Commentary on: Safety and Effectiveness of Single Session Mega Volume Fat Grafting for Breast Augmentation: A Space-Creating Concept and Clinical Experiences

In 1987, thirty-five years ago, after several serious complications and an in-depth investigation, a committee of the American Society of Plastic Surgeons determined that fat grafting to the breast was neither safe nor effective.1 The procedure was banned because fat grafts, as performed then, left necrotic masses in the breast that were highly suspicious for cancerous nodules. It was not until some 20 years later, when Dr Sydney Coleman showed that only micro-grafts survive whereas larger blobs die, that fat grafting to the breast witnessed a resurgence of interest.2,3 That seminal finding, which made it acceptable to fat graft the breast, is now challenged by this report from Dean Hsiao et al.4 Dr Kotaro Yoshimura’s team studied the process of fat graft survival and elegantly showed what happens to the grafted fat.5-7 On the outermost surface of an injected fat lobule, a fraction-of-a-millimeter–thick crust...