Avant Now Covers Fat Transfer Procedures

We are writing to you to let you know that after consultation with ASPS, Avant has recently made some changes to our coverage for plastic surgeons which benefits both Avant members and their patients.

From 1 July 2018, cover will be included for transfer or injection of non-vascularised fat (including autologous fat transfer for both reconstructive and cosmetic breast surgery) for all plastic surgeons, without the need to seek endorsement from Avant.

Importantly, cover for these procedures is limited to practitioners who hold a FRACS, and excludes cosmetic practitioners who are not recognised surgical specialists.

Following the evidence presented to the Annual Scientific Meeting of The Royal Australasian College of Surgeons in Sydney in May 2018, AVANT (the predominant medical indemnity insurer for most of Australia’s plastic surgeons) has finally removed the restriction placed on its surgeons from performing breast augmentation using the patient’s own fat.

With the validation of autologous fat transfer to the breast in Australia, it is surprising that negative information continues to be published on the internet.  It is clear that, in the past, most surgeons have been unable to perform this procedure because they have not been covered by their Medical Insurer.  As a result they have not developed experience with the procedure and therefore favour the use of breast implants.  It is clear that breast implants may be the preferred method of breast augmentation for some women (especially those desiring a very large increase in breast size), however autologous fat transfer is a far safer alternative, especially for the many women who desire a 1-2 cup size increase in breast volume with an enhanced cleavage and more fullness in the upper pole.  The evidence is now clear that using correct techniques and with close attention to detail, a significant and permanent increase in breast volume and shape can be obtained for nearly every woman.

From a Cosmetic Clinic in Sydney:-

“Please note that we strongly advise against fat transfer for breast augmentation. Although performed by some surgeons, it is widely held over the world that this procedure is not only likely to prove unsuccessful in the long-term when the injected fat disappears but more importantly it can produce areas of micro calcification on mammograms that could be difficult to differentiate from breast cancer.”

This is clearly incorrect information. They go on to say that large volume transfers have less chance of survival and that you may need serial transfers of smaller volumes of fat.

This is incorrect.

They go on to state that their “inability to guarantee permanency of correction has always been the major drawback of fat transfers”.

This may be true in their hands. Perhaps they are not using the correct technique?

And what about a Cosmetic Surgery Centre based in Melbourne? They state:-

“The main reasons Australian Plastic Surgeons have not yet embraced fat transfer as a primary breast augmentation procedure include:-

This is “Fake News”!

Having performed several hundred fat transfer procedures, these statements do not correlate with our own experience.

In fact, we find that a high percentage of the fat does “take” following transfer; that most patients require only 1 procedure to get a really good result; that results are certainly not “minimal” per procedure; that there are very few problems with the donor site (assuming correct technique is used in the harvesting); infections are almost non-existent; we have never had a situation where we have had to remove transferred fat!

These surgeons go on to state that the fat cells may form nodules or lumps – or expand unevenly – with any later patient weight gains.

With adequate attention to surgical technique, the formation of lumps can be avoided and we have never had uneven expansion!

According to these surgeons:-

“Implants are still the preferred method of most Australian plastic and cosmetic surgeons, for reasons of predictability, size and shape control and overall results”.

Having performed over 5000 breast implant operations, I can state unequivocally that, with experience in the technique of fat transfer, implants are no longer my preferred method. Excellent predictability and improved size and shape control is obtained by autologous fat transfer. Furthermore breast implants are associated with all sorts of problems and the only thing that is predictable is that further surgery is likely to be required to correct complications.

I have only provided a few examples above to illustrate some of the negative comments which cause unnecessary concern to many women.

With 20,000 breast implant surgeries performed in Australia each year we have a situation where tens of thousands of women will require their implants to be removed due to a long list of well-known complications. News Corporation (publishers of The Sunday Herald in Sydney) have recently started a campaign to ensure that women who require expensive surgery for breast implant removal have the costs of their surgery reimbursed by the implant manufacturer. Breast implants with a textured surface have now been linked with a disease known as Anaplastic Large Cell Lymphoma (ALCL) which is an indolent cancer of the capsule surrounding the implant.

Allan Kalus

FRCS, FRCS(Ed), FRACS