‘Liquid Gold’ - Fat Transfer : Discussions with our founder, Mr Allan Kalus

As Australia’s leading expert in Fat Transfer, our founder, Mr Allan Kalus recently spoke with Trish of the Plastic Surgery Hub, a prominent plastic surgery blogger, for her podcast series. You can hear Mr Kalus share his thoughts on fat transfer and latest innovations in fat grafting techniques with Trish via the podcast here or read their conversation below.

Trish: I’m here today with Dr. Allan Kalus, from Avenue Aesthetic Surgery based in Melbourne. Today, we’re going to talk about fat grafting, fat transfer to the breast or any other part of the body, really. And Dr. Kalus is actually one of the early pioneers. So, it’s only just something that a lot of surgeons have just recently started doing, but Dr. Kalus has actually been doing it for years. So, we are going to have a bit of a chat with him about why fat is what I like to call liquid gold. So, I should be worth a fortune. But here, let’s talk about the liquid gold. So, thank you so much for joining us today, Dr. Kalus.

Dr. Kalus: It’s a pleasure. And I love the way you talk about fat as liquid gold, because that’s the way it actually looks. Once you’ve harvested the fat and washed it and prepared it ready to graft, the actual fat we graft does have a very rich gold colour. So, liquid gold is very appropriate. And of course, the thing about fat grafting for the breast is that it’s a completely natural way to increase not just the volume of the breast, but the appearance of the breast. I think of it more as a breast enhancing operation.

The demographic of women that we find are coming along for fat grafting of the breast is really quite different from the one that has a breast augmentation. Often, these are young mothers who have breast fed and have lost a little bit of fullness in the breast, and they want to restore their breast to how it was before, or perhaps make it a little larger. But they are not after something really large that everyone’s going to notice. And fat grafting does this beautifully. It does it actually, in a much better way than an implant could ever do it. Because we use the fat a little bit like putty. And we can put a bit in the cleavage, a bit into the upper pole, a bit into the base to increase projection.

And we find that even with small volumes of fat, 100 or 200 mils, we can really not just increase the volume of the breast, but enhance the appearance of the breast. And of course, the other thing about the fat is, that there are numerous stem cells in the fat. And one thing they were talking about at the meeting today was how these stem cells can regenerate the breast. People who’ve got slightly saggy skin, the skin quality improves. So, I think that grafting of the breast is really the miracle that we’ve been looking for, in terms of rejuvenating and enhancing the breast.

Of course, there’s some women who still want to have breast implants. If you want to go up two, or three, or more cup sizes, breast implants allow you to do that. And at this meeting, it was interesting. They were talking a little bit about hybrid breast augmentation.

Trish: Oh, I loved that talk, and I loved watching the results that they can get and the fact that all the little fine bits that you can fix with it.

Dr. Kalus: Exactly right. So with hybrid or composite breast augmentation, it allows you to put a slightly smaller implant in, and then also to use fat around the edges of the implant. And so what that means is, by having a smaller implant, many of the complications associated with breast implants are reduced. You don’t have as much weight, as much pressure on the skin. You don’t have all these changes. And most breasts will accommodate a small breast implant very easily. And you can then use the fat in the cleavage, and in the upper pole to enhance the overall effect of the implant, and to conceal the edges of the implant, to prevent rippling if that’s going to be a problem, and really to prevent many of the problems with breast implants.

And of course, the other big advantage of fat grafting, whether you’re doing it as a hybrid or as a stand-alone procedure, is that you have to remove the fat from some part of the body. So, for many women, you get the secondary benefit of liposuction, say from the tummy or the hips or the inner thighs. Some women ask, “Well, if I don’t have much fat, can I still have this procedure? Can I still have fat grafting, either as a hybrid or as a primary procedure?” And this is something that I’ve found a bit of a challenge early on, would I be able to get enough fat from thin women. And the answer is absolutely yes. And it’s supported here at the meeting today. Every woman has 100 mils of fat in their inner thighs, for example.

Trish: I heard that. One of the doctors said you can get fat from even a skinny person, because everybody’s got fat on their inner thighs.

Dr. Kalus: Everyone has some there. And we’ve also found that in the hip area, every woman has got some fat deep in the hips. Every woman has got some fat around the front of the thighs. So, there’s never been a patient, and we’ve done over 200 patients now, with fat grafting. There’s never been anyone that we haven’t been able to get any fat.

Trish: Yep. And I know for a fact that you’ve got a bit of a process that people have to follow after you’ve done a fat transfer, haven’t you, which helps to hold that fat even more, as well. You’ve got your own little technique that you get them to follow, the recipe?

Dr. Kalus: Exactly right. Not only after the operation, but even before the operation, we like to stimulate the breast, the recipient site, so that it’s going to be more receptive to take this fat, which are living cells. It’s going to be a graft of cells. So, we like to start stimulating the breast before the procedure. And then after the procedure there’s a whole programme that we put patients on to enable the fat cells not just to survive, but also to grow inside the breast. This is very exciting. This is the research that we’re doing at the moment, how can we best make the breast grow?

And this was something else that was brought up at the meeting. It was asked, “What happens to patients if they put on weight in the future?” And the answer is that the breast will grow, because you’ve got the extra fat in the breast. Interestingly, many patients ask, “Well, I can put on weight, but what happens if I lose weight after the operation?” And I think the answer is that if you’ve lost a lot of weight, perhaps you may lose some of the volume that we put into the breast. But one case was presented where the woman gained 5 kilos, and her breasts grew. And then she lost 5 kilos, and the breasts maintained their size.

So the breast fat seems sometimes to be influenced by different factors and the fat in the rest of the body. But it is one reason that we do suggest that women be at or close to their target breast weight when doing fat grafting, because it would be good if they could put on a kilo or two after, initially, after the operation. And after all, if you’re going to have a bigger bust, you’re going to have a bigger weight. So we do like a slight extra weight after the operation.

Trish: And it’s really, what I find really interesting is looking, watching the videos of doctors doing it and all that sort of thing, it’s actually quite labour-intensive. It would take a long time, so it’s not going to be, it’s not one of those short, quick, cheap procedures. It’s going to be, takes longer, it’s a bit more expensive, and it’s a lot more sort of, specialised. You’ve got to get it all in the right spot.

Dr. Kalus: Well, it’s certainly very specialised. I think as plastic surgeons, we love doing this, because it’s really reconstructive surgery. And we’ve all been trained in skin grafts and flaps and so on. This is a graft. In fact, we are taking living fat. We have to make sure it survives, and then graft it to another site. When we started doing it, a procedure would take about three hours. But now, I think we’ve got it down to perhaps, one and-a-half hours, so just a little bit longer than an augmentation with implants. And we’ve developed some very good systems for taking the fat now, and the harvesting. We have a very systematised approach. So, it does take a little longer, but not as long as in the beginning.

Trish: And one of the things, I hadn’t even thought about this, but one of the things that I was blown away by was the fact that the ladies that have had a mastectomy due to breast cancer and all that, the results that they can get with the fat transfer, because it might just be little bits here and there that just need to be filled out.

Dr. Kalus: Absolutely so. There’s been a lot of talk about using fat grafting in the reconstructive setting. Usually with an implant, so to hide the edges of the implant, because of course once you’ve had a mastectomy, the skin can be very thin and the implant can show under that. And so, putting some fat around the implant can hide that, or a little defect after segmental mastectomy. And we are certainly doing a lot of that. But it’s so versatile fat. You can take a very small amount, even 20 mils, which does not take a lot of time, and you can use that just to enhance an area. And the other point that was made is, that you can keep doing it. If you want a bit more fat later on, there’s no reason why you can’t repeat the procedure. And you know, it gets better each time. It’s almost like the soil has been really prepared, and it’s got a higher vascularity. And the fat seems to do better each time that we put it in.

Trish: One of the pictures I saw, she’d got the final result she wanted. This is a mastectomy lady. Oh, you would’ve seen it, too.

Dr. Kalus:  Yes.

Trish: But after the fourth time, it was just like, “Right, I can see,” it’s actually, almost like a process that you have to go through.

Dr. Kalus: Correct. So, what I envision happening now in the reconstructive situation, is the patient may start off with a breast implant after a mastectomy, or a double mastectomy sometimes, and we put some fat in. And then we could put a smaller implant in. Or in the case of an expander, we could deflate the expander slightly. And then you could put a bit more fat in and deflate the expander a bit more, until ultimately, the woman would have just fat and no implant. And I think this is the aim ultimately, the Holy Grail, in a reconstructive scenario, can we create a whole breast just with fat, with no implant whatsoever? I think with some women, that’s going to be possible.

Trish: That would be like being skinny and having big boobs.

Dr. Kalus: That’s right.

Trish: The perfect life. Well, that’s great. Well, thank you so much for that today, Dr. Kalus. That’s been really, really helpful. So ladies, if you’re looking at having some fat transferred to the breast, or as I said, anywhere else in the body, you can contact Dr. Allan Kalus through our website, or otherwise drop us an email to info@plasticsurgeryhelp.com.au, or otherwise just Google Avenue Aesthetic Surgery in Melbourne. Thanks very much.

Dr. Kalus: Thank you.

As our founder and lead plastic surgeon, Mr. Allan Kalus is on hand at Avenue Aesthetic Surgery here in Melbourne to consult with you if you are considering fat transfer procedures. You can learn more about his innovative approach to fat transfer here and contact our clinic on 1300 271 839 to arrange a consultation.