Last year breast augmentation was the number one cosmetic surgery. But what if you could have the same effect without the use of implants, using your body's own natural tissue?

So Wrinkle Free Friday looked into the pros and cons of a study being done by a local doctor. It's a look that many women want, lean on the bottom but curvy on the top. The most popular way to achieve that look is with breast implants. 

"I regret that I ever did have implants and over the last 20 years I've had 4 surgeries," says a patient. 

This patient we'll call "Libby" is a very in shape, youthful looking 62-year-old.  Twenty years ago, she got implants to balance her out-of-proportion body.  But very hard scar tissue formed and her skin even tore. So she said enough and underwent surgery with LSU Health Sciences Center plastic surgeon Dr. Kamran Khoobehi to have them taken out.  But Libby knew her breasts would be left misshapen with no volume, so she opted for a procedure that is controversial among doctors.

"When I made the decision to do this surgery one of the good things was that the fat transfer could be taken from the thighs, which was great. I never would have considered liposuction just for the sake of cosmetic liposuction to change the body, but when it was for a fat transfer, it was a win, win," says Libby.

After the implants were removed, fat was carefully harvested from Libby's lower body and then injected into her breasts.  The result is full, uplifted and symmetrical breasts made from her own tissue. And unlike with implants, no hard scar tissue will form. 

"When they see the results, they are just ecstatic. I had one patient who had 5 years the implants and was not happy with it and when she had the surgery she was the happiest patient I've seen," says Dr. Khoobehi. 

Fat transfer from one part of the body to another has been done for many years into the face, lips, hands and buttocks.  Injecting it into the breast is more common in Europe, South America and Japan.

But over the years in the U.S. fat transfer to the breast through liposuction has been controversial for two reasons. The first is how it would affect a mammogram.

Plastic surgeon and breast reconstruction specialist Dr. Frank DellaCroce explains why. "When you do anything related to a surgical procedure, we are creating the potential for a scar tissue development.  When we transfer fat that may or may not be viable at the end of the day, the fat in all likelihood will reabsorb it may calcify as well.  So anyone who is contemplating having this done needs to understand those issues."  

Scar tissue, calcification or cysts, if they form, can be seen on a mammogram or felt during an exam.  Metairie plastic and reconstructive surgeon Dr. David Jansen did fat transfer to the breast in the past, but has stopped.  

"I have had some women come back and we watch them, we watch those lumps," says Dr. Jansen. 

He says he follows those specific patients closely and so far the lumps have caused no harm.  

"The whole idea of mammograms not being able to tell the difference between injected fat that develops calcium around it and a breast cancer that has calcium around it that issue has been solved, and that was the big reason we didn't do it years ago because you couldn't tell the difference.”

Dr. Khoobehi says so far his patients and women who had the procedure in a study in New York have not had problems having their mammograms read.

"But even after mammograms, they were acceptable the things that we worry about like cysts, calcification, nodules they really did not find those. So from that point of view indicated that it is safe and did not interfere with the mammogram reading," says Dr. Khoobehi. 

The second reason this kind of surgery is controversial is that the question of whether or not it puts a women at higher risk for breast cancer is unknown. 

"Many medical organizations have expressed skepticism about fat transplantation to the breast. The main reason is we really don't know what happens when fat is introduced into a tissue that's capable of forming cancer," says Metairie dermatologic surgeon Dr. William Coleman.

"So the consensus of the American Society of Plastic Surgery, you need to be very cautious. You're taking a stem cell and putting it into an organ that has a one in eight chance of developing a cancer. So we can't tell the patient what the risk is of developing cancer, says Dr. Jansen. 

But Dr. Khoobehi says so far there are no studies linking fat or stem cells to breast cancer.  

“Because you are taking your own tissue and putting it another part of your body, that it is your own, I don't see how it's going to stimulate or decrease or increase the risk of  cells developing into cancer," says Dr. Khoobehi.  

"Most of the breast is fat, so why would fat from one part of your body be more inclined to develop issues related to stem cells than the fat that's already in the breast. So I don't think that's an issue," adds Dr. DellaCroce.

Dr. Khoobehi is now doing a study in Metairie. It has been approved by the LSU Health Sciences Centers Institutional Review Board. 

So is it good that this issue is being studied? "It's always good to study something like this," adds Dr. Coleman. 

Dr. Khoobehi is collecting information from patients who are undergoing fat injections alone or after implant removals or with breast lifts.  His surgical pictures show that the women are the same size after the fat injections as they were with implants, but they are more natural looking. You can also see how patients now look with fat injections which helped repair problems caused when implants are removed. And as for Libby, immediately in the operating room the difference is noticeable with the fat injections compared to after the implants were taken out.  She says even with the medical controversy she's pleased.

"I feel like I made the right decision for the time for what it was at the time," she says.

(For more on the study, call (504) 779-5538)