Autologous breast augmentation uses the patient’s own tissue to enlarge the breast. The main thrust is the use of the patient’s own body fat. It is harvested by liposuction and injected into the breast.
In an abstract sense the concept sounds ingenious. Usually fat is available, it is not a foreign body, all complications (capsular contractures, implant malposition) and concerns (cancer, collagen vascular diseases) related to implants can be avoided, there is an additional benefit of removing unwanted volume in one area (say waist or hip rolls) and use it where volume is actually wanted.
In practice, however, large volume fat grafting is fraught with uncertainties and obstacles.
First, a really substantial volume of several hundred milliliters per side is needed to achieve the immediate effects of a small implant. An informal consensus reached at a recent breast meeting in Atlanta stated that all logistics needed to be setup in way so a single surgeon can do the entire procedure on both sides in less than two and a half hours. Compare this with a generous estimate of an hour of operating time for implants, which can be decreased to around forty minutes consistently using process driven scripting techniques derived from industrial manufacturing processes. Total costs for both procedures seem to break even at two and a half hours of operating time for the fat transfer, which would balance out the additional cost of the implant needed for traditional breast augmentation.
Second, even after years of intense research it is still unclear what the truly best harvesting and processing techniques are, how much of the transferred fat actually survives and what the longterm effects of the interaction of transferred fat and local tissues are. At the same meeting mentioned above an Australian research group presented some really intriguing data showing that under certain experimental conditions none of the transferred fat survives at all, but the mix of molecules and stem cells in the transferred fat stimulates the growth of fat at the recipient side (e. g. breast). The MRI data of a small series of autologous breast augmentations showed that there is an increased fat content after injection particularly at the interface of chest wall muscles and gland, but is of course insufficient to refute the alternative hypothesis that this is just increased local growth.
Third, due to its consistency harvested fat is not well suited to expand anything to make it bigger. The advice here is to use an external expander to first create some space for the fat to go. Commercially available and reasonably well studied is the Brava(TM) device. It requires considerable patient cooperation over several weeks to wear this suction cup over the breast to increase the size of the breast. Thereafter, grafting must be performed, as shrinkage of the breasts would occur once the external expander is removed.
There are at least theoretical considerations in relation to breast cancer that would make one tread carefully with respect to large volume fat grafting to the breast. Fat is rich in enzymes increasing local estrogen levels, which is exactly the opposite of what one desires from a cancer standpoint. On the other hand non surviving fat ends up as lumpy, calcified, palpable nodules, all big red flags during breast cancer screening and mammography. As with anything new, there is just insufficient data and longterm experience to assess if any of these animal, laboratory or theoretical hypothesis have any meaning for the individual patient in cosmetic surgery.
Undoing an autologous augmentation or modifying it in case of weight gain (which is mainly increased volume of fat) is another area without certain answers. Implants can be removed. The aesthetic consequences of explantation can be ameliorated by breast lifts in a substantial fraction of patients if so desired. I do not see a similar straightforward answer for fat grafted breasts. Liposuction or formal breast reduction come to mind, again without a large body of available evidence or experience.