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No patient is too slim for our breast reconstruction or augmentation procedure. We’ve rarely turned down patients for not having enough fat. Even if the woman does not have a localized area of excess fat, we have developed techniques that allow us to evenly harvest a very small amount of fat out of a large surface area.
We use the “palm measure” to estimate the area and the amount of fat to harvest. The average male surgeon’s palm measures 10 x 20 cm = 200 cm2. If out of such a surface area we evenly harvest a thin layer of fat—about 0.25 cm (3/32in)—we can obtain 50 cc per “palm measure.” Since the thigh of the most petite woman is at least 8–10 “palm measures,” one can easily see how with only a portion of the thigh we can obtain the 200–300 mL of necessary fat.
While it might sound counterintuitive, we ask the patient not to gain weight prior to the procedure. We prefer to harvest and graft the smaller fat cells, not the plumped up oil bags that develop with weight gain. If at all possible, we ask the patient to try to lose weight prior to grafting so that when she regains her normal weight, the transferred fat cells plump back up again and the grafted site grows.
All things being equal we prefer to harvest the fat from areas where the fat does not tend to fluctuate much with weight changes. For instance, if a patient tells us that when she loses weight her belly fat goes away but she can hardly lose fat from her thighs, we prefer to harvest the more stable and less likely to be lost thigh fat. In this particular patient if we transfer the belly fat, her breasts will fluctuate in size depending upon her food indulgence.
Some of our best results occur with thin patients since their fat is mainly composed of cells. As the woman’s weight increases, the fat cells become larger oil bags. Therefore for the same volume, the fat of heavier women contains more oil and less cells. Oil bags are more fragile and less likely to survive the process of harvesting and grafting. The addition of 200cc to the chest of a thin woman makes a significant effect while the same 200cc added to the chest of a larger lady is barely noticeable.