Using Fat to Create Beautiful Breasts After Implant Removal [Episode 10]
Whether you’re having your breast implants removed or never had them at all, the volume lost can be replaced with your own fat and beautiful, long-lasting results can be achieved.
During a fat transfer, fat is taken out of areas it is unwanted and transferred to different areas where fat is desired. Fat is the perfect filler because it is versatile and able to maintain itself over time.
Fat can be used to restore volume, reduce skin laxity, and improve shape, which is one reason why procedures such as the Brazilian Butt Lift (BBL) have become so popular in recent years.
In this episode, Dr. Rob explains the process of fat grafting, including how the procedure is done, the precautions which must be taken to preserve and protect the fat at every point in the process, and how much fat you can expect to retain.
About our Breast Implant Illness series
Since 2016, more than 500 women have asked Austin plastic surgeon Dr. Robert Whitfield for help removing their breast implants.
This series is a journey through Dr. Rob’s experience with breast implant illness, from the first shocking discovery through hundreds of unusual cases and surprising clinical breakthroughs.
New episodes are released every Thursday. Subscribe to our private BII email list for updates and case reports at https://holisticandscientific.fireside.fm/bii and follow the show wherever you listen to podcasts.
Speaker 1 (00:04): Welcome to the Holistic and Scientific podcast with board certified plastic surgeon, Dr. Robert Whitfield, Austin's natural choice for plastic surgery and the expert in smart laser and energy treatments.
Dr. Robert Whitfield (00:20): Today, we're going to talk about fat, but in a good way. So fat grafting, fat transfers, or in Europe, commonly referred to as lipo filling has been done for over a hundred years. So let's just start there.
Dr. Robert Whitfield (00:33): This is not a new treatment. I have this kind of relationship with fat, it goes way back so to speak. So as a second year resident, I did a research project that looked at fat. And so I'd go to the research wing of the hospital where I worked, and we would harvest fat cells using closed suction syringe technique.
Dr. Robert Whitfield (00:58): We would numb the area around the umbilicus, which is your belly button. And we would use a syringe to harvest the fat. So the fat that I was harvesting was being used to study leptin. Leptin is a hormone your body releases that helps it maintain your normal weight on a long term basis.
Dr. Robert Whitfield (01:19): The level of leptin in your blood is directly related to how much body fat you have. Leptin resistance causes you to feel hungry and eat more, even though your body has enough fat stores. So this is 1998 and 99 I'm doing this.
Dr. Robert Whitfield (01:36): And then fast forward, I get done with my general surgery training. I'm in my plastic surgery residency training. And what are we doing? We're remaking breasts with flaps that are composed of skin and fat, which is called the DIEP flap or deep inferior epigastric artery perforator flap.
Dr. Robert Whitfield (01:58): We're doing liposuction. So we're taking fat out of areas where we don't want it. Our hips, love handles, inner outer thighs. We're putting it in different places. We'll think of the craze of the Brazilian butt lift. We're making butts out of fat. So why can't we take out an old implant and replace that volume holistically with your own fat?
Dr. Robert Whitfield (02:24): So it's my holistic mommy makeover. I take your fat out of your hips, abdomen, inner outer thighs. I improve the shape of the waist and we take out and perform an explant as we previously described. And then we put fat where it's supposed to be. Back in the space where it belongs.
Dr. Robert Whitfield (02:45): So it's very important when we put fat back that we place it in the correct position. We don't put it where we took the implant out of because it won't survive there. There's no blood supply for it to live there. There's no matrix or structure to it. When we transfer it back, we put it beneath the skin, but above the breast tissue.
Dr. Robert Whitfield (03:06): So that plane is the fatty plane that everybody has. You can look it up and see the breast conically shaped. And then there's a layer of fat over the breast tissue.
Dr. Robert Whitfield (03:18): Now that once it heals, which takes three to nine months, we'll say, it's going to live with you and change with you. So think of the breast, not in this standard conical or cone dimensions, but two thirds to three quarters of the breast is really above the position of the nipple towards the collar bone.
Dr. Robert Whitfield (03:41): This is where the majority of the fat can be transferred. This is where you get most of your volume restoration. It has the most space versus the area below the nipple complex, which is shorter in distance, maybe five to nine centimeters, average of seven centimeters to the fold itself. Dr. Robert Whitfield (04:00): Let me tell you why fat is such a great filler. So fat, once it heals, it's soft, it's natural. It's going to maintain itself over time, provided diet, hormones, other variables can remain as constant as possible.
Dr. Robert Whitfield (04:19): There's a lot of things written about fat not being a good filler. It causes necrosis or cysts. And I want to explain to you that fat not only is a good filler, it's a great filler. Why and how you get it to be such a great filler is one, a technical one. How you remove it.
Dr. Robert Whitfield (04:40): I always remove it consistently with the same diameter cannula. That's between a 3.4 and a 4 millimeter cannula. I use a very specific collection system by Wells Johnson. I have no financial incentive to say anything about them in full disclosure. I don't get paid by Wells Johnson.
Dr. Robert Whitfield (05:04): It sits there, it's sterile. We use an antibiotic solution to wash over the fat and rinse it. We have a shaker. We don't centrifuge the fat, which I get asked a lot about why I don't centrifuge fat. And then we place it back with the same diameter tube that I took it out with.
Dr. Robert Whitfield (05:20): So the cannula to put it back with is a four millimeter cannula. So think of fat. Fat is not like a series of Skittles, which are all shaped the same. Fat is more like unevenly cooked popcorn or the popcorn you get in the tin at Christmas. There's all sorts of varieties, all sorts of sizes of shapes.
Dr. Robert Whitfield (05:44): When it goes back through those tubes that you took it out with, if it's the same diameter you cause the least amount of injury. You're not creating a pressure, that's going to damage the fat. Now most, if everybody won't know this, but I was in a sarcoma group for a really long time at my previous academic position. I studied adipose derived stem cells.
Dr. Robert Whitfield (06:09): It was my research project. How they affect and translate with fat transfers and do they cause cancer and all these things. So there's lots of things when you break down the components of a fat transfer, but I'll tell you the quintessential thing that I try not to do is injure the fat that I took out so carefully.
Dr. Robert Whitfield (06:30): And when I put it back, I try to put it back in a very careful and holistic manner in the proper position, which is below the skin, but above the breast tissue in the fatty plane. And it occupies the two thirds of the breast from the collarbone down to the nipple complex, because that's where you could put the most. And I don't put a ton on the bottom because it just, there's not enough space and with or without a lift, I do those things as well.
Dr. Robert Whitfield (06:57): But think of it this way, it's very, very psychosocial and important for a woman to have made this complicated decision and have on the other side, a way to look and feel as good as she can about the appearance of her breasts. And so whatever the situation I can get to an end point to restore volume, reduce skin laxity or sagging, improve shape, lengthen the torso in appearance, narrow the waist, improve the thigh gap, reduce the saddle bag, take away the love handle. And that's a holistic mommy makeover.
Dr. Robert Whitfield (07:41): So everybody asks, "How much fat will be there when you're done, Dr Whitfield?" there's lots of factors that I think that you need to address before you completely commit to that. One, everybody who's a client of mine, I try to get their diets organized.
Dr. Robert Whitfield (08:01): If you're going to do body contouring, whether you're doing a liposuction for aesthetic purposes or you're doing a fat transfer for a butt lift or a breast lift or an explant and a fat transfer, you need to know that your food is the fuel that gets you through the process.
Dr. Robert Whitfield (08:18): And I do food sensitivity testing now in my clinic. And the point is if you don't know what you don't know, I can't help you recover to the best of your ability. And then you won't be able to maintain your results. So for instance, I'm allergic to eggs basically. So I've cut eggs out of my diet and lost about 12 pounds. Dr. Robert Whitfield (08:41): Now I didn't lose 12 pounds of fat. I lost 12 pounds of fluid. If I took every one of my clients, 96% are female between the ages 33 and 55, if I told them they'd lose 10 pounds with a blood test, how many people would do it? Raise your hands. I work with this great company called Rupa.
Dr. Robert Whitfield (09:00): Rupa will send you the blood test because I have clients all over the United States and they'll help you get drawn in your area. Or obviously if you're local to me, you just bring it with you to your next appointment and we'll draw it for you for free. Everybody's heard of an elimination diet or an autoimmune critical diet. So this blood test gives you the answers to an elimination diet. It's like taking the test with the answers.
Dr. Robert Whitfield (09:27): You already know what you're going to react to. So if you remove the severe and moderate columns, which are the ones that are most stimulating to your immune system, you'll reduce your overall inflammation. So how does that help? When I examine somebody I'm looking very carefully and I can touch tissue and tell whether it's got too much fluid or is it fatty and use the analogy of the sponge on the kitchen.
Dr. Robert Whitfield (09:56): So there's a dry dish sponge. You know how that looks. As the dish sponge collects fluid, it expands. Now in somebody who's really inflamed, there will be even more fluid in the sponge. Now, when I perform a fat transfer or liposuction, I have to put fluid in order to take the fat out because that's called tumescent anesthesia. That's what we do.
Dr. Robert Whitfield (10:20): Now think of that sponge full of even more fluid. Now I'm a really experienced plastic surgeon in liposuction. I rarely have ever had a contour problem after liposuction, because I can feel exactly what I did afterwards. That's how I was taught. Liposuction is a removal and tactile response to the area with which you just treated.
Dr. Robert Whitfield (10:44): And you compare it to other areas to get your thickness. And so rarely should there be an issue, but when you're swollen or inflamed, let's just say, you can imagine how that would be more complicated for me to do the procedure for you. So if we remove inflammation by reducing the foods in your diet that promote inflammation, your gut swelling, fluid retention in your abdomen, your hip love handle area, your thighs even will go down.
Dr. Robert Whitfield (11:19): So that is part of the process and I've felt so strongly about it I've adopted it into basically my preoperative testing for each of my clients because that coupled with the next things we need to talk about are your hormones.
Dr. Robert Whitfield (11:37): So we'll just say I'm taking care of a client who's had two children, she's got implants and she wants an explant. She wants a fat transfer as well. Women who've had children a lot of times are deficient in copper. It's a micronutrient that's very, very important in cellular processes.
Dr. Robert Whitfield (11:57): Typically I find patients who have autoimmune thyroiditis or called Hashimoto's and that's a common problem. So if you're suffering from thyroid dysfunction and alternatively you have diminishing levels of estrogen, progesterone and testosterone, we'll have to look at that as well because to maintain lean body mass, have healthy fat we'll say, you need balanced hormones.
Dr. Robert Whitfield (12:25): And so you may need replacement, not so much of estrogen, but probably testosterone. Lack of energy, decreased libido, decreased hair and nail growth, cognitive dysfunction. Hormones all play a role with this. So when you balance these out and when you look at food as the fuel, coupled to my very strong programs for managing nausea, swelling around the time of surgery, nerve pain, localized pain in the area of operation at the time with nerve blocks with liposomal bupivacaine or exparel.
Dr. Robert Whitfield (13:02): Of course, everybody wants to know about recovery. Liposuction recovery's always been marked at six weeks and you use compression. In our office, we have a certified lymphatic therapist to help further diminish this recovery period. We also have a lymphatic massage device, the Ballancer Pro to help diminish the swelling that exists after liposuction.
Dr. Robert Whitfield (13:24): Whether or not we're doing a fat transfer is beside the point. We want to reduce the swelling in the areas where the fat was taken from. And we put you in compression and at a week I see everybody and we decrease the size of the compression garment, because we want to get more of that fluid out. We use these other techniques like lymphatic massage, the lymphatic assist device, the Ballancer Pro.
Dr. Robert Whitfield (13:47): We want to get that fluid out as quickly as possible to further increase and enhance recovery. Obviously there's no guarantees in life, but if you follow along with what I just said, that will decrease your recovery.
Dr. Robert Whitfield (14:01): If the food you eat is the fuel for recovery and you eat the foods that don't stimulate inflammation and you do the things in the program to reduce inflammation and you use compression and ice and anti-inflammatories, all of it collectively will work in your favor to get you recover more quickly.
Dr. Robert Whitfield (14:22): So fat retention, the best study is a breast augmentation study and it showed there was 50% fat retention at a year. Now, breast augmentation studies, you have to be careful in how you interpret the result of breast augmentation studies.
Dr. Robert Whitfield (14:36): So that's a patient with a lower BMI who has, we'll just say smaller breasts because that's why they want an augmentation. So typically those are patients I wouldn't be able to do a fat transfer on. So with an explant patient there's already space because there was an implant. It's already been stretched. So the skin has been stretched out.
Dr. Robert Whitfield (14:56): Typically they're a higher BMI because they're typically older in age and we usually gain weight as we age. We don't lose or maintain typically. So you'll have fat, which is what you need as the filler. You'll have space created by time, which is laxity, weight loss, weight gain expansion through pregnancies.
Dr. Robert Whitfield (15:19): And so when you go and then place this in my experience, the take rate should be between 70 and 80%. How long does it take for final results to appear? I like to evaluate fat transfer, fat grafting, lipo filling results on a quarterly basis.
Dr. Robert Whitfield (15:36): So I look at my patients at three months and six months and nine months and a year. And usually between that 9 and 12 months, you'll have a very clear indication of what the fat transfer has delivered for this patient, sometimes as early as six months. But you can still have swelling at those times. So I would tend to be patient and take a long term approach to those results.
Dr. Robert Whitfield (16:00): What are the risks of transferring fat to breast? So fat transfers should not promote risks to the breast if placed in the proper position. The question has always been asked, does fat transfer increase the risk of breast cancer? The answer is no. Breast cancer is an epithelial. Fat is from mesenchymal stem cells.
Dr. Robert Whitfield (16:24): It can't form an epithelial cancer. What it can form is a sarcoma and there's been no evidence that that will form. So the answer is no it's not going to lead to risks. Now the other risks that people ask about are fat necrosis, oil cyst formation and typically to me, that concern pertains to how it was transferred.
Dr. Robert Whitfield (16:47): So one seeing we go back to how we technically do it. We use the same size tube or liposuction cannula, a four millimeter and we put it back with a four millimeter and the way we put it back is not a syringe method, but it's on a roller pump. So it's consistently being pumped at the same speed. That allows for even distribution of the fat as it's coming out of the cannula back and forth.
Dr. Robert Whitfield (17:16): I get asked, will my fat transfer affect interpretation of my mammograms? And the answer is no because the fat belongs in the plane under the skin. If you put fat inside of a breast, you will create a mammogram abnormality. So mammograms specifically, what they're looking for are micro calcifications as it relates to cancer.
Dr. Robert Whitfield (17:40): Fat should not cause that. It should not mask it if it's not in the breast. So if you don't put fats in the wrong place, it shouldn't compromise your mammograms at all. Fat belongs in the layer between the skin and the fatty layer.
Dr. Robert Whitfield (17:54): On our next episode, we'll talk about post op and recovery. We do some unique and special things to make recovery as smooth as possible for our patients.
Dr. Robert Whitfield (18:03): New episodes will be released every Thursday. So please make sure you follow the show and subscribe to our BII email list. If you are out there wondering if you have BII and want to reach out, look in the show notes for links to our office and to read more about our practice.
Speaker 1 (18:21): Dr. Robert Whitfield is a board certified plastic surgeon located in Austin, Texas near 360 and Walsh Tarlton in Westlake. To learn more, go to Drrobertwhitfield.com or follow Dr. Rob on Instagram at @DrRobertWhitfield.
Speaker 1 (18:39): Links to learn more about Dr. Rob's smart procedures and anything else mentioned on today's show are available in the show notes. The Holistic and Scientific Podcast is a production of The Axis.