2 weeks, 6 weeks, 3 months and 1 year after surgery.
As with every surgical procedure breast augmentation with lipofilling is associated with both anaesthetic and surgical risks. Preexisting conditions such as Diabetes, obesity, heart and blood vessel diseases, immune diseases and smoking significantly increase the risk of complications.
General complications of all surgical procedures include:
Bleeding/Hematoma, infection, thrombosis (including pulmonary embolism)
The most common surgical complications after breast augmentation with lipofilling include:
- postoperative bleeding, hematoma
- contour irregularities
- under- or overcorrection
- complete loss/absorption of the graft
- oil cysts
Rare complications after breast augmentation with lipofilling include:
- thrombosis or pulmonary embolism
- permanent decreased sensation or numbness of the skin
- skin necrosis
- scarring of the skin or subcutaneous tissues
Is it possible that my body might reject the fat graft?
No. Since it is your own tissue, that apart from being washed and separated from some unwanted components, has not been modified in any way, your body will still recognize it as your own. If however the grafted fat cells do not receive an adequate blood supply from the surrounding tissue, they will not survive and will be broken down. If this happens to large deposits of fat cells, a so-called “oil cyst” can form. These are not dangerous, but can be palpable or even cause visible contour irregularities. In rare cases the broken down cells can cause calcifications which themselves are harmless, but can be confused with cancerous lesions in mammographies or MRI’s.
Is it possible to freeze my fat and use it at a later time?
Theoretically yes. Studies have shown however that the freezing and defrosting process can be damaging to the fat cells. This means that the amount of the initial volume of injected graft that is lost is usually substantially higher than when fresh cells are used.
Can fat grafting cause cancer?
Fat grafting or lipofilling is a technique which has been used for decades to correct volume loss or scarring in various parts of the body. Extensive research and clinical studies have not been able to prove any link between fat grafting and development of cancer. There have however been a small number of reports of patients who developed breast cancer after augmentation with lipofilling. Whether these patients were destined to develop breast cancer irrespective of the grafting procedure or if the grafts caused the cancer remains unknown. There have also been some animal studies that have shown that the stem cells, which are amongst the fat cells that are injected, can under some circumstances turn into cancer cells within breast tissue. This finding has not been observed in humans, but has also not been disproven so far.
The Swiss Society of Plastic Surgeons has put forward clear guidelines for breast lipofilling. Your surgeon will discuss the most current recommendations with you and decide whether or not you are a suitable candidate for the procedure.
How long does the effect of lipofilling last?
To achieve the desired breast size with lipofilling usually requires more than one session. These can be timed 6-12 weeks apart. The portion of grafted fat which doesn’t take is broken down and absorbed by the body over a period of approximately 3 months. The volume you are left with 6 months after the final procedure will last for many years. However, the grafted fat cells react identically to bodily changes as fat cells anywhere else in the body, so weight gain or weight loss will also affect the volume of the breasts.
What happens if I develop a palpable oil cyst?
Oil cysts are not dangerous but if they are large or superficial the can be both palpable and or visible from the outside. Smaller cysts can usually be left to be absorbed by the body over time, larger cysts can be drained with a syringe through the skin. Sometimes an ultrasound is needed to clearly localize the cyst.
Will I be able to breast feed after a breast augmentation with lipofilling?
Your ability to breast feed will most likely not be affected by the procedure.
Can I still have a mammogram after breast augmentation with lipofilling?
Yes. However, your radiologist must be made aware of the fact that you have had the procedure, as the fat grafts within the tissue can be confused with possible cancerous lesions.
Are there activities I will no longer be able to do after surgery?
No. You will be encouraged to refrain from strenuous physical activities for 6 weeks after surgery. This includes exercise such as jogging and lifting heavy objects. After this period when the tissues have settled there will be no restrictions.
Do I need to stop my own medication prior to surgery?
Most medication can be continued normally. Some drugs such as blood thinners (e.g. Aspirin or Warfarin/Marcoumar) can increase the risk of postoperative bleeding and may need to be stopped or replaced before the procedure. We ask you to bring a complete list of all your medication and their dosages to your first consultation.
Does my GP need to perform or organize any special investigations or before surgery?
Usually not. The surgical team including the anaesthetist will need to be aware of any preexisting conditions (especially cardiovascular or lung diseases) which may be associated with an increased anaesthetic risk. We ask you to provide as much detailed information on your past medical history as possible when you come for your preoperative consultation so we can coordinate any necessary tests with your GP.
Do I need to stop smoking before surgery?
We seriously recommend stopping all nicotine consumption, including smoking at least 6 weeks before any surgical procedure. One of the most common complications following any type of surgery is delayed wound healing or wound breakdown. The main cause of this is usually bad blood circulation to the skin and tissues in the operated area. Nicotine is a chemical substance, which causes blood vessels in the body to constrict (narrow). This lowers the blood circulation to the wound and significantly increases the risk of complications.
How long before I can go back to work after surgery?
This depends on your work. Light duties, such as office jobs can usually be resumed after about a week. Lifting heavy objects and activities that strain the upper body and chest muscles should be refrained from for at least 6 weeks. Especially if you have small children it is important for you to plan and ensure enough support for their care other household chores during your recovery period.
Will I get a sick certificate for the time I am off work?
Sick certificates cannot be issued for cosmetic procedures. You will need to take leave for the entire period that you are absent from work.
If the procedure is covered by health insurance, you can be issued a certificate.
Will my health insurance cover the costs for the surgery?
No, breast augmentation is a cosmetic procedure which is not covered by health insurance.
In the case of severe asymmetry, breast malformation or after surgery for breast cancer your health insurance may cover some of the costs for the procedure. Written confirmation of approval to cover the costs from your insurer will need to be obtained prior to the procedure.
Will my health insurance cover the costs of treatment if I develop any complications requiring medical treatment, hospitalization or even further surgery?
Yes, provided the complication is purely medical, e.g. an infection. Corrections of aesthetic complications (e.g. unsatisfactory shape, size etc. ) are not covered.