Breast Fat Transfer with CAL

Breast is your true symbol to feminity. Breast enlargement will increase a woman’s confidence, feminity and enhance body shaping. Undergoing the knife and having foreign implants (silicon implants) can be a tough decision for some people.Women can now choose to undergo minimal invasive method to have breast enlargement such as the MIAMI Breast Augmentation. This technique is from USA by Dr Roger Khouri in Miami known as MIAMI (Minimal invasive Autologous Mastectomy Incisionless)

In addition, we also combine stem cell assisted techniques to ensure better fat cell survival and intake. These techniques are adapted from Japan. We were taught personally and guided by Prof Kotaro Yoshimura in the Cell Assisted Lipotransfer (CAL) technique. He is a leader of the new wave of interest in this field due largely to the his work from the laboratories of Tokyo Medical University as well as Ritz Clinic. This is the landmark clinical paper.

How does it work?

MIAMI Breast Augmentation involves the use of Fat Transfer, which harvests fats from other part of your body. Fat is a natural substance from your body which provide benefits of excellent natural texture, and elimination of post-implant contractures, ruptures and torsion

The procedure involves the use of BRAVA, external tissue expander that allows growth of breast tissue without surgery. In cases, where there is good and sufficient breast tissue then there is no need to use the BRAVA system.  Fat cells are injected from your body to the breast. The procedure involves the use of needles to extract and plant fats into the breast, which means minimal incisions and less possibility of scarring.

For many years, this technique was not very successful as there was poor uptake of the fat. However the MIAMI breast fat augmentation technique has overcome these problems with up to 70% uptake of the grafted fat cells. The key to this is the concept of preparing the ground (breast tissue) for the seeds (grafted fat cells) so that they can begin quickly to live in the new tissue. This has been achieved by using external expander, BRAVA. In addition, stem-cell enriching of the breast is also crucial in getting better survival. See below the illustrations.

1. The concept is rather simple – we want to inject fat cells from your body into the breast and want them to happily live on there.


2. The solution that has been gaining good success in the US has been to externally expand the breast with BRAVA 1st then inject the grafted fat. Need to prepare the ground for the new fat cells..

3. The diagram below explains that external expansion increases tissue space in the breast so that it will be able to house the new fat cells.

In addition to this, the fat cells are handled gently during the process. Earlier concerns about abnormal calcifications post breast fat grafting has also been overcome by doing pre and post procedure MRI or mammograms.

The benefits of this procedure are the excellent texture and feel of the breast and the elimination of post implant contractures / implant rupture and torsion. There is also almost no scar as there is no incision but only injections. The procedure has the usual risk of any minimally invasive procedure i.e. infection, bleeding, bruising abet lesser.

After Procedure

Downtime after the procedure is minimal, patient are advised to rest for 1-2 days. There would be some discomfort from the donar site as well as in the breast for up to 1 – 2 weeks but you will be able to resume to normal activities.

The Results

You will be able to see the enlargement of the breast post op. Resorption of the fat by 30-40% will occur in the first 1-2 months, after which the implanted fat cells will stabilize and survive permanently. You can expect about 1 cup size increase. For some patients this may be sufficient, however, patient can be recommended to undergo a second session in 3-6 months to get more volume increase.

Post-care Treatment

After the procedure, we would provide pressure garments to be used in the donor site for 1 month. For the breast, we recommend using a wired support bra that is one size larger so that there will be minimal pressure on the breasts. For first month post-procedure, patients are strongly advised not to insert any pressure on the breasts and there must not be any massage on the breasts. There will be some small incision on the donor sites and the lower border of the breast. They measure 0.5 -1 cm on the donor sites and much smaller on the breasts (approx 0.2-0.3cm). They usually heal quickly and stitches if placed will be removed in 1 week.

*All these illustrations and pictures are courtesy of Dr Roger Khouri and obtained with thanks from