Megavolume Autologous Fat Transfer : Part I .

550 “Doctor, can’t you just take some from here and put it there?” All plastic surgeons with at least a modest experience in breast surgery have heard these words, and have sadly replied that it was not possible. We present our theory and principles based on the literature and our personal experience with over 1000 fat-grafting procedures to the breast as evidence of a paradigm shift in the realm of possibilities in surgery. The facts were that we knew of multiple attempts at fat transfer, dating back to the beginning of the twentieth century, and that Chajchir and Benzaquen1 and Guerrerosantos2,3 had been grafting liposuctioned fat successfully since the 1980s. However, the fundamentals of realistic large-volume fat grafting for breast augmentation had yet to be determined. Coleman4 achieved seemingly miraculous results with small-volume fat transfer in the face and gave us the fundamental principle of “microdroplets” (although we now favor the term, “microribbons”) as small units of fat that can survive acute transfer to a subcutaneous bed. Coleman and Saboeiro,5 Delay et al.,6 and Rigotti et al.7 also described experiences with fat grafting the breast, but the capacity to enlarge the breast by more than 200 ml in one stage, or to completely reconstruct a breast after total mastectomy, using fat graft alone, remained an elusive goal whose time had not come.