In clinical practice of fat grafting to the breasts, multiple factors derived from surgeons and patients seriously affect clinical outcomes, survival of injected fat tissue and complications derived from fat necrosis. The technical factors include techniques of liposuction, storage, preparation, and injection of graft fat as well as devices used in the process, while patient factors include skin envelop redundancy and availability of fat tissue in donor site. Asians have higher incidence of post-operative persisting erythema and hypertrophic scars/keloids and Asian females are generally thin (low BMI) with less available donor tissue; thus we need some particular considerations in treating Asian females.

Implant has drawbacks if we put it permanently, but it is very useful for expanding the breast skin envelop and can be replaced with fat grafting in the following session. Hybrid use of breast implant and fat grafting is getting more popular for both cosmetic augmentation and reconstruction after mastectomy. As a standard strategy, I would propose “Implant-first and replacement with hybrid or fat” for both breast augmentation and reconstruction. Implant is placed sub-glandular for cosmetic sugmentation and sub-muscular for reconstruction.

Fat grafting seems to be an easy and efficient method for stem cell enrichment of the target tissue and can be therapeutically applied to stem cell-deficient tissues such as irradiated tissue, chronic ulcers, ischemic diseases, and hypertrophic scar contracture. This can be an unusual tool to improve not only the volume but the quality of the tissue, which means tissue revitalization by providing stem cells and vascularity to the target infertile tissue. As stem cells can detect and modulate inflammation, fat grafting is effective also for reducing immunoreaction associated with breast implant.

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