Breast fat transfer in Tunisia

The breast Lipofilling technique, also called fat injections to the breasts or Liposculpture or lipomodelage of the breasts, is a plastic surgery that has for a goal; the augmentation of the breasts’ size, by taking the patient’s own fat cells from generous areas through liposuction (such as the hips, abdomen, ) and then injecting it to the breasts for more volume.

First, it is critical to know that breast augmentation through lipofilling, can never replace the attribute for a breast implant.

lipofilling augmentation is for:

• Women who show a moderate breast hypotrophy.
• Women who do not wish to have a foreign body placed in them (breast implants).
• Women who have a lot of fat localized in one place (Abdomen, hips, thighs…).

The SOFCPRE (Société Française de Chirurgie Plastique Reconstructrice et Esthétique) recommends for now, limiting the plastic mammary augmentation technique only for women who are under 25 years of age, with no history of Breast Cancer for them or their family.

• The finishing results of the breasts Lipofilling offers :
  • a moderate breast size, because of the systematically reabsorbed fat that was injected to the body, by 30% to 40%
  • The result of the breast augmentation is the equivalent of 200-250cc as a max, and a cup or two more sizes.
• In addition, Lipofilling can only occur, if the patient has already enough fat to donate for the intervention.
• This technique is prohibited for patients who have a history with breast cancer for them or their families.

In cases where the patient desires a significant augmentation for the breasts size, breast implants remains for now as the best choice of treatment for attaining the desired results.

There for, in order to find the breast size results similar to those obtained by breast implants, it is possible to go through a second intervention, 6 or 1 years after the first fat injection procedure.

Breast augmentation by Lipofilling is an intervention with many advantages:

• Avoiding risks related to breast implants such as the implants breaking, deflating and rippling, rejection of the implant, capsular contracture…
• It is a good alternative to breast implant revision.
• Slimming of the silhouette thanks to the lipoaspiration administrated on the areas presenting the excess of fat used for the Lipofilling of the breasts.
• There would not be a risk of rejection for the fat cells injected: since it is the patients’ own fat.
• There is little to no scarring (only one of a small micro-incision).
• The aspect, touch and consistency of the breasts are very natural.

The breast lipofilling gives the donor a breast size that is natural and permanent by injecting the patient’s own fat, with no use for breast implants.

• The results of the breast augmentation are limited: the augmentation is esteemed to be a cup or two sizes more.
• If the fat located in the donor, area is not sufficient it would not be possible to do a second session of Lipofilling.
• The amount of fat reabsorbed by the breasts may differ from a breast to another, giving an asymmetrical aspect of which you may need a retouch.
• A risk of a bad Engraftment, engendering a grease necrosis with the forming of nodules of “cytosteatonecrose “. These usually go spontaneously, or they would need eventually a surgical removal.
• Risk of oil cysts forming, which might need a surgical removal.
• The possibility of a calcifications forming at the mammography, engendering confusion with a breast cancer, if the radiologist lacks experience.
• It is possible to resort to a second or a third intervention in 6 months or 1 year after the first lipofilling intervention, in order to proceed to a more important volume augmentation and to have the breast size desired by the patient.

It should be noted that “injecting a lot of fat” increases the risk of cytosteatonecrose and oil cysts forming and uses up uselessly the fat storage of the patient.

Like all surgical interventions, the breast Lipostructure requires a full blood test before surgery. In addition, it is necessary to prepare a radiological assessment of the breasts (echo-mammography) since its normality (ACR1 or ACR2) is required to proceed with the intervention.

The medical instructions that must be followed are

• The intake of tobacco and oral contraceptives must be stopped one month prior to the intervention.
• A prescription of all the Aspirine based medicaments, the Anti-inflammatory and/or the anticoagulants is mandatory for at least the first 15 days before the Lipofilling
• A prescription for oral contraception (pills), one moth prior to the surgery.
• You must avoid getting pregnant during a whole year after the Lipofilling.

• The types of anesthesia : like all breasts Lipofilling surgeries requires a classic general anesthesia.
• Methods of hospitalization : The breast Lipofilling surgery requires a hospitalization of 1 to 2 nights at the clinic (depending on the quantity of the fat aspirated).

The fat graft for the breasts is achieved in three steps:

• The usual zones from which we harvest fat, for the breasts lipofilling, are determined by the sufficiency of the quantity needed for the procedure.
• The fat harvesting is done the same way with the classic liposuction, through small incisions. This liposuction should be done in an atraumatic way to conserve the vitality of the fat cells.

The harvested fat should be spin-dried according to Coleman’s method, this Spin-drying procedure permit to separate the fat cells from other consistencies (oil and serosities).

The reinjection of the fat at the breasts level is done through small incisions by micro-cannulas according to the following method: the retro-tracing technique, in many plans, in many different fanning paths. All these important technical details, enlarge the contact surface between the grafted fat cells and the bed receiving the grafting, and permit to increase the rate of the graft taken.

the quantity of the fat injected varies between 100 to 300cc, depending on the fat volume available in the donor zones.

the time length of the breasts’ Lipofilling surgery is 2 hours to 2 hours and 30 minutes.

• At the donor zones : the scars from fat sampling are all small and discreet (like those of the Liposuction).
• At the breast level : the scars for fat reinjection are tiny (two at the breasts level and two at the areola).

We have to wait 12-18 months to assess the final outcome of scars.

• A feeling of moderate pain at the breasts as well as the donor areas.
• Edema and bruises fading after 3 weeks to 1 month.
• General fatigue during the first two weeks.
• It is necessary to wear a wireless bra, 24 hours during at least 6 weeks.
• For a period of six weeks, the patient must wear a compression garment (jacket) 24 / 24, following liposuction.
• It is necessary to plan to rest from work for more or less 8 to 12 days
• The practice of sport is banned for two months
• An appreciation of the final result (volume and shape of the breasts) is estimated possible after 3-6 months after lipofilling breast surgery.

The end result of a lipofilling can be enjoyed after 4 to 6 months. This surgery often ensures satisfaction: the woman have a moderately increased breast with a shapely figure

In case when the patient wishes for more volume in her breasts, it is possible to proceed to a second, even a third session of breasts lipofilling, if the fat donor zone allows it, and from the 6th month after the 1st session.

We must remember that the engraftment is approximately of 60-70 %, the fat absorption is of 30-40 %.

This breasts fat injection technique or fat transplant is a method of definitive breast enlargement because the transplanted cells remain alive.

Therefore, it should be remembered that the fat cells, as they have a genetic memory, evolve in line with the weight loss or taking the weight of the patient. It is strongly recommended to have a stable weight before surgery so that the result of breast lipofilling remains stable.

Since November 2011 in France, the French Society of Plastic Reconstructive and Aesthetic Surgery (SOFCPRE) determined the criteria for breast augmentation by lipofilling to be the following:

• Women of less than 35 years, without personal or family history of breast cancer.
• Preoperative radiological assessment (ultrasound and mammography) is required with its normality (or RCA1 ACR2) is essential to the realization of this lipofilling technique.
• The patient agrees to make a reference imaging assessment one year after the intervention (preferably by the same radiologist) and then regularly checked annually.

Fortunately, the breasts lipofilling has very few complications and a very low degree of risk as patients who go through such intervention are mostly very satisfied with the results they get. Nevertheless, one is never immune to unpredictable complications despite the skills of the practitioner.

Complications are divided into two groups

• Thromboembolic risks (phlebitis, pulmonary embolism).
• Very rare risk of infection.
• Risk of pleural breach pneumothorax, exceptional.

• Cystostéatonécrose risk due to incorrect "engraftment.
• Risk of oily cysts formation.
• Risk of imperfections in the result: asymmetry, excessive resorption, insufficient volume irregularities.

The intervention of breast augmentation by lipofilling is a cosmetic procedure with limited risks. Do not overvalue, but be aware of these risks since they are associated with any medical or surgical procedure as simple as it is.

The price of breast lipofilling in Tunisia is 1900€.The price of breast augmentation by lipofilling in Tunisia is quite affordable and cheap compared to the prices in France or Switzerland or other countries...If you want to know how much a lipofilling of the breasts in Tunisia and have a personalized price estimation, please contact Dr. Shiraz Bouzguenda .