Breast Reconstruction and Breast Augmentation using Autologous Fat Grafting at Park-Klinik Birkenwerder/Berlin

Breast reconstruction using autologous fat grafting is a new and genuine alternative to silicone. It offers the big advantage of a natural look and the absence of visible scars. Furthermore, this intervention is far less painful.

Human fat cells (adipocytes) have a size of up 0.1 mm and a life span of probably 4 to 6 weeks. So-called pre-adipocytes are attached to them. These are stem cells out of which new fat cells develop constantly, which means that the fatty tissue is constantly renewed. 1 gram of human fatty tissue contains approximately 550,000 stem cells.

The first report on the possibility to successfully transplant autologous fatty tissue was already published in 1893. Professor Neuber (Kiel/Germany) observed that such transplantations were successful once smallest fat units were evenly distributed in healthy tissue.

Unfortunately, these early findings were subsequently discarded and often, large amounts of fat were injected at one single site, so that surgical outcomes varied from excellent to failure and at worst caused calcifications and the development of oil cysts.

At Park-Klinik Birkenwerder/Berlin, we have made major progress: For breast reconstructions and breast augmentations using autologous fat grafting, we use a particularly gentle and effective method to collect fat cells: the BEAULI™ Method that we have developed and that is globally successful.

Please do not hesitate to contact us for a personal consultation. Our surgeons will review, explain in detail, and discuss your options regarding »breast reconstruction and breast augmentation using autologous fat grafting« at Park-Klinik Birkenwerder/Berlin.

Breast reconstruction using autologous fat grafting: the conventional method

At the beginning of the 1980s, Dr Sidney R. Coleman, a plastic surgeon from New York, developed a procedure to gently collect and transplant fat cells. With this, he laid the foundation for a successful transplantation of fat cells.

Since 1999, we have been routinely using this procedure for the transplantation of smaller amounts of fat, mainly performed in the face.

In March 2007, Dr Coleman published Fat Grafting to the Breast Revisited: Safety and Efficacy in the Plastic and Reconstructive Surgery Journal, a globally renowned journal for plastic surgery. He published the results of examinations that were done several years after fat tissue grafting and that demonstrated their long-lasting success. Subsequently, further publications (Illouz/Delay from France), covering 25 years and 10 years of experience with fat grafting respectively, confirmed these very positive results.

The major problem of conventional or classic grafting of small fat units consists in the very cumbersome and time-consuming collection of fat. In most cases, small syringes were used to manually suck the amounts of fat that were then centrifuged. As a result, approximately 5ml of fat were obtained per syringe, which then had to be transferred to 1ml syringes for the injection into the breast.

Breast reconstruction using autologous fat grafting: The BEAULI™ Method

Inspired by the excellent results and following further, similar publications from Italy and France, we have developed a new procedure for a particularly gentle collection of fat cells via waterjet liposuction, the so-called BEAULI™ Method, in collaboration with the company Humanmed AG, from Schwerin, Germany, in 2007.

The results were published in the leading German Journal for Plastic Surgery, Plastische Chirurgie, in December 2010.

BEAULI™ (pronounced ‘Bjoolee’) is the acronym of

Berlin
Eigenfett (autologous fat)
AUfbau mit (reconstruction with)
LIpo (=Fett-)Verpflanzung (Lipo-transfer)

or

Berlin Autologous Lipotransfer

The cells are washed out with water and collected in a sterile container. Subsequently, they can be transplanted with the use of small syringes. The survival of fat cells depends on them connecting as quickly as possible to tissue that has a good blood supply. This is why fat cannot be transplanted in larger chunks, but thin cannulas have to be used to distribute individual fat cells like strings of pearls in the tissue.

In order to well document the results of this surgical procedure and to support this method to achieve a break-through, our team at the Park-Klinik Birkenwerder/Berlin had this data assessed in a clinical trial, the results of which will be published shortly.

In the meantime, several hundred treatments of breast augmentation using fat grafting have been performed globally using our method. All of them have been successful. Apart from genuine breast augmentations, we have also performed reconstructive breast surgery following cancer and also surgery in cases of so-called capsular fibrosis after silicone implants where these were removed and their volume replaced by grafted fat within the same session.

Who would benefit from a breast reconstruction using autologous fat grafting with the BEAULI™ Method?

Breast reconstruction with autologous fat grafting is ideal

  • For women with typical fat distribution abnormalities (ample fat on thighs and buttocks, slim upper body and small breasts)
  • After weight loss and remaining fat pads in the abdominal area
  • In cases of smaller breasts and the urgent wish for an augmentation and a dislike of silicone implants
  • In cases of capsular fibrosis caused by implants
  • For reconstruction, in cases of asymmetric breasts following the completion of cancer treatment

Prerequisites for a breast reconstruction using autologous fat grafting are:

  • Non-smoker (a minimum of 10 days before surgery)
  • Of normal weight or slightly overweight (BMI 20 – 30)

The procedure of breast reconstruction using autologous fat grafting

Approx. 1 week before the intervention, a preparatory examination is done which includes photo documentation, blood sampling and clinical examination.

On the day of surgery, the areas for liposuction are marked in the morning.

The surgery is performed under twilight anaesthesia or general anaesthesia, if requested. At the end of the intervention, the breasts are protected by a cotton dressing and compression pants or a compression garment are to be worn, over the areas that have undergone liposuction.

Approx. 2 hours after surgery, you are allowed to eat and drink again.

During the following days, the breasts are swollen and there might be some bruising. More severe pain is not to be expected. You are more likely to feel the areas having undergone suction. In most cases, the pain is described as a muscle ache.

Bruising and swelling disappear within the next three weeks. Compression garments will have to be worn over areas of liposuction for four to six weeks.

Usually, the patient will see her doctor one week after surgery and then again after a further four weeks. The final results are to be expected after three months. However, no major changes are to be expected after the sixth week at the latest, as approx. 80% of the lasting results will have been achieved by then.

What are the complications that can occur in breast reconstruction using autologous fat grafting?

A small part of fat cells will not survive the transplantation and will be reabsorbed by the body. In our first evaluations of our MRI images taken before surgery and half a year later, we could show that, on average, 76% of the fat transplanted using the BEAULI Method are incorporated.

The main risk of a breast augmentation using autologous fat grafting is considered to be the fusion of non-incorporated fat cells with the subsequent development of oil cysts in which very many fat cells stick together and the body is unable to eliminate them. The BEAULI-technique of fine distribution within the tissue allows our team at Park-Klinik Birkenwerder/Berlin to prevent this problem to a large extent.

In a US-study looking at two year-follow-ups after fat grafting (though performed with a different method), three to four percent of 70 patients reported smaller calcifications that were clearly identified as benign in mammography. In rare cases, inflammations developed (immediately after surgery), which usually were suppressed by antibiotics.  Only in an extremely unfavourable case, one would have to face the development of an abscess. This would require a surgical intervention and could possibly lead to breast mutilation.

However, such consequences have not yet occurred under the BEAULI™ Method. Furthermore, all these side effects can occur under any kind of breast surgery, including breast augmentation with silicone implants.

Why does one read so much contradictory information about breast reconstruction using autologous fat grafting?

Fat injections have been and are still performed without proper attention being paid to the correct handling of fat cells. Sometimes the fat collected in conventional liposuction is directly injected into the breasts through large cannula. Thus, a large part of cells are dying and they subsequently lose their content (oil). In the case of larger fat lumps, the oil that has merged is no longer metabolized in the body, but secreted within its surrounding tissue. This tissue can later calcify and become visible on x-ray images as an oil cyst. If calcifications are numerous, the whole breast can harden. This is why we have given our method its genuine name in order to clearly differentiate it from other procedures.

Why does one have to warn against stem cell enrichment?

Sometimes the so-called transplantation of stem cells is propagated for the breast augmentation using autologous fat grafting. As we have already described above, fatty tissue is a mixture of mature fat cells and microscopic small stem cells. These stem cells can develop into fat cells, if they are located in fatty tissue and a fat cell dies within its vicinity, but they can also develop to become muscle cells, bone or other cell types. Therefore, the stimulus to cell renewal within the environment is decisive. In other words, once a fat cell dies due to old age within the fatty tissue, a stem cell incorporates oil and turns into a fat cell. However, it only does it, once it gets this stimulus.

In breast reconstruction with autologous fat grafting, some centres mix a concentrate of stem cells with the fat that is to be transplanted, hoping to improve the incorporation result. However, this method, which is very contested among physicians, has not yet provided a scientifically sound proof of a better result and we oppose it for fundamental considerations.

REPORT MAINZ (German first TV channel, ARD) impressively confirmed our warning against stem cell enrichment, a position that we also represent globally on professional congresses: http://www.swr.de/report/

What are the costs of breast augmentation using autologous fat grafting?

The costs for breast reconstruction and breast augmentation using autologous fat grafting depend on the individual scope of services. For average prices, please refer to our price list.