April 14, 2011 — Breast augmentation involving injections of fat taken from other parts of the body is an increasingly popular alternative to breast implants and traditional lifts. But there are new concerns that the procedure may interfere with mammogram readings.
In a newly published study from China, nearly one in seven women who had the fat injections developed calcifications in their breasts that were considered “highly suspicious” for breast cancer. The findings appear to contradict other research, published just last month, in which researchers concluded that the calcifications resulting from fat injections were unlikely to be mistaken for cancer by radiologists.
Both studies appeared in the journal Plastic and Reconstructive Surgery, published by the American Society of Plastic Surgeons.
Fat Injections Controversial
Known medically as lipomodeling, lipoinjection, or fat grafting, the practice of reshaping the breasts using a woman’s own fat is still somewhat controversial.
Reconstructive surgeon Kamran Khoobehi, who directs the aesthetic surgery training program at Louisiana State University, has performed more than 200 of the procedures. He says many surgeons with very little experience are now also doing them because they have become so popular with patients.
“A lot of people are jumping on the bandwagon who may or may not know what they are doing, so patients need to be careful,” he says.
In the study, researchers followed 48 women who had fat injections to enlarge or reshape their breasts, performing mammograms 18 months to several years after the injections.
These mammograms showed calcifications that raised the suspicion of breast cancer in eight of the women. Breast biopsy confirmed that none of the women actually had breast cancer.
Researcher Cong-Feng Wang, MD, and colleagues concluded that the calcifications appeared to be caused by injected fat cells that had died and clumped together.
The researchers found the clustered calcifications to be indistinguishable on mammograms from those associated with breast cancer, and they concluded that fat injections should not be used for cosmetic breast augmentation.
Radiologist: ‘Fat Cells Look Different’
But Khoobehi disagrees, calling the Chinese study highly flawed.
He says the researchers appeared to make no attempt to avoid injecting dead fat cells along with living cells when they performed the procedure, which would have increased the chances for calcification.
And he says their practice of massaging the breasts following fat injections in an attempt to distribute the fat cells may have had the opposite effect by causing the fat to clump.
Radiologist Eva Rubin, MD, says fat injections, like any other breast augmentation procedure, can result in fat necrosis and calcifications within the breast, but most of the time these are easily distinguishable from breast cancer.
Rubin is clinical director of the breast imaging center for Montgomery Radiology Associates in Montgomery, Ala.
“There are cases with very early calcifications that may mimic breast cancer, but if you know a patient has had a (breast) procedure you are probably not going to jump right in and do a full workup,” she says. “Within a short period of time these calcifications tend to look like more typical fat necrosis.”
Advice: ‘Choose Surgeon Carefully’
Khoobehi says women who are considering fat injections for breast reshaping need to be very careful about choosing a surgeon.
- Choosing a surgeon certified in plastic and reconstructive surgery who has performed at least 20 fat injection procedures.
- Choosing a surgeon who insists on long-term follow-up.
- Avoid surgeons who do not take questions about the risks seriously. “If a surgeon tells you mammograms aren’t an issue because their patients don’t have calcifications, walk away,” he says.
He says patients should also avoid any surgeon claiming to perform breast augmentation with stem cell injections.
“This has not been approved by the FDA for use in the United States, but it is all over the Internet,” he says. “Unethical surgeons may be claiming to do it, but who knows what they are injecting.”