Trish: I’m here today with Dr. Allan Kalus, and Dr. Kalus is a specialist plastic and reconstructive surgeon who works from Melbourne and he’s one of the pioneers and probably one of the Australian experts in autologous fat transfer, and today we’re going to be talking about the autologous fat transfer to the breast or what is sometimes known as fat transfer to the breast, organic breast implants or whatever you want to call it. There are so many different names that we came it, but today we’re going to talk to Dr. Kalus. Thank you so much for taking the time to talk to us today Dr. Kalus.
Dr. Kalus: It’s a great pleasure Trish. It’s great to speak with you about something that is just so new in Australia and so exciting. We’ve been using fat in the face for maybe 20 years, and it’s now gaining popularity and we know that we can use your own fat in the lips and nasolabial grooves and cheeks to produce augmentation, but the volumes in the face have always been very small, about 10 or 20 mL. The idea that we could transfer 100 or 200 or 300 mL of a patient’s own fat into the breasts in order to increase breast size has been really a dream until about 3 years ago. At that time, a few surgeons around the world got together and thought about the problems that were involved and developed some new ideas and new equipment and we’ve been very privileged to be part of this process here in Melbourne, Australia. It’s interesting. How often do you hear the expression, “I’d love to take a little bit of fat out of my hips and put it in my breasts”?
Trish: All the time. All the time.
Dr. Kalus: If a women says that and it’s just been a dream but now it really is a reality. It’s all about robbing Peter to pay Paul. The procedure simply consists of removing some fat by a process which is similar, not the same as liposuction, but similar to liposuction and taking the fat and then after preparing it in a special way, placing it carefully, grafting it into the breast tissue, and the process is known as autologous fat transfer. Autologous means that the fat has to come from the same person. Only an identical twin would be able to transfer fat between different individuals. Autologous fat transfer best describes the use of fat where we transfer it from one part of the body to the other.
We do an operation very similarly to an ordinary breast augmentation using silicone implants in that it can be done as a day case, but the huge advantage it has over silicone implants is that it’s your own body tissue and you just never have to worry about having implants, and so many of our patients come and say that they would never have breast implants but now that there’s this option of using their own tissue it’s something that’s appealing to them.
Trish: Lovely. I know for a fact that you’ve done a lot of these procedures, Dr. Kalus. Can you tell us roughly how many you’ve done over the last however many years?
Dr. Kalus: We’ve done several hundred of these procedures now, and I must say that we’ve been refining it all the time so that the procedure we use now I think is a lot better than the one we used when we started 3 years ago. Not only that, the indications have changed. For example, we used to only treat patients that had an excess of fat, fullness of the thighs or fullness of the hips, and we knew we could take that and then transfer that to the breasts, but recently I’ve had some girls who are only 50 or 55 kilos and they don’t have really a lot of excess fat, but we’re still able to remove some fat from their back and the front of their thighs where they don’t really noticed it’s been removed, but it’s just enough to give them about a one cup size increase in breast volume. The indications for fat transfer to the breasts are broad now, not only to people who you previously considered overweight but also for those who are normal but just would like some slight increase in their breast volume.
I think it’s interesting when we select patients for fat transfer, I think we’re at the point now we would pretty much guarantee a one cup size increase in breast size. For some people we’re able to provide two and even more cup sizes increase, but that amount of fat is always available. When we consult with a patient now, we usually put a small implant into their bra, just a one cup size implant. Patient’s can do this at home. They can take an old sock stocking and a measuring jug and some rice and put about 150 mL of rice into the stocking and tie a knot at the end and put that into their bra and that’s a minimum amount that almost everyone can achieve with autologous fat transfer. If they want more than that amount, it’s possible that they have sufficient fat available, but in that situation an implant may be more appropriate.
The thing about breast implants is that you can select the volume. What you choose is what you get. If you choose 300 or 350 or 400 mL or whatever, that’s the volume that you get. Whereas in autologous fat transfer it’s how much fat we can take and then after preparation how much is available, and then of course the big question that everyone asks is what percentage of the fat survives. What we’ve found is it depends on so many factors, and very often we have patients who achieve 100% survival of their fat. It’s very exciting. What we need in order to achieve that, there are a number of steps.
First of all, we’ve noticed that when we remove the fat or when we harvest the fat if we use ordinary liposuction, the suction pressure is so great that the fat just is boiling in the collection jar, just broken down. The fat cells are so delicate they’re destroyed by normal liposuction. We actually take the fat using very low pressure liposuction which is the opposite to the way most liposuction procedures are performed where surgeons want to remove as much fat as quickly as possible. We try to remove it very slowly, very carefully. Then the fat has to be prepared in a special way. It’s washed with a special solution, and we find that through the preparation process and the filtration process we discard about half the volume of fat that we remove.
If we actually remove a litre of fat from someone, usually that means we’ll discard half of that, 500 mL, and have 500 mL available for fat transfer. That means about 250 mL per side, and if we do it in this way we pretty much will get 100% fat survival, but then it also depends on how the patient manages the situation in the first 2 or 3 weeks after surgery because doing autologous fat transfer is a little like sowing seeds in your garden. If you don’t fertilize them, they’re not going to grow. We learned early on that the hormone that is best suited for stimulating fat cells to grow is insulin, and the way you stimulate to grow insulin is to have a high carbohydrate diet. Now this is an anathema to most women, most women hate the idea of having a high-carb diet, but just for 2 weeks after surgery, a high-carb diet will raise your insulin and it’s the best way that we can ensure those fat cells grow.
The other thing we’ve found is that the drug melatonin, which is used sometimes for jet lag, it’s a very mild sleeping tablet, in the laboratory it was found that it seems to stabilize the cell membrane. We advise our patients to take melatonin for a week prior and a week after the grafting procedure and this seems to stabilize the cell membranes and that also helps us get these high levels of fat survival. In fact, there have even been some patients, Trish, where they’ve gone away and they’ve stayed on the high carb diet and the fat has just grown and grown in their breasts, and of course, the fat’s been removed from their hips and thighs so they don’t put on weight on their thighs anymore. Any weight they put on all goes to their breasts so we’ve had people with perhaps 200% survival. It really is living tissue, moving living tissue from one part of the body to another.
Trish: That sounds like the ideal world. When you put on weight and it goes onto your breasts. What more could someone ask for?
Dr. Kalus: Better than the hips.
Trish: Yeah. One of the things … I know that was the biggest question actually that the readers were asking me to ask you, was the percentage of fat. Basically, to explain it in normal terms, you’ve been doing this for so long you’ve kind of perfected it to the point where you can actually get up to 100% of the fat because of the processing and combined with what the person straight after surgery in those crucial beginning weeks.
Dr. Kalus: Exactly, with the patient’s compliance and with the way we process the fat, the way we handle it, the instrumentation that we use to take the fat, the way we inject the fat, not as one big blob, it’s almost like spaghetti into the breasts, multiple strands of fat. Then of course we have to avoid any lumpiness in the breasts so we massage the fat all around the breasts, and it’s very important we counsel all of our patients that of course if ever they get a lump in the breast in the future they have to treat it seriously and have a mammogram, but radiologists can tell 100% whether it’s a lump of fat or breast cancer. You can miss a breast cancer by the patient thinking, oh it just must be a little bit of fat that’s formed a lump, but I have to say all the cases we’ve done, we’ve never had a lump left in the breast.
When you think about it, the breast cancer actually comes from the ductal tissue of the breast gland, not from the breast fat, so the breast fat doesn’t really have any influence over breast cancer in the breast. That was one of the reasons in the early years we were concerned about it, we were so concerned with putting so much fat in the breasts we were sure to get a lump and the patient would then have to have a biopsy and so on. The reality is we haven’t had any lumps. If we do get a lump, you just need to get a mammogram and that will be able to reassure you as to what it is.
Trish: Let me ask you another question. One of things that the girls on the closed Facebook support forum talk about is they talk about with the fat transfer that you can’t move the fat from your … If you get the fat from your thighs it’s going to be different in your boobs. Can you give us a bit of insight on that?
Dr. Kalus: Once we put the fat into the breasts, it feels completely like breast fat. The breasts feel completely natural, and that’s another interesting point. You don’t get quite the same look you get with implants. If a woman wants to have a slightly fake look, a slightly fuller upper pole, which is quite popular in certain parts of our community these days, clearly an implant is the only way to achieve this. Fat transfer of the breast really gives you an extremely natural-looking breast with a very natural teardrop shape. One thing we can do with fat as well that makes it preferable to implants, we can preferentially placed the fat in the cleavage area. We might for example put 60% of the fat into the cleavage area and only 40% more out peripherally because of course women don’t want breasts out the side, they want the breast tissue to be more in the cleavage area. We’re able to mold and modify the breasts in this way in a way that’s much better, that’s just impossible to do with a breast implant.
Trish: Say for example, what about for the ladies that have had … Is it going to work for someone who’s had say a mastectomy or it’s really not the right procedure for that.
Dr. Kalus: No, so now we can do it for women who have had mastectomies. They may need perhaps more than one fat transfer, perhaps 2 or maybe 3 fat transfers to the breasts but certainly using their own fat we can build a breast and we can also make a nipple for them, and some of the best results of breast reconstruction have been achieved with autologous fat transfer. Interestingly, it’s not just a breast reconstruction but many women now are having their old breasts implants removed and replaced with their own fat.
Trish: That was my next question. I’ve noticed that of late there’s definitely been, for us for inquiries, there’s definitely been an increase of people looking to get their implants removed and they don’t necessarily want them replaced with implants so they’re looking down either not having them replaced at all and having a lift or looking down the fat transfer option, and up to now we’ve kind of thought that it really hasn’t been an option for them because there’s a lot of space there when the implant’s removed. You’re saying that, I mean providing they’re not huge big implants, but if you’ve got implants and you have them removed, you can actually give them another nice return with the fat transfer.
Dr. Kalus: Absolutely. You may not be able to achieve quite the volume that you’re removing. If someone has for example 400 cc implants, you may not be able to get quite that amount of fat depending on their figure of course, but many women are happy to go down a cup size. Many women say look I’ve been a double D now for so long and it’s a bit awkward, I’m happy to go down to being a full C cup for example. What we do, we remove the implant and you can’t put the fat into the same space as the implant because they’d be no blood supply there. You have to put the fat into the actual breast tissue, so it’s a little trickier than doing it in a patient who has an implant.
You have to put the fat into the breast tissue where there’s a good blood supply. Especially if an implant for example has been behind the muscle, well then there’s no trouble putting the fat in all the tissue above the muscle. If the tissue has been on top of the muscle, the breast tissue often has been compressed so we have to ensure that we work within that narrow plane of breast tissue. Certainly we do that procedure and patients are very, very grateful afterwards and they feel that the breast is soft and natural and of course so many women with breast implants, the implants do look a bit unnatural. It may feel a bit hard. Sometimes that causes the breast to sag a bit so sometimes we do do a lift procedure together with the fat grafting. There are many combinations.
Some women have tummy tucks and instead of throwing the fat away from the tummy tuck, they decide to have it put in their breasts. I mean, why throw it away. If you’re removing it anyway, you might as well use it in your breasts. There’s just so many ways of doing it. I do hear people come to me and they say that I heard that the fat doesn’t survive or doesn’t last, and I understand if you don’t follow a very strict protocol the fat simply won’t. If you do it with full power liposuction for a start, the fat’s all dead before you’ve even injected it so it will be useless. There are numerous procedures that have to be done, but I’m very confident now that the fat cells survive and as you put on weight they’ll grow and the volume is really dependent on how much you want to grow your own breasts.
Trish: That is so interesting. It’s quite mind blowing really because we hear all these things out there, but it’s really good to hear you actually clarify all those queries that we have. I do want to ask you another thing. You mentioned before that it’s a one day procedure, so basically you can … There’s no overnight stay in the hospital to have this done. Is that right or that depends?
Dr. Kalus: Actually we do the procedure in the morning and it’s not a very invasive procedure. It’s probably in many ways less invasive than breast augmentation. There’s no cutting. Little tiny incisions for the liposuction cannulas and for the injections, but really the complications are very few and far between. There’s a little bit of bruising both in the breasts and in the areas where the fat’s been harvested. We’ve never had an infection. We’ve never had a breast lump, and I’ll say the only complication, if you could call it that, would be the woman saying, ah, you know I wouldn’t mind another 100 ml. We say, we put in as much as we could find. You’re welcome to come back and have another procedure. Most people are very, very happy with the volume they had and certainly they can go home the same day. We usually in our practice just check them the next day after the surgery. Many of our patients come from interstate and they fly back home the next day and we might see them 3 weeks later.
I always ask the patient how long their swelling has lasted because it’s always a bit swollen immediately afterwards and we know it does go down, and most people said it’s about 2-1/2 weeks. In other words, the result in 2-1/2 weeks is the final result, it’s stable after that time. The swelling does go down the first couple of weeks but by 2-1/2 weeks that’s your final result, but of course if you continue with a high-carb diet the breast fat will grow and grow even more than that.
Trish: We’re just talking about the recovery now. You mentioned there is swelling. When you finish your procedure, do you have to wear anything? What’s the aftercare as far as the … You wouldn’t have a compression bra would you?
Dr. Kalus: No, just an ordinary supportive bra is probably most comfortable and as far as the hips and thighs a panty girdle of some description is a good idea just for a bit of pressure just to reduce the swelling in those areas and that’s all. Most women are driving again and doing most normal duties by 2 or 3 days afterwards, perhaps don’t do any intense exercise for a month or so, but certainly most things they can do after a couple days.
Trish: That sounds amazing. You’ve answered so many questions that people have said, oh yeah, but this and that, so you’ve actually clarified a little bit for us but of course it’s the same old thing. You’ve done over 200 of these procedures; you’ve got lots of happy patients. It’s a one day procedure. It’s only going to be as good as what the aftercare and what the patient does themselves afterwards as well to help to sort of keep that fat level for the first 2 weeks or so in the body and the taking of the melatonin as well. It’s a day procedure.
Dr. Kalus: You’ve summarised it very well. It’s such a wonderful natural procedure. Everyone is talking about natural products these days and living a natural life, well how much better to use your own fat than using some form of foreign implant.
Trish: That makes a lot of sense. That sounds really amazing. Like you said, if there’s girls that like the implant look then it’s not going to work for them, but for someone who wants that more natural look, just go up a cup size, don’t want to have the big boobs or anything, just want to go up a cup size, little bit more shape, this could be perfect for them.
Dr. Kalus: That’s exactly right, Trish.
Trish: Awesome. Thank you Dr. Kalus. If anybody would like to see Dr. Kalus, he’s available at Avenue Plastic Surgery which is located in Melbourne and Dr. Kalus has lots of fly-in fly-out patients for this procedure because he’s done so many of them over the years. Thank you for taking the time Dr. Kalus.
Dr. Kalus: Thanks Trish. It’s been a great pleasure.
Trish: If you’re looking for Dr. Kalus and you can’t find him, just drop us an email at firstname.lastname@example.org, and we’ll put you through. Thank you so much.
Dr. Kalus: Thanks Trish.