Drs. Marissa Tenenbaum and Terry Myckatyn

Cosmetic breast surgery continues to be a popular choice for many women, and the efficiency, safety and results obtained by these procedures have improved over time. However, not every new cosmetic surgical trend is ready for prime time when it comes to breasts.

Dr. Terry Myckatyn, a board-certified plastic surgeon with West County Plastic Surgeons of Washington University, serves on the American Society of Plastic Surgeons Clinical Trials Committee and is a principal investigator in a new, multi-center study that will explore the safety and efficacy of fat grafting in both cosmetic and reconstructive breast surgery. The clinical trial will involve patients at Washington University’s Siteman Cancer Center, MD Anderson Cancer Center, Memorial Sloan-Kettering Cancer Center and the University of Chicago Comprehensive Cancer Center.

Fat grafting (also known as ‘fat transfer’) is becoming a popular cosmetic technique for a variety of uses. It involves removing fat from one area (often the abdomen, hips or thighs), purifying it, and then injecting it into another part of the body. The fat acts as a dermal filler, plumping up the areas where it is injected while giving patients the benefit of fat removal from other target areas.

When it comes to fat grafting for breast augmentation, people tend to assume that the procedure is safer than silicone or saline breast implants. Yet this may not be the case, according to Myckatyn. “I don’t want to bash fat grafting because I do a lot of it in particular circumstances,” he says. “The average person would think, Of course, it’s my own tissue. It’s got to be safer. But breast implants have been around since the late ’60s, whereas fat transfer in its current form has taken off in the last five to 10 years. The problem is that it’s not been well studied, and there are legitimate concerns.”

For instance, fat contains adult stem cells. “One type of stem cell in adults is the adipose-derived stem cell, which lives in a small percentage of our own fat,” Myckatyn explains. “In animal models, it’s been shown that if you take these stem cells and put them next to an active breast cancer, it can aggravate the cancer and make it more aggressive.”

Myckatyn’s study aims to examine whether this phenomenon also occurs in humans. The implication could be that women who have undiagnosed breast cancer or are at high risk for developing breast cancer might be putting themselves in danger by transferring fat containing adipose-derived stem cells to the breast. “I can’t prove that’s the case, and I honestly hope it is not the case, but (fat transfer) is being aggressively advertised without everything being appropriately disclosed and framed,” he says.

Fat transfer does have a role in postcancer breast reconstruction, however. Because women who’ve had mastectomies have no remaining breast tissue, fat transfer to supplement an implant and create more natural contours is considered safe, and Myckatyn performs this type of procedure on a regular basis. “You can’t fan the flames of breast cancer cells that aren’t there,” he notes.

Breast augmentation and lift options that have been studied for safety over several decades abound, and most women can achieve the results they desire without putting themselves at risk beyond the known risks that accompany any type of invasive procedure.

Myckatyn’s clinical partner, Dr. Marissa Tenenbaum, also a board-certified plastic surgeon, notes that the ‘laser bra’ gives women a lift with less blood loss and more efficiency than traditional breast lift procedures. “We use a CO2 ablative laser to do things that historically would have been done with a knife,” she says. Removing excess skin is quick and bloodless with laser excision, and the remaining tissue becomes a tougher, stronger dermal layer due to thermal changes that occur from the laser’s heat.

“It’s important for women to understand that we feel that implants are fairly safe. Across the world, there are millions of women who have breast implants, and most of them do very well,” Tenenbaum says. However, she notes that implants are not considered ‘lifetime devices.’

“At some point, you may have to have the implant changed out or have a revision surgery,” she says. She also suggests that women wait with breast lifts and reductions until they are done childbearing because these procedures may affect the ability to breastfeed.

Myckatyn and Tenenbaum are excited about the research, although results will not be available for several years. “It brings questions to the forefront so we can make things better for our patients,” Myckatyn says.