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Fat injections - a risky procedure.

The American Society of Plastic and Reconstructive Surgeons (ASPRS) strongly condemns the use of fat injections for breast enlargement, warning that the procedure may hamper the detection of early breast cancer or result in a false-positive cancer screening. It also cautions that fat injections used to minimize wrinkles on the face or treat surface defects on other areas of the body may offer only temporary benefits.

In a fat transplant, unwanted fat is removed through a syringe or liposuction tube from one part of the body--usually the abdomen, buttocks, or thighs--and injected into another area that needs more fullness. With the increased popularity of anti-aging treatments, such injections have been heralded by some as the natural alternative to synthetic skin-plumping fillers, such as collagen, because they use the patient's own tissue and eliminate the risk of allergic reaction. However, the ASPRS is concerned that some practitioners are promoting the experimental procedure as a permanent cure-all without making patients aware that the results often are temporary and vary widely from person to person.

Furthermore, women who seek the procedure for breast enlargement sometimes are not informed that much of the injected fat will die, causing scar tissue and calcifications that can mask the presence of early breast cancer or cause a false-positive result. Calcification may take years to develop and, when it does, often mimics the appearance of breast cancer in a mammogram. In a worst-case scenario, a patient may face painful exploratory surgery or even a mastectomy because of an uncertain mammography examination result. Breast implants filled with saline (salt water) currently are the only widely available alternative for women seeking breast enlargement.

Although mammograms may be more difficult to read once implants are in place, skilled radiologists and technicians have learned special techniques for examining females who have them.

Although physicians have experimented with fat transplants since the 1890s, researchers still have not determined what causes the great variation in the duration of the results. There is no evidence that injecting fat into areas of the body other than the breasts poses any medical risk except infection at the site of the fat removal and/or the injection. However, because an estimated 70% of the fat is absorbed by the body after six months, those who decide to have the procedure should be aware that injections must be repeated regularly to maintain the desired result. To allow for this rapid shrinkage, more fat than is required to mask the defect must be injected initially, causing temporary excessive fullness in the affected area. irregularities in the contour of the skin surface also are a cosmetic risk of the procedure.

Physicians may recommend numerous techniques they believe offer patients more predictable and long-lasting results from fat injections. Some feel that multiple, small injections are more effective than single, massive transplants. Others believe that the key to successful transplantation is the presence of small clumps of tiny blood vessels in the injected fat. There also is some speculation as to whether "washing" the removed fat of any blood or oils before reinjecting it will give a better result than simply reinjecting the fat exactly as it is removed. Patients should be aware that no one technique has been shown to give consistently reproducible successful results.

Plastic surgeons who perform the procedure have concluded that the more appropriate sites for fat injection are laugh lines between the nose and mouth, wrinkles in the forehead and near the mouth, and indented or depressed areas of skin caused by disease, trauma, scarring, birth deformity, or previously performed liposuction surgery. They also have noted a greater success rate in young patients compared to older adults, and better results when fat is injected in the trunk of the body or the extremities as opposed to the face. However, the ASPRS cautions that, even in successful cases when some of the fat cells survive, much of the new plumpness on the surface may be due to an internal reaction, or the formation of scar tissue that occurs in the area of injection.
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Title Annotation:fat injections in plastic surgery
Publication:USA Today (Magazine)
Date:Oct 1, 1993
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