Two for One-- Liposuction and Fat Transfer to the Breasts for Augmentation? An Interview with Dr. Jennifer Walden

Does it sound to good to be true to increase your breast size and slim down your tummy or thighs at the same time? On Wednesday morning, Gretchen Carlson and Steve Doocey on cable TV’s top rated morning news show, Fox and Friends, interviewed me on the newest procedure in breast enhancement by fat transfer from other areas of the body. Possible interference with mammography and breast cancer are discussed as well as the technique used for this method used to enhance the female breast. I am Dr. Jennifer Walden, and serve as the program director of the Dept of Plastic Surgery at Manhattan, Eye, Ear and Throat Hospital, and performs breast augmentation, lift, and reduction surgery in New York.

For years, saline and silicone implants have served as the most effective method for breast augmentation, and many studies and FDA approval declare both saline and silicone implants to be safe. Breast augmentation has been the most commonly performed cosmetic surgical procedure in recent years.

The relatively uncommon fat transfer breast augmentation procedure has women everywhere buzzing about the ‘benefits” of this seemingly more natural breast enhancement option. Present clinical evidence does not conclude that fat grafting is safer or better than saline or silicone implants, but the idea of taking one’s own fat and repositioning it to augment the breasts is rapidly capturing the attention of medicine, consumers, and the media.

Breast enhancement using fat grafts (lipoaugmentation) rather than silicone or saline implants employs fat suctioned from the patient’s buttocks, thighs or other fatty areas. This type of breast surgery can be used to increase the size of the breast or to fill in defects or abnormalities in existing breasts, including enhancing the appearance after breast reconstruction and softening the look of existing implants. Fat injections of the breasts may offer patients augmentation with a natural look and feel and the benefit of body contouring through liposuction—without the requirement for incisions or implants.

However, long-term safety and efficacy data as well as the effect of the procedure on breast cancer screening using mammography is still being evaluated in clinical studies. Concerns about fat grafting for breast enhancement include unpredictable or low survival rates of the transferred cells (which are frequently absorbed by the body), development of cysts, calcification and tissue scarring. Another major concern is long-term problems with breast cancer detection due to difficulties in telling the difference on mammograms between calcifications associated with breast cancer and calcifications associated with fat transfer.

This procedure does offer a modest opportunity for enhancement— specifically, about one cup size increase and the degree of enlargement will depend on the amount of spare fat that the patient has. But, numerous questions remain about this new technique: How much of the fat survives? Does the procedure have to be repeated? Are the breasts hard and uncomfortable for long periods after the procedure? And most importantly, what are the cancer implications of this technique? Research projects, funded by the Aesthetic Surgery Education and Research Foundation (ASERF) of the American Society for Aesthetic Plastic Surgery are being conducted to determine the safety and efficacy of breast enhancement with fat.

In the meantime, plastic surgeons will continue to study the intricate details of the procedure for the safety of our patients– namely, the techniques of harvesting, preparation, and placement of the fat tissue, who should receive fat transfer, when it is appropriate, and whether it is safe for the long term. Results of clinical studies this far seem promising—so maybe going up a cup size with the benefit of a little liposuction elsewhere will be common practice at some point. Anyone reading this should be aware that this procedure is very technique dependent and to avoid complications it must to be done correctly by a properly trained, board-certified plastic surgeon. Methods for tissue harvest and tissue injection have been refined, as fat cells are carefully removed by a specialized liposuction procedure using numerous syringes and transferred to the breast via dozens of minutely small injections. This technique results in increased survival of the fat cells.

Autologous fat grafting is currently used for touching up reconstructed breasts which it is safe and effective for given that the breast tissue has already been removed and these patients are getting routine surveillance imaging. The procedure can also soften the appearance of existing implants and hide visible rippling which is particularly apparent in very thin women with a bony chest wall and little skin or fat with which to work. The amount of fat injected with these procedures is usually a lot less than that used in breast augmentation as well. So, the take home message here is the more long-term clinical trials involving multiple centers as well as radiologist and oncologists need to be done before a blanket endorsement of the procedure can be made. It also serves to mention that this would not be the method of choice for breast augmentation in women who have had or have a family history of breast cancer.

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Two for One-- Liposuction and Fat Transfer to the Breasts for Augmentation? An Interview with Dr. Jennifer Walden

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The Past, Present & Future of Breast Implants

Dr Jennifer Walden discusses the future of breast implants, fat injections and soft tissue fillers in the breasts. Skin firming creams like Rodial and Mamma Mio Boob tube are also covered as well as external breast enhancing devices like Brava.


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This is taken from article that I wrote for Makemeheal.com that talks about the history of silicone and saline breast implants as well as the future of breast augmentation, including anatomic shaped highly cohesive gel implants that are yet to be approved by the FDA. As I mention, these implants are widely available in Europe and have high rates of patient satisfaction. These teardrop shaped (often called "gummy bear") implants are textured and contain a highly crosslinked form of silicone to minimize the possibility of migration as well as upper pole collapse and folds in the implant shell.  There are a matrix of different implants to choose from with varying width, height, and projection for the best patient fit, and are called Contour Profile Gel implants if by Mentor or Style 410 implants if made by Allergan Corporation.  One of the only potential drawbacks is that they are a bit firmer, and don't lateralize like normal breast tissue does when you lie down. (see the above  photos of Sarah with a style 410 implant on her chest on the left and a smooth round responsive gel implant on her chest on the right on the couch in our office). For more info click on the "read more" link above, and thanks for stopping by!

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Night of Beauty a Success!!

The Night of Beauty at the W New York Hotel was a success (see release on ReutersNewswire)! With a turnout of over a hundred people interested in health and beauty, we had such a blast. Metamorphosis Spa provided services like back and shoulder massages as well as gift cards for facials, Beach Bum tanning provided mini- facial spray tans and dental whitening, and MAC Cosmetics provided complimentary makeovers. It Cosmetics provided lip gloss and a "My Beautiful Breasts" body makeup kit as well.




Food, wine and champagne topped off the reception while ladies lined up for the services. Dr911, a concierge medical service that Dr. Walden partners with was there, as well as Allergan Medical Aesthetics to provide the latest information on breast implants, Botox, and soft tissue fillers like Juvederm.


The second hour of the event was devoted to an educational talk by Dr. Walden and Nurse Sarah going over rumors and trumors about breast surgery, silicone and saline implants, breast cancer and preventative measures such as mammography given that October is breast health awareness month. The night was concluded by live injections: a longtime patient of Dr. Walden received Botox in order to help educate the crowd on this safe cosmetic treatment.

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Night of Beauty a Success!!

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The Real Story of the Ugly Duckling, Playboy style

The Girls Next Door, also known as The Girls of the Playboy Mansion, is an American reality television series broadcast on the E! cable television network. The series was created by executive producer Kevin Burns and Hugh Hefner, founder and editor-in-chief of Playboy magazine. The show has been going strong for 6 seasons and has brought the life of this legend and his three blonde girlfriends into millions of viewers living rooms.
According to wikipedia.com, "Madison moved to Los Angeles in 1999 to attend Loyola Marymount University, where to make money she competed to become a Hawaiian Tropic model and worked at Hooters. This led to invitations to the Playboy Mansion, at a time when Hefner had seven other girlfriends. Madison moved into the mansion and became one of Hefner's official girlfriends in August 2001, after more than a year of visiting the mansion. In February 2002, after all but two of his girlfriends left, Madison became Hef's "#1 Girl" and moved into his bedroom at the mansion."
Any die hard fan can tell you, that Holly hasn't always looked like the Holly we now see on our television screens every Sunday night. On the inside she may still be the same, but she has definitely had some help to improve her exterior.



According to goodplasticsurgery.com they seem to believe Holly has undergone multiple surgeries including, facial fillers (to make her cheeks and under eye area fuller and younger), lip augmentation, rhinoplasty and also a brow lift. They seem to have forgotten the most noticeable one, breast augmentation!

Whatever she has actually had done she looks beautiful and not overdone (in a bleached blonde-Playboy bunny kind of way- hey, everything is relative!). If she's thinking any more work in the near future, I'd advise her to stay away from having anything else done for a while. Its amazing what her "before" pictures look like, compared to the ones now; Amazing but subtle transformation. She's got a very good plastic surgeon.
Have a good weekend everyone!

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The Real Story of the Ugly Duckling, Playboy style

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Brooke Hogan's latest addition

Looks as though Brooke Hogan, reality star and daughter of famous wrestling champion Hulk Hogan is enjoying her new assets as she has been seen prancing around her home town of Miami, Florida in tiny bikinis and practically busting out of barely-there outfits.
From pictures seen on makemeheal.com it seems as this budding beauty has added on. "Perhaps her “girls” were feeling neglectful, singing along with her chart topping single, “What about us?” Brooke looks like she went up to either a full C or D cup with these implants, a little big but I guess it offsets her 6 foot tall stature

According to some sources like makemeheal.com, recent photos of Brooke have shown a scar in her armpit, suggesting that she had her implants inserted through the armpit. With this technique, a small one-inch incision is made in a discrete fold inside the armpit. Typically, the implant is placed partially under the pectoralis major muscle of the chest, which helps the implant look and feel more natural. The only question that remains is whether Brooke has gone for the now approved silicone implants or for saline implants. It's hard to tell from the photos whether she has saline or silicone implants, but since their FDA approval we have seen a spike in women wanting silicones because they look and feel more natural.

I’m happy for her, she seems to have gone to a surgeon who knew what he/she was doing, rather then hearing another sob story of a celebrity plastic surgery case gone wrong. Way to go Brooke!

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Brooke Hogan's latest addition

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Christina Applegate bravely undergoes bilateral mastectomies for breast cancer and BRCA + gene

Christina Applegate's choice to bravely undergo a double mastectomy puts her in the company of a growing number of women taking aggressive steps to avoid dying of breast cancer. A recent article in USA Today states that studies show more patients are choosing mastectomies, even though women are just as likely to survive if they have smaller, breast-conserving surgeries.
Some of this growing trend has been spurred by technology: MRI scans that can detect smaller, earlier cancers; sophisticated genetic tests that can warn women of their inherited risks like the one Applegate was positive for. Newer techniques in plastic surgery for that makes more aggressive surgery more appealing (we are now able to do free flap reconstruction with the patients' own tissues to rebuild the breast, or use newer generation silicone gel implants after tissue expansion for reconstruction). There is no doubt that some women are opting for mastectomy because their fear of cancer and mortality looms larger than the immediate appearance of their breasts postoperatively. Federal legislation mandates insurance coverage of breast reconstruction after cancer so this is good for patients too.

Applegate, 36, was at high risk for breast cancer, both because her mother had the disease and because she carries a rare genetic mutation in a gene called BRCA-1, which increases the risk of developing aggressive disease at a young age--women with this gene have up to an 84% risk of breast cancer. Applegate told Good Morning America Tuesday that she had early-stage cancer in only one breast and underwent two lumpectomies, and she that opted for a double mastectomy after learning of the genetic mutation. Only about 5% to 7% of breast cancers carry these mutations.

Some women with the mutations opt to have preventive mastectomies even if they haven't been diagnosed with cancer given their high liklihood of developing breast cancer in one or both breasts in the future. A recent study in the International Journal of Cancer, for example, found 18% of women with the mutations took this approach. Applause for Christina Applegate for bringing public awareness to a disease that is diagnosed in 1 in 8 women. I wish her all the best in her recovery.

Every woman should remember to do monthly self-breast exams, mammogram starting at 40 or even earlier or with an MRI with a positive family history, and to consult with their doctor with any abnormal findings.

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Christina Applegate bravely undergoes bilateral mastectomies for breast cancer and BRCA + gene

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Has Paris Hilton had a breast augmentation or is this a new bra line?

More photos of Paris Hilton's increased bust got people talking at the opening of club Apple last week. (Source: X17 Online) But despite seemingly going from an A-Cup to a C-Cup, a Paris insider assures them that it's not the work of a good plastic surgeon, just an extremely effective push-up bra. A quote in the article says,
"Paris has never had plastic surgery and has been wearing a prototype from her bra line she has been developing. At Apple she looked amazing and everyone was asking where they could get that Bra."
I agree, she probably has a great padded push-up bra (or perhaps a small submuscular breast enhancement that gives her a little "extra" in the right bikinis and low-cut shirts). In any case, its a great idea to market it as a new type of push-up bra! Paris is always reinventing herself in such an entrepreneurial fashion.

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Has Paris Hilton had a breast augmentation or is this a new bra line?

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A Beauty Obsessed Culture Affecting Young Women?

A new report on Reuter's today says that America's obsession with beauty is posing serious problems for the health and economic well-being of women and young girls.

The report is based upon a study done by the nonprofit YWCA in the United States which said that women and girls are spending more and more money in their quest to look like idealized, air-brushed magazine models. The report, Beauty at any Cost, noted U.S. women spent some $7 billion a year, or an average of about $100 each, on cosmetics and beauty products. They mention that $100 a month, if saved and invested for five years, would pay for a full year of tuition and fees at a public college, the report calculated.


The report also cited that nearly 11.7 million cosmetic surgical and nonsurgical procedures were performed in the United States in 2007 -- a 446 percent increase in 10 years, according to the American Society for Aesthetic Plastic Surgery. Botox injections as well as liposuction and breast augmentation are the most popular nonsurgical and surgical procedures.

It mentioned that weight loss and smoking are big issues among young women (as they have always been). I think that young women should try to put everything in perspective, and not spend all of their money on beauty treatments, and not start at such an early age. Once you start it can become a slippery slope, with the cost of upkeep as you go along...just think about highlighting your hair. But, I also think a lot of women get plastic surgery to address a certain issue about their anatomy like breast asymmetry or flatness, or a bump on a crooked nose, that has always been an area of concern to them. They are not all junkies or addicts, and sometimes the public has a skewed vision of what's going on because of reality shows like Extreme Makeover and Hollywood. I am glad the YWCA is shedding light on the issue.

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Has Ali Lohan had a Breast Augmentation?

Rumor has it that 14- year old Ali Lohan had a breast augmentation. That would be really weird, seeing as breast enhancement for cosmetic purposes is not recommended or approved by the FDA of the United States as well as plastic surgery specialty societies like ASPS (American Society of Plastic Surgery) and ASAPS (American Society for Aesthetic Plastic Surgery) for girls under the age of 18. Hmmm, could it just be a regular growth spurt? Probably. She has such a cute figure, and I can't imagine a surgeon implanting a 14- year old girl, especially one of such notoriety and fame since he or she would automatically be scrutinized for that choice. (She looks like she has on a good padded push-up bra too in the picture on the right).

Of note, reputable plastic surgeons and the FDA do approve of using breast implants for the reconstruction of abnormal breasts in women of any age, including those under 18. Certain developmental deformities such as tuberous breast syndrome and severe congenital breast asymmetry give a good reason for breast implants in women of younger ages given the embarrassment and difficulty finding clothes that fit growing up. Photo credit of Us Weekly Magazine.

Good luck defending yourself among the paparazzi, Ali!

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Has Ali Lohan had a Breast Augmentation?

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Without Breasts There Is No Paradise

My assistant, Janie, brought to my attention a soap opera in Latin America that has become wildly popular. The soap opera "Sin Senos no Hay Paraiso" is on NBC's Telemundo and is based on a book inspired by a true story about a group of young women that have decided to do whatever it takes to escape their humble town where poverty reigns. The story takes place in two locations: Colombia and Mexico. and The story is mostly revolved around Catalina, a beautiful young high school girl obsessed about getting breast augmentation in order to become a high class prostitute in order to get her family (her mother and her brother) out of poverty. Her schoolmates and best friend Yesica have breast implants and tell Catalina that the only way to really make money is to get the operation and get the biggest breasts possible. They remind her daily that men only care about breasts in the business. Along with her school mates and the help of Yesica she is able to "book" jobs in order to try to raise money for her operation. She believes breast implants is a short cut to easy money hence happiness.

However since she is inexperienced and naive she has relations with other men, all with fruitless jobs and bad intentions. She now encounters Lorena from Mexico and she promises Catalina and other pre-op girls modeling contracts in Mexico with the condition that they be operated by her surgeon. Little do they know that she is working for a narcotrafficker, Martinez, and the shady surgeon plan to fill the implants with bags of heroin in order to sneak the drugs out of Colombia to Mexico. (Crazy!?) So Catalina is then tricked into going through the augmentation and she has no idea that she is carrying a significant amount of drugs in her chest. Although she thought that once she had breasts she would be happier and life would be better, she is realizing that she is now being humiliated and mistreated and further away from happiness which ironically she thought breasts would bring her.

Amazing how in our culture and in other cultures breasts are praised and "sought after" for various reasons. The storyline is a little out there, but its interesting to see what becomes a hit in different places all over the world. Hey, we've got All my Children and Days of Our Lives.

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Without Breasts There Is No Paradise

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