Fat transfer is an excellent way to fill in hollows, enlarge breasts, and soften scars. Introduced in 2008, WAL fat transfer, or water-jet-assisted liposuction, has made fat transfers safe and routine procedures.

Background‍

Fat transfer underwent a revolution in 2008 when WAL fat transfer arrived in Finland. WAL enables gentle fat transfer and fat collection in a directly transferable form. During fat transfer, large amounts of fat can be transferred to the desired location, such as the breasts. Sairaala KL was one of the first to adopt the new method and has since published two studies on WAL combined with stem cell transplants.

To whom is fat transfer suitable for?

Fat transfer works in flexible tissue with good blood circulation. There must be enough fat in the body for fat transfer – preferably enough to perform several transfers. With the second transfer, more fat will adhere due to the increased blood circulation and softening caused by the first transfer. Blood circulation is poor in areas that have undergone radiation therapy and have scar tissue, and the first transfer only softens the tissue and scar. Patients who suffer from tightness and pain in scar tissue benefit from fat transfer as these symptoms are alleviated. 

Fat transfer to the breasts may be recommended if the patient desires natural, soft breasts and breast augmentation. A more significant change usually requires two or more transfer sessions. Fat transfer does not achieve the same type of shape correction as silicone implants, but it adds tissue evenly and thinly. 

Fat transfer is a good option for breast asymmetry, as breasts enlarged with fat transfer gain weight, lose weight, and age naturally. Fat transfer can also be performed in conjunction with prosthesis removal. The shape of the breasts can be corrected later with a breast lift if necessary.

Fat transfer can also be used to repair the after-effects of surgical procedures such as cancer surgery. A removed breast can be repaired with several consecutive fat transfers.

Fat transfer appears to improve skin quality. Stretch marks, thin and wrinkled skin, or sun-damaged skin may appear healthier after the transfer.

After fat transfer, weight loss also reduces the amount of transferred fat. Weight gain after fat transfer, on the other hand, may cause swelling in the transferred area. 

We do not recommend fat transfer if there is not enough fat for at least two transfers.‍

How much fat can be transferred at one time, and how much remains?

Depending on the size of the breast, 150–400 milliliters of fat can be transferred to the breast at one time. About half of that amount is expected to adhere to the tissue. In our study , we have found that half of the total volume remains in the breast. Most of the post-operative swelling disappears in the third week, and the final result can be assessed after about three months. The procedure can be repeated at the earliest three months after the previous transfer. The fat that has settled and adhered to the breast is alive and permanent.

Where is the fat taken from?

The point of application is not particularly important in terms of adhesion. The essential thing is that there is sufficient amount of fat. 

Suitable areas for fat removal are the stomach area, love handles, thighs, saddle bags, and inner knees. It is impossible to remove fat from a slim person unless it is a very small transfer, for example to the face.

Fat transfer can be planned to be performed in two or even three separate sessions. In this case, not all extraction sites will be touched, as fat is difficult to obtain from scarred areas that have previously been breastfed.

How is fat extraction and transfer performed?

Small fat transfers are performed under local anaesthesia, while larger procedures are performed under spinal anaesthesia or general anaesthesia. The fat collected using the WAL method is transferred to smaller syringes and injected in thin streams into the subcutaneous fat of the breast and under the mammary gland into the pectoral muscle. The fat removal site is covered with a support garment.‍

How do you prepare for the procedure?

Fish oil capsules, omega fatty acid supplements, and garlic can cause proneness to bleeding, and you should stop taking them four weeks before the procedure. Anti-inflammatory drugs should also be discontinued two weeks before surgery. It is also important to remember that smoking is not conducive to the well-being of fat cells.

Support stockings are put on the day of the procedure and kept on for 1-2 days. A mammogram is always done before the procedure.

What are the risks associated with the procedure?

Infection / wound infection

Extremely rare, but possible as with all surgeries.

Bruises

Bruising is common both at the injection site and in the transfer area. It usually disappears within 2-3 weeks.

Sensory disturbances / numbness

During the first few weeks, skin sensitivity may decrease, especially at the fat transfer site. Numbness may be followed by a hypersensitive phase, during which the skin may be sensitive to touch for a few weeks. Sensory disturbances in the breasts are very rare after fat transfer. The transfer does not affect breastfeeding.

Unevenness at the fat removal site

Liposuction is performed through crosscut incisions, which minimizes skin irregularities after surgery. Fat is removed from the deep layer of the skin, allowing the superficial fat layer to smooth out any irregularities. Removing all fat or suctioning too superficially will inevitably cause unevenness.‍

Skin wrinkling

Supple, thick skin rich in collagen and elastin retracts and straightens better than thin skin that is already wrinkled.

Blood clot

Prevent with compression stockings or flight socks and a mini-heparin preparation. Early movement after surgery plays a very important role in recovery. Avoid lying down too much.

Fat embolism

A very rare and serious complication that requires hospital treatment.

Possible late problems?

Without blood circulation, the fat graft dies and can form oil cysts or small lumps and calcifications.

Calcifications appear on mammograms as small benign deposits. Calcifications are most likely to occur in scarred and damaged tissue. 

Oil cysts, on the other hand, usually appear only a year or two after the procedure and feel like a superficial lump in the breast. Oil cysts are not dangerous and can be punctured. 

When undergoing a mammogram later on, you should mention that you have had fat transfer surgery on your breasts.

What about aftercare?

Support garments should be worn day and night for two weeks, and then at least another two weeks during the day. Bras are not recommended for the breast area for four weeks. The breasts should be kept warm for four weeks to ensure maximum blood circulation. A carbohydrate-rich diet is recommended for four weeks after the transplant. Fasting or dieting may weaken the graft's ability to take root, but weight gain is also unnecessary.

You can go home on the same day after the operation. You can only take a shower the following day. The wound dressings must be kept in place for 2–4 weeks until the follow-up examination. The stitches will dissolve on their own. Pain and minor bruising are common in both the transfer area and the liposuction site, especially when starting to move or during rapid movement. You can move around immediately, but strenuous exercise and sweating should be avoided for two weeks.

More extensive liposuction at the same time?

In the same procedure, more extensive fat removal can be performed after fat transfer. For example, there may be a large amount of fat in the abdominal wall, of which only a small portion is transferred.

Our publications related to fat transfer and stem cells:

1. Stem cell enrichment does not warrant a higher graft survival in lipofilling of the breast - a prospective comparative study. H Peltoniemi, A Salmi *, S Miettinen, B Mannerström, K Saariniemi, R Mikkonen, H Kuokkanen, C Herold. JPRAS 2013
2. Abdominoplasty improves quality of life, psychological distress, and eating disorder symptoms. A prospective study. K Saariniemi, A Salmi, H Peltoniemi, M Helle, P Charpentier, H Kuokkanen. Plastic Surgery International. 2014, Article ID 197232
3. Aesthetic liposuction results in fewer eating disorder symptoms. A prospective study, K Saariniemi, A Salmi, H Peltoniemi, P Charpentier, H Kuokkanen. Plast Reconstr Surg Glob Open 2015.
4. Enrichment with Adipose-Derived Stem Cells Does Not Enhance Water-Jet Fat Graft Survival in the Breast—A Prospective Comparative Study. Hilkka H. Peltoniemi1, Asko Salmi, Kai Saariniemi, Hannu Kuokkanen, Christian Herold Surgical Science, 2016, 7, 485-495