Today, fat grafting is extremely popular. However, amidst this popularity, we must seriously address one critical point: compared to other injectable fillers, how many times greater are the risks of fat injection relative to hyaluronic acid? According to relevant statistics, the risks of fat injection are 10-50 times higher than those of hyaluronic acid. This means the risks of hyaluronic acid injection are significantly lower than those of fat injection. Therefore, fat often warrants more research and exploration than we might imagine.At the "2015 Southern Micro-Aesthetic Forum & National Young Physicians' Injection Aesthetics Workshop," Professor Lu Feng from the Plastic and Aesthetic Surgery Department of Nanfang Hospital, Southern Medical University, delivered a dedicated presentation on fat, further analyzing new concepts and philosophies in fat grafting.
>>>On-Site Coverage: 2015 Southern Plastic Surgery Academic Forum
Professor Lu Feng, Department of Plastic and Aesthetic Surgery, Nanfang Hospital, Southern Medical University
Structural Fat Grafting Transplants More Than Just Fat Cells
For beauty enthusiasts, the term "fat grafting" holds immense appeal—the ability to transfer unwanted fat to desired areas achieves both beauty enhancement and body contouring.However, Professor Lu Feng from the Plastic and Aesthetic Surgery Department at Nanfang Hospital, Southern Medical University, cautions that achieving this is far more complex than commonly imagined.First, we must understand the nature of fat.
What does fat look like? Professor Lu Feng vividly describes it: "Fat tissue resembles a 'string of grapes.' Anatomically, fat closely resembles grapes. Moreover, fat tissue doesn't exist in isolation—it resides within 'little houses' surrounded by a rich network of capillaries and numerous sympathetic nerve endings.Fat tissue cannot survive when transplanted from one location to another without its protective structure. This is a crucial concept. Therefore, during fat grafting, the entire 'house' containing the fat tissue—including surrounding stem cell components—must be relocated, rather than simply isolating fat cells for transfer. This is known as structural fat grafting." Professor Lu Feng emphasizes that structural fat grafting involves transplanting the entire unit, not just fat cells, to achieve satisfactory results.
Regarding the concept of fat cell renewal: "We previously believed fat cells did not regenerate. Now we can definitively state that fat cells are constantly renewing, albeit at a relatively slow rate." Professor Lu Feng concluded that fat cell numbers are not static but continuously renewing. This also explains why fat rebound occurs after liposuction—it stimulates the proliferation of fat cells.
The Evolution of Autologous Fat Transfer: From Rejection to Mainstream
During the workshop, Professor Lu Feng also traced the historical development of autologous fat transfer. From the 1904 discovery of fat's transplant potential to the advent of micrograft fat transfer in 1987, fat grafting remained largely "unaccepted" within mainstream medical circles due to its unpredictable outcomes.Consequently, in 1987, the American Society of Plastic Surgeons prohibited the use of fat grafting in large-scale clinical applications. From the late 1990s to the early 2000s, improvements in grafting techniques—notably Coleman's structural fat transfer—dramatically advanced fat grafting for breast augmentation. Even the French Society of Plastic and Reconstructive Surgery, which had strictly banned fat grafting for breast augmentation since 2007, reversed its stance in 2011.Subsequently, rapid advancements in liposuction techniques and continuous exploration by numerous clinicians worldwide reignited the popularity of autologous fat grafting. Recent years have witnessed particularly rapid development, establishing it as one of the most sought-after cosmetic procedures globally. It is now widely applied in facial contouring, volume restoration, and breast augmentation.
"In my personal view, the most serious issue with fat grafting isn't the high absorption rate, but the unpredictability of outcomes and the poor controllability. Another critical concern is the potential impact of breast fat grafting on breast cancer, which demands serious consideration."
Understanding the Three Core Issues of Autologous Fat Transfer Breast Augmentation
Regarding fat transfer breast augmentation and breast cancer, Professor Lu Feng outlined three core questions: 1) How to reduce fat absorption post-transfer? 2) Does fat transfer interfere with early-stage breast cancer imaging diagnostics? 3) Does it promote breast cancer development or post-surgical recurrence? Specifically, is there a direct link between breast cancer and autologous fat transfer?Professor Lu Feng stated that while no direct link between autologous fat transfer breast augmentation and breast cancer has been proven to date, patients who have undergone mastectomy due to breast cancer, or those with a personal or family history of breast cancer and carriers of breast cancer susceptibility genes, should carefully consider whether to undergo autologous fat transfer breast augmentation.Regarding whether fat grafting affects early-stage breast cancer imaging, the consensus in both Europe and the United States is that this is no longer an issue. Radiologists are now highly skilled at distinguishing calcifications caused by autologous fat grafting from those caused by breast cancer.However, the American Society of Plastic Surgeons requires all patients undergoing fat grafting to retain a mammogram before the procedure and another 3 to 6 months afterward, primarily to rule out potential future imaging interference."
Additionally, regarding autologous fat transfer breast augmentation, Professor Lu Feng advises that patients should clearly understand: if the primary goal is volume enhancement, implant-based augmentation is more suitable. However, if the focus is on achieving a natural feel and shape with minimal volume increase, autologous fat transfer is an excellent choice—particularly for correcting breast deformities following benign tumor resection."Breast augmentation via fat grafting should not prioritize volume expansion; its primary indications involve contour refinement and improvement—such as mild post-lactation glandular atrophy and ptosis, bilateral breast asymmetry, or localized depressions following benign tumor excision."