procedure. technically, the external vacuum expansion of the recipient-site tissues created a skin envelope as it stretched the mastectomy scar, and so generated a fertile breast-tissue matrix to which were injected large-volume fat grafts (150–600 ml) to create a breast of natural form, look, and feel. the fat graft breast reconstructions for 33 women (47 breasts, 14 irradiated), whose clinical statuses ranged from zero days to 30 years post-mastectomy, began with the pre-expansion of the breast mound (recipient site) with an external vacuum tissue-expander for 10 hours daily, for 10–30 days before the first grafting of autologous fat. the breast mound expansion was adequate when the mastectomy scar tissues stretched to create a 200–300 ml recipient matrix (skin envelope), that received a fat-suspension volume of 150–600 ml in each grafting session. at one week post-procedure, the patients resumed using the external vacuum tissue-expander for 10 hours daily, until the next fat grafting session; 2–5 outpatient procedures, 6–16 weeks apart, were required until the plastic surgeon and the patient were satisfied with the volume, form, and feel of the reconstructed breasts. the follow-up mammogram and mri examinations found neither defects (necrosis) nor abnormalities (neoplasms). at six months post-procedure, the reconstructed breasts had a natural form, look, and feel, and the stable breast-volumes ranged 300–600 ml per breast. the post-procedure mammographies indicated normal, fatty breasts with well-vascularized fat, and few, scattered, benign oil cysts. the occurred complications included pneumothorax and transient cysts. explantation deformity the autologous fat graft replacement of breast implants (saline and silicone) resolves medical complications such as: capsular contracture, implant shell rupture, filler leakage (silent rupture), device deflation, and silicone-induced granulomas, which are medical conditions usually requiring re-operation and explantation (breast implant removal). the patient then has the option of surgical or non-implant breast corrections, either replacement of the explanted breast implants or fat-graft breast augmentation. moreover, because fat-grafts are biologically sensitive, they cannot survive in the empty implantation pocket, instead, they are injected to and diffused within the breast-tissue matrix (recipient site), replacing approximately 50% of the volume of the removed implant – as permanent breast augmentation. the outcome of the explantation correction is a bust of natural appearance; breasts of volume, form, and feel, that – although approximately 50% smaller than the explanted breast size – are larger than the original breast size, pre-procedure. breast augmentation the outcome of a breast augmentation with fat-graft injections depends upon proper patient selection, preparation, and correct technique for recipient site expansion, and the harvesting, refining, and injecting of the autologous breast filler fat. technical success follows the adequate external vacuum expansion of the recipient-site tissues (matrix) before the injection of large-volume grafts (220–650 cc) of autologous fat to the breasts. after harvesting by liposuction, the breast-filler fat was obtained by low g-force syringe centrifugation of the harvested fat to separate it, by density, from the crystalloid component. the refined breast filler then was injected to the pre-expanded recipient site; post-procedure, the patient resumed continual vacuum expansion therapy upon the injected breast, until the next fat grafting session. the mean operating room (or) time was 2-hours, and there occurred no incidences of infection, cysts, seroma, hematoma, or tissue necrosis. the breast-volume data reported in breast augmentation with autologous fat grafting: a clinical radiological study (2010) indicated a mean increase of 1.2 times the initial breast volume, at six months post-procedure. in a two-year period, 25 patients underwent breast augmentation by fat graft injection; at three weeks pre-procedure, before the fat grafting to the breast-tissue matrix (recipient site), the patients were photographed, and examined via intravenous contrast mri or 3-d volumetric imaging, or both. the breast-filler fat was harvested by liposuction (abdomen, buttocks, thighs), and yielded fat-graft volumes of 220–650 cm3 per breast. at six months post-procedure, the follow-up treatment included photographs, intravenous contrast mri or 3-d volumetric imaging, or both. each woman had an increased breast volume of 250 cm3 per breast, a mean volume increase confirmed by quantitative mri analysis. the mean increase in breast volume was 1.2 times the initial breast volume measurements; the statistical difference between the pre-procedure and the six-month post-procedure breast volumes was (p< 00.0000007); the percentage increase basis of the breast volume was 60–80% of the initial, pre-procedure breast volume. non-surgical procedures in 2003, the thai government endorsed a regimen of self-massage exercises as an alternative to surgical breast augmentation with breast implants. the thai government enrolled more than 20 women in publicly funded courses for the teaching of the technique; nonetheless, beyond thailand, the technique is not endorsed by the mainstream medical community. despite the promising results of a six-month study of the therapeutic effectiveness of the technique, the research physician recommended to the participant women that they also contribute to augmenting their busts by gaining weight. complications and limitations medical complications in every surgical and nonsurgical procedure, the risk of medical complications exists before, during, and after a procedure, and, given the sensitive biological nature of breast tissues (adipocyte, glandular), this is especially true in the case of fat graft breast augmentation. despite its relative technical simplicity, the injection (grafting) technique for breast augmentation is accompanied by post-procedure complications – fat necrosis, calcification, and sclerotic nodules – which directly influence the technical efficacy of the procedure, and of achieving a successful outcome. the chinese study breast augmentation by autologous fat-injection grafting: management and clinical analysis of complications (2009), reported that the incidence of medical complications is reduced with strict control of the injection-rate (cm3/min) of the breast-filler volume being administered, and by diffusing the fat-grafts in layers to allow their even distribution within the breast tissue matrix. the complications occurred to the 17-patient group were identified and located with 3-d volumetric and mri visualizations of the breast tissues and of any sclerotic lesions and abnormal tissue masses (malignant neoplasm). according to the characteristics of the defect or abnormality, the sclerotic lesion was excised and liquefied fat was aspirated; the excised samples indicated biological changes in the intramammary fat grafts – fat necrosis, calcification, hyalinization, and fibroplasia. the complications associated with injecting fat grafts to augment the breasts are like, but less severe, than the medical complications associated with other types of breast procedure. technically, the use of minuscule (2-mm) incisions and blunt-cannula injection much reduce the incidence of damaging the underlying breast structures (milk ducts, blood vessels, nerves). injected fat-tissue grafts that are not perfused among the tissues can die, and result in necrotic cysts and eventual calcifications – medical complications common to breast procedures. nevertheless, a contoured abdomen for the patient is an additional benefit derived from the liposuction harvesting of the adipocyte tissue injected to the breasts. (see abdominoplasty) technical limitations when the patient's body has insufficient adipocyte tissue to harvest as injectable breast filler, a combination of fat grafting and breast implants might provide the desired outcome. although non-surgical breast augmentation with fat graft injections is not associated with implant-related medical complications (filler leakage, deflation, visibility, palpability, capsular contracture), the achievable breast volumes are physically limited; the large-volume, global bust augmentations realised with breast implants are not possible with the method of structural fat grafting. global breast augmentation contrasts with the controlled breast augmentation of fat-graft injection, in the degree of control that the plastic surgeon has in achieving the desired breast contour and volume. the controlled augmentation is realised by infiltrating and diffusing the fat grafts throughout the breast; and it is feather-layered into the adjacent pectoral areas until achieving the desired outcome of breast volume and contour. nonetheless, the physical fullness-of-breast achieved with injected fat-grafts does not visually translate into the type of buxom fullness achieved with breast implants; hence, patients who had plentiful fat-tissue to harvest attained a maximum breast augmentation of one bra cup size in one session of fat grafting to the breast. detection a contemporary woman's lifetime probability of developing breast cancer is approximately one in seven. however, there is no causal evidence that fat grafting to the breast might be more conducive to breast cancer than are other breast procedures; because incidences of fat tissue necrosis and calcification occur in every such procedure: breast biopsy, implantation, radiation therapy, breast reduction, breast reconstruction, and liposuction of the breast. nonetheless, detecting breast cancer is primary, and calcification incidence is secondary; thus, the patient is counselled to learn self-palpation of the breast and to undergo periodic mammographic examinations. although the mammogram is the superior diagnostic technique for distinguishing among cancerous and benign lesions to the breast, any questionable lesion can be visualized ultrasonically and magnetically (mri); biopsy follows any clinically suspicious lesion or indeterminate abnormality appeared in a radiograph. therapy breast augmentation via autologous fat grafts allows the oncological breast surgeon to consider conservative breast surgery procedures that usually are precluded by the presence of alloplastic breast implants, e.g. lumpectomy, if cancer is detected in an implant-augmented breast. in previously augmented patients, aesthetic outcomes cannot be ensured without removing the implant and performing mastectomy. moreover, radiotherapy treatment is critical to reducing cancerous recurrence and to the maximal conservation of breast tissue; yet, radiotherapy of an implant-augmented breast much increases the incidence of medical complications – capsular contracture, infection, extrusion, and poor cosmetic outcome. post-cancer breast reconstruction after mastectomy, surgical breast reconstruction with autogenous skin flaps and with breast implants can produce subtle deformities and deficiencies resultant from such global breast augmentation, thus the breast reconstruction is incomplete. in which case, fat graft injection can provide the missing coverage and fullness, and might relax the breast capsule. the fat can be injected as either large grafts or as small grafts, as required to correct difficult axillary deficiencies, improper breast contour, visible implant edges, capsular contracture, and tissue damage consequent to radiation therapy.