I had breast fat grafting last year; do I need 'repair work' again this year?

If fat cells are simply transplanted, they are absorbed and lost to the original breast tissue after a short time; therefore, to overcome this, stem cells must be extracted from the adipose tissue and then mixed with purified fat cells in a specific ratio before being injected. ⓒHealthO

Ms. Bae (30, female), an office worker, is contemplating whether she should enlarge her breasts again through fat grafting this year. She had been stressed about her small breasts for a long time and eventually underwent surgery for the first time last summer. However, feeling hesitant about having implants, she decided to aim for a size increase through "autologous fat breast grafting," which was trending at the time.

I chose this without hesitation after hearing that it was less burdensome because no foreign substances were inserted, and that it looked natural since it used fat from my own body. However, the effects did not last as long as I expected. At first, I was satisfied as my previously loose bra filled up snugly, but I couldn't get through the autumn season before it felt like it had gone back to how it used to be. I knew the results wouldn't last long, but I never imagined my breasts would sag this quickly. During the winter, I masked the fact that my breasts had shrunk with thick sweaters and outerwear, so no one noticed, but as summer approaches, I am becoming anxious. With the season to take out my bikini approaching, I am debating whether I should get "repair work" done again this year.

A considerable number of women are disappointed after breast augmentation using autologous fat grafting because the results do not last as long as expected. The duration of the effect is determined by the 'graft survival rate.' When only fat is transplanted, the cell survival rate is only 20–30%, causing the beautiful breasts to fade quickly.

Caution is required because excessively increasing the amount of fat to compensate for this can lead to side effects such as fat necrosis and calcification. Calcification refers to the sensation of round lumps or hard clumps felt when touching the surgical site. It usually occurs when an excessive amount of fat is injected, and in most cases, it is caused by the patient's excessive ambition or the doctor's inexperience. 

In such cases, 'stem cell autologous fat breast augmentation,' which overcomes the disadvantage of a low engraftment rate, can be considered. This procedure is attracting attention for raising the engraftment rate—a limitation of simple fat grafting (around 20–30%)—to the 70% range. While the process of harvesting fat cells from the patient is the same as autologous fat grafting, this method involves isolating fat-derived adult stem cells, mixing them with fat tissue at a ratio of 1:4, and injecting them into the breasts.

Dr. Shin Dong-jin, director of Apgujeong SC301 Clinic, explained, “If fat cells are simply transplanted, they are absorbed and lost to the original breast tissue after a short time. To overcome this, stem cells must be extracted from the fat tissue, mixed with purified fat cells in a specific ratio, and then injected into the breasts.”
Although it varies from person to person, approximately 1000 cc of fat can be extracted based on an average body type. Typically, the amount of fat transplanted to one breast is about 200 to 250 cc, which is similar to the size of commonly used implants.

Director Shin stated, “The reason stem cell breast augmentation looks more natural than autologous fat grafting is that the patient’s own stem cells are used,” adding, “Just like inflating a balloon, injecting stem cells and fat cells together fills the breasts with volume while maintaining their original shape.”

Director Shin Dong-jin created the first guidelines in Korea suitable for stem cell plastic surgery and has been presenting them at domestic and international academic conferences, including the International Society of Aesthetic Plastic Surgery, since 2009. In his master's thesis from Shandong University School of Medicine in China, which was approved last August, he demonstrated a high fat engraftment rate of over 70% due to the effects of stem cells, thereby enhancing the credibility of the procedure.

The paper currently being prepared this year is expected to achieve an even higher engraftment rate of around 75%. There are two secrets. As a precautionary measure, the breasts are expanded using a device similar to the commercially available 'Brava' to secure space for the stem cells. By using strong negative pressure to spread the breast skin outward, extra space is created in 'flat breasts' (where the breast tissue is narrow) and 'dense breasts' (where the breast tissue is firm). This provides a safe haven for the stem cells and pure fat cells, allowing them to survive in greater numbers and for a longer period.

In terms of post-operative care, a low-power fat-dissolving laser called the 'Laypex Cutine Laser' (LCL) is used to prevent the recurrence of abdominal obesity. After stem cell breast augmentation, one must consume high-quality fats, such as omega-3 fatty acids, and an appropriate amount of protein. However, consuming fats to enlarge the breasts can lead to fat accumulating in the abdomen before one realizes it; LCL effectively prevents this. Approved by the U.S. Food and Drug Administration (FDA), the laser light with a wavelength of 658nm creates holes (bubbles) in fat cells, breaking down triglycerides into water, free fatty acids, and glycerol, which are then released from the fat cells.

Director Shin stated, “Since the end of 2012, using negative pressure breast expanders and LCL based on know-how in pre- and post-procedure care methods, we have observed a significant improvement in volume after the procedure.”
"...was there," he said, adding, "I will prove the effectiveness of these methods through clinical statistical papers."