Trish: Okay. I am actually on, so we’re just gonna set up a little bit. Tonight we’re doing our Facebook Live with Dr Allan Kalus, and he’s from Avenue Plastic Surgery in Victoria. And I’m just gonna do a little invite for him now, so just bear with me a sec.

Trish: I can hear you. How are you, Dr. Kalus?

Dr Kalus: I’ve very well, thank you, Trish. How are you?

Dr Allan Kalus

Dr Allan Kalus

Trish: Excellent. Good, good. Thank you so much for taking the time to have a chat with us tonight on this Facebook Live.

Dr Kalus: It’s a pleasure, a great pleasure. It’s great to use this new technology.

Trish: Yes. Well, tonight’s the first night we’re actually doing a two-way, because normally people would just be talking, or you would just be talking, and there would be no interaction. So this is good, so I can take the questions from the people as they’re coming up on my other screen. So I’ll leave that open over there. Yeah, then if there’s any questions, I can actually see them come up and I can ask you as they come up as well, just to make your job a little easier.

Dr Kalus: Oh, that’s great. So tell me: Do the other people who come on, do they see you or do they see me?

Trish: They’ll see us both.

Dr Kalus: See us both? Wow. Okay.

Trish: Pretty good, hey? So, now, I know … We’ve emailed you some questions through today that had already come through. I’m just gonna set this up so I can actually look at any questions that come up as they go, and I’ll mute myself on that screen over there. But it’ll take a couple of minutes for people to start to come on. We’ve got a few people online already, but it’ll take a couple minutes just for people to refresh their screen and see that we’re going on here, so I’ll just give them a bit of a background about yourself, and you can tell me if I’ve missed anything out, which I know I’ll miss a lot out, but …

Okay, we’re on. I’m just gonna pause this, mute this so I don’t have to hear myself on there, perfect.

So I know we’ve got lots of questions here tonight, ladies. This is pretty exciting. “Organic” breast augmentation, or fat transfer to the breasts, it’s Dr. Kalus’s specialty. Dr. Kalus’s been doing it for … how many years, Dr. Kalus?

Dr Kalus: About five years, now, into the breasts.

Trish: Okay, so Dr. Kalus has been doing it for about five years. He’s done hundreds of these procedures. And just bear in mind that every surgeon has a different procedure, every surgeon has a different way of doing things. So probably the very first question that I’m gonna ask Dr. Kalus is:

What actually sets you apart from other surgeons doing this technique, Dr. Kalus?

Might as well get that out front first thing.

Dr Kalus: Well, first of all, it’s interesting that not many surgeons are yet doing it in Australia. There are a number in the United States and there are a number in France and just a few in Australia. And the reason is that the surgeons are not covered by their medical insurance to do the procedure, and they don’t have the experience and the training, and so their medical indemnity insurance is not giving them the go-ahead to do this procedure, which is considered, after all, a fairly new procedure. And understandably, the health insurance funds are concerned about potential complications, and they want to be sure that the surgeons who do the procedure are adequately trained and experienced in it. So I’m fortunate that about five years ago, my insurance company did indemnify me against the procedure and we’ve been able to do it since then.

So I guess what sets me apart: First, I’m one of the few surgeons even who offer the procedure. Secondly, the experience. We’ve been doing it now for five years past, and that means that we’ve done over 400 procedures, so we have had a good opportunity to know what works, what doesn’t work, for which women it’s suitable, for which women it’s not suitable. Over those five years, we’ve developed and refined our technique constantly, really, and it’s a technique which is different from that which is done by other surgeons around the world. And we have proven results. We know that our technique works and we get great results with the way we handle and the way we graft the fat.

So the time we’ve spent, the experience, the technique, and last but not least: our staff, who are also very experienced. And there’s a six-week intensive aftercare programme with fat transfer to ensure the fat cells take and then grow in the breast, and our staff are just very, very onboard with this, very excited by it, and with every patient. And it really is a joint venture between us and the patient to do something exciting about this, to take fat from one part of the body, and then to prepare it, and then to graft it onto another part, and then to see it grow and to see it flourish. It’s really quite an exciting thing to do.

Trish: Well, I’ve just attended that conference that, of course, you were at recently, about breast augmentation, and it seemed a lot more like … A couple of years ago, probably, people didn’t even want to talk about it, whereas now, people are realising that this is definitely something that’s becoming popular, and a few more surgeons are taking it on. So I’m really excited that we’ve got you to be able to tell us a lot about it as well.

Dr Kalus: That’s why I said, Trish, you know, it’s been … The rate of increase in the US at the moment, where they have some figures … It’s going up at about 30% a year, the number of cases, so it’s rapidly increasing. And I expect in two or three years there’ll be lots and lots of surgeons doing it, many women will be out there talking about it. But it’s important still to know that it’s not for everyone, you know. It’s a procedure which does have its limitations, and I don’t think it’ll every replace entirely breast augmentation using implants. And then part of the experience of having done a lot of cases is to know when to say, “Well, it’s not suitable for you.”

Trish: Of course, you do breast implants as well?

Dr Kalus: Of course.

Trish: Yeah, you would do them both as well?

Dr Kalus: My background … I’ve put in, you know, more than 6 thousand breast implants over my career. But, you know, anyone who thinks about breast implants, if you think about it, it’s just a round spacer that fits inside the chest. You’re not really augmenting the breast. You’re not putting it inside the breast, you’re not really changing the breast. It’s just putting something on the ribcage and pushing the breast forwards. It’s just a spacer.

And of course it has so many problems. We know, over the years, all the difficulties, all the many women we see who come to us and say they wish they’d never had breast implants, and many women have had multiple operations. So, really, the stimulus for fat grafting came from that, and asking the question, “Is there a better way? Could there be a better way?” And fat grafting has been around for many, many years. We’ve been using it in the lips and the cheeks, but putting the fat into the breasts was something else altogether. We were also worried they would get lumps, and that women would confuse these with breast cancer. And it wasn’t until about five or six years ago that the radiologist told us that, when they do a mammogram, they can distinguish between a lump of fat tissue and a breast cancer 100% of the time. So once they gave us that go-ahead, we started experimenting with putting fat into the breasts, and I guess it’s grown from there, and we now have a procedure which, for some women, is a very good alternative to using implants.

Trish: And I noticed as well … something that’s going to be trending is what they’re calling a “hybrid” breast augmentation, where they’re doing the implants as well as the fat transfer as well, just to sort of give it a bit more shape in different….

Dr Kalus: Exactly. So you’re already ahead of your time, Trish, because hybrid is really very new, but of course women who are very thin … Breast implants never look quite right, you can often see the edge of the implant. Implants are not really good for the cleavage, whereas fat can be put very precisely into the cleavage area, into the upper pole. And it’s a wonderful way to add to the beauty of a breast after putting an implant in. And also, we’re doing a lot with breast lifts, now. Whenever we do a breast lift procedure, we’re putting a little bit of fat just into the cleavage, into the upper pole, just to give a bit of extra oomph to the breast. So it’s got multiple uses, like. This is a very, very exciting new area.

Trish: Well, we should get onto our questions, otherwise you’ll miss out on your dinner tonight. So do you want me to read them to you?

Dr Kalus: Yes, go ahead, please.

Trish: Yeah, alright.

So one of the ladies asks:

“Who’s suitable for breast fat transfer, and exactly how much fat does the patient need to have to be able to use it for their fat transfer?”

Dr Kalus: Okay. So, primarily, a woman who’s interested in her health and wellbeing. And we see lots of ladies now who are very athletic and they’re very careful of what they eat, and they just would not have an implant put into their body. And they come along and say, “Well, is fat transfer an option for me? What’s the volume? What can I expect? Am I wasting my money, having a fat transfer?” So, you know, I’ve had to become a bit of a fat hunter. I’ve had to find fat where no one thought fat existed before. And usually, even in thin women, I can get enough for about a one-cup size increase. Usually. When we talk about volume, what is a cup size? If a woman wears a 10 bra, each cup size is a 125 mils. So an A-cup is 125 mils, a B-cup is 250, a C-cup is 375 mils. So if a woman comes along and she has an A-cup, she’s 125 mils of her own volume, all I need to do is produce another 125 mils, and that’ll give her a B-cup, a fully natural B-cup. And that’s what we usually try to do.

Trish: Okay. So is there … This is not me, but it’s just put up a question for me.

So is there a limit to how much you can do in one session?

Like, if I had three layers of fat to remove … I don’t even know if that … Is that legal to remove that much fat in Australia? If I had three layers of fat removed?

Dr Kalus: Yeah, so the first thing you need to know, Trish, is that, once we remove the fat, not all of it is suitable for fat transfer. And again, some surgeons do put all the fat in. And obviously then half, if not all, of the fat will die, there’ll be so many blood cells, there’ll be such an inflammatory response. And I think that’s one of the reasons that some surgeons say the fat doesn’t last. We find that … Let’s say I took one litre of fat from the person, which is quite normal, to take a litre of excess fat from the hips and thighs and tummy, a lot of women will easily get a litre … By the time we’ve put it through our purification processes, we end up with half of that, 500 mils, which is 250 per side. So I guess the commonest procedure, we’re putting in about 200 or 250 per side, quite easily, and that gives us a very nice sort of a 1-1/2-cup size increase.

But of course there’s some people who are very thin, and we have to make the best of what we’ve got. On the other hand, occasionally, my dream girl comes along with lots of fat …

Trish: That would be me.

Dr Kalus: No, not at all.

But then I guess … The most we’ve put in is 350 cc or mils per side. That’s the most. What can tend to happen, as you put in the fat, the breast becomes very, very tense. And we can’t have it so tense that the blood supply is shut off, otherwise the fat won’t survive. So we have to judge a little bit, move the fat around the breast, makes sure it’s all comfortable sitting there, so that … after all, because the fat has to grow, has to survive in the breast. So it’s true that women with lots of fat, they can produce a bit more, we might get 300 or 350, but usually about 250 mils is about the limit that we put in.

Trish: Okay. Alright.

“Is breast fat transfer permanent, and are the results long-lasting?”

Dr Kalus: So, when you talk about “permanent,” this has to be seen against the background that a woman’s breasts change all her life. The breasts are made up of two types of tissue: There’s the breast gland, which obviously will change in size due to hormonal factors, with the menstrual cycle, with pregnancy, and so on. In fact, they’ll change in size if a woman stops taking the pill; her breasts may get a bit smaller, for example. So there’s the glandular side of the breast, and there’s also the fat tissue in the breast. And what we are augmenting is the fatty tissue. And of course the fat will vary in size according to her weight. If a woman puts on some weight, the fat cells will all grow, and if the woman loses weight, the fat cells will become a bit smaller.

So what we like to do with fat transfer is to transfer stubborn fat … you know, fat from the hips or thighs a woman just can’t get rid of … and we like to do it when she’s at or near her normal weight. And once that stubborn fat goes into her breasts, it’s unlikely to go anywhere. So it’s likely to stay. Indeed, if she puts on a bit of weight, that’s probably going to be the first bit of fat that actually increases in size. So that’s what we find. We like to have the patient at or near their ideal weight, and then to put on a kilo after the operation, because you want the fat cells to feel loved and to grow in their location.

But certainly, all our studies now … out at six months, twelve months, three years, even five years now after the surgery … and we’re finding that the breasts are staying their size, and even growing. In fact, we have two patients now who asked me to put in as much fat as I could find, and they went away and put on some weight, and now they’ve come back and say, “You know, my breasts are now too large. I’d like you to do some liposuction to remove some of the fat.”

So, really, we don’t know the limits. It’s biological. The fat is now in your breasts, and it depends on your lifestyle as to what happens to the fat afterwards.

Trish: Yeah, right. That makes a lot of sense, because I know a few ladies who’ve had a breast reduction, and then their breasts have grown back.

Dr Kalus: Absolutely.

Trish: And I’m pretty sure in each one of those women, they’ve put on a little bit of weight, and whether it was that time of their life or whether… yeah, they’ve put on weight and their boobs have got bigger again.

Dr Kalus: Absolutely. But, you know, it’s all natural. They’ve got their own natural fat in their breasts, they’ve got a larger version of their own breasts, with more fat, and then how they look after their bodies is up to them. But compare this with breast implants where, in some series, there’s a 25% re-operation rate even in the first two years. And every surgeon now says you should expect to have implants changed every eight or ten years. And you can expect to have two or three put in in your lifetime, so really … And with fat transfer, you know, if a person feels that they’d like a little bit more fat put in their breasts later on, they can do that. We’ve got about now, I think, five patients where we’ve done a secondary procedure, and the fat, it’s like it takes even better the second time around.

Trish: So I’ve just had … I know we asked this question, but this is a funny question, because in an ideal world this would just be perfect.

Can my stubborn fat be harvested and donated to someone else?

Dr Kalus: Only your twin sister, if you have one.

Trish: Oh, really? Is that true?

Dr Kalus: That would be true. So twins, of course, so long as you’re identical, are genetically identical, so you could transfer it to a twin. But you can’t transfer it to anyone else, because it’ll be rejected, just like another organ. Now, of course, theoretically, we could do it, like we do kidney transplants, but it would mean that you would be on immunosuppression and there’d be so many other medical problems that we really wouldn’t do it.

Trish: I spoke about this the other day with someone, and I thought, “Well, who knows what can happen in five or ten years along? We just don’t know, hey?”

Dr Kalus: Absolutely. If we could turn off the immune receptor cells, we could do that, absolutely.

Trish: Let me ask you the next question.

“How big can a patient go with breast fat transfer? “How many cup sizes can you increase?” And “can you have a second op to increase a size if you’re not happy with the first, and does this cost as much as the first procedure?”

Dr Kalus: Yeah, okay. So these are questions people often ask. It looks certain you can have a second operation. And we have had a few people have had a second procedure, and it works extremely well. We call it a “popup operation,” and it costs about 2/3 of the original operation, because we’re not going for as much fat as we can get. We’re usually going just for enough just to do the cleavage or just to add another half a cup size or something like that.

I guess the most cup sizes I’ve gone up have been maybe three, but I wouldn’t want to say…

To hear lots of other questions that Dr Kalus has answered for us, check out Part 2!!


Trish is a plastic surgery blogger. She is passionate about wellbeing, health and beauty, and doesn't mind a little bit of 'help' from the amazing cosmetic and beauty procedures that are available today. Trish spends her days talking to women and men who are looking for suggestions and advice on procedures that are available to them. Cutting through the sales pitch and hype, a down-to-earth response on general information is what you will get.

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