Dr. Sam Jejurikar Discusses Alternatives to Breast Implants: Is Fat Transfer Safer?

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Breast implants are widely used in both reconstructive and cosmetic surgical procedures globally, with some 100,000 implants utilized in breast reconstruction surgeries, and another 300,000 in breast augmentation annually in the United States alone, per statistics published by the American Society of Plastic Surgeons.

This widespread use of implants has led doctors to become more informed and aware of the potential risks and complications resulting from breast implant surgeries and the use of breast implants over the long-term.  This has, in turn, led to an increased interest in alternatives to breast implants for patients who seek reconstructive surgery after breast cancer, or those who simply want breast augmentation. In conversations with us, Dr. Sameer Jejurikar of Dallas laid out his experiences with implants as well as their popular alternative: fat transfers.

Common Complications from Breast Implants

Breast implants are not designed to be worn for a lifetime. The longer your breast implants are in place, the higher the likelihood that complications may develop and that you may need to have your implants removed.

Complications and adverse reactions from the use of breast implants are noted as being significant when they affect a minimum of 1% of implant patients at any time. Some of these complications may require additional surgeries or non-surgical treatments in order to correct the condition.  About 20% of individuals who undergo breast augmentation with implants will require surgical removal or revision of their breast implants within 8 to 10 years following the augmentation procedure.

Complications associated with the use of breast implants may include such things as capsular contracture, which occurs when the tissue capsule around an implant tightens, causing hardening of the breast; or calcifications around the implant, which may sometimes be mistaken for nodules in the breast during a mammography.  Implants may collapse, deflate, or rupture.  Some patients may develop a seroma, or collection of fluid surrounding the implant, while others may experience conditions such as swollen or enlarged lymph nodes.  Wrinkling or rippling of the implant that is visible through the skin may also occur, or the implant may become palpable through the skin.  Some women may experience delayed wound healing, or pain in the breast, and in rare cases, infections, and even toxic shock syndrome may develop as a result of breast implant surgery.

Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

In 2011, the FDA turned up a possible link between breast implants and the occurrence of anaplastic large cell lymphoma (ALCL), but so few cases of ALCL had been reported at that time, that risk factors for the condition were unknown. In response to its findings, the FDA emphasized the need for further research to better understand ALCL in individuals with breast implants.

By 2016 the medical community had developed a better understanding of ALCL and the World Health Organization classified breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) as a T-cell lymphoma that may develop in individuals following the insertion of breast implants. Due to limitations in global data on breast implant procedures, it is difficult to determine how prevalent the problem is; however, data suggests that the development of BIA-ALCL is more frequent following insertion of textured breast implants rather than implants with smooth outer surfaces.

It is important to note that BIA-ALCL is not a form of breast cancer, but rather a type of non-Hodgkin’s lymphoma that affects the autoimmune system. Fortunately, BIA-ALCL is most often found contained within the scar tissue and fluid immediately surrounding the breast implant. In rare cases, however, the disease may spread from those sites to other areas of the body.

Breast Implants and Rare Diseases

In September of 2018 researchers at the University of Texas MD Anderson Cancer Center evaluated almost 100,000 patients with either saline or silicone implants in a study to determine the long-term safety of breast implants.  Their findings conclude that certain autoimmune disorders and rare diseases may be associated with silicone breast implants, although the study did not establish a direct causative link between breast implants and these conditions.

The Anderson research team evaluated data supplied by two separate implant manufacturers, placing patients into two groups based on which brand of implant they were wearing. The research team found that incidences of rare conditions such as scleroderma, melanoma, Sjogren syndrome, and rheumatoid arthritis were 2 to 8 times more frequent in one group when compared to the frequency of incidence in the population at large, while the other group reported more than twice the frequency of Sjogren syndrome, dermatomyositis, and scleroderma in comparison with the general public. The study also turned up one case of breast implant associated anaplastic large cell lymphoma (BIA-ALCL).

Options for Breast Implant Revision

If you do experience complications with your breast implants, such as swelling of the lymph nodes, or an infection, you may need to have revision surgery to correct the problem.

Revision may include capsule removal or surgical removal of scar tissue around the implant, or it may mean scar or wound revision to remove built-up scar tissue, surgical repositioning of the implant, implant removal, replacement with a new implant, or options such as fat transfer or fat grafting which replace the removed implant with fat harvested from the patient’s own body.

The option of simple removal is the least recommended of all, because the breasts tend to look cosmetically unattractive following removal of breast implants.  The breasts may appear deflated and sunken, with dimpling or puckering in the skin, and severe sagging due to lack of volume and firmness.  The skin on the breasts may also appear wrinkled and striated.

While doctors have stepped up their long-term monitoring of breast implant patients in response to the growing concern, patients are also seeking other options for breast reconstruction or augmentation without implants.   For this reason, many plastic surgeons are now recommending implant revision using fat-transfer or fat grafting to replace the volume in the breast with the patient’s own fat cells, as this procedure presents significantly reduced risks of complications in most patients.

Fat Transfer vs Breast Implants

Dr. Sameer Jejurikar is a board-certified plastic surgeon working at the Dallas Plastic Surgery Institute in Texas, and an expert in both implant surgery and fat transfer procedures.  Dr. Jejurikar has been monitoring all of his breast implant patients very closely, noting any complications or side effects, and focusing particularly on patients that display early warning signs of any of the autoimmune conditions or rare diseases that were mentioned in the Anderson MD study, as well as ALCL.

“Whether or not breast implants can cause autoimmune diseases is still a very controversial topic as clear, definitive studies linking these entities still do not exist,” states Dr. Jejurikar.  “That being said, given the small but known association of breast implants with Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), it does seem plausible that, in a small minority of patients, an inflammatory reaction can occur which promotes more generalized illness. Although large scale data linking Breast Implants to Breast Implant Illness still isn’t forthcoming, the patients I have seen presenting their symptoms tend to be very compelling in their symptoms and stories.”

Dr. Jejurikar notes that his patients are increasingly concerned about the risks associated with breast implants, and that many are seeking revision procedures to remove implants in order to reduce their risk of ALCL and other conditions.

“In the past year, I’ve taken out several breast implants in patients. Most of these were for relatively standard reasons, including capsular contracture, rupture, infection, and droopiness. Some of these patients insisted they had breast implant illness, though it really seemed as though this association only was made after they spent time in an online community devoted to the subject. In two of the patients, however, there was a clear linkage between the onset of fatigue, joint pain, aches, and unintentional weight loss after the placement of their implants. Once their implants were removed, these symptoms went away within weeks.”

Dr. Jejurikar recommends the fat transfer or fat grafting procedure as an option for those who want to replace lost volume in the breasts following the removal of breast implants, or for patients undergoing breast reconstruction or augmentation. The fat transfer procedure consists of two parts, and these both provide unique benefits to the body.  The first part of the procedure uses liposuction to suction away excess fatty tissue from specific areas in the body, such as the abdomen, hips, thighs, or buttocks.  The fat removed from these areas is then liquefied and injected directly into the breasts, filling in the fullness and volume once provided by the breast implant.

“Fat transfer to the breast is a viable alternative for patients who wish to have their implants removed or even for patients without implants who seek a more natural alternative to breast implants,” explains Dr. Jejurikar. “Instead of dealing with an implant and implant related complications, once the fat cells incorporate, patients can achieve a natural, softer and fuller breast.”

The fat transfer procedure is far less risky than the process of inserting breast implants, and fat grafting requires no incisions.  The risk of any dangerous adverse reaction is very low with the fat grafting procedure, because the procedure uses the patient’s own fat cells.  The only potential drawback to the fat grafting procedure is that the body may absorb a percentage of the fat cells injected into the breasts, meaning that you may need more than one treatment session in order to accomplish your aesthetic goal.

A safer alternative to breast implants, breast reconstruction or augmentation with fat grafting or fat transfer produces a more natural-looking look and feel than implants, with very little risk over the long-term.

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