The fatty revolution

Fat, fat and even more fat. The world is obsessed with fat at the moment. You’re either too fat or too thin. You might despise your fat, but a certain percentage of body fat is essential to your normal metabolism, and that fat you hate can be used to make part of the beautiful new you.

The human body has great resilience and we owe our  ability to survive to the pre-programing of genetics, over the millennia, of the evolution of Homo sapiens. The ability to do this is related to storing energy reserves, in times of plenty, and the ability to metabolise them, in times of need. This is done by your fat. Hence, why a certain percentage of body fat is essential to a person’s normal metabolism.

Physiologically, there are three different types of fat: brown fat, alpha adipocytes (fat cells) and beta adipocytes. Brown fat is very important for thermoregulation in babies, but disappears in the adult. All fat deposits in adults contain a mixture of alpha and beta adipocytes, however, there are areas in the human body that may have a greater concentration of one or the other. At times of starvation, the beta adipocytes give up their energy stores before the alpha adipocytes. Therefore, areas that have a high concentration of alpha adipocytes are generally relatively diet resistant. Often, it’s the love handle area or the saddle bag.


Dr Sydney Coleman, a plastic surgeon from New York, pioneered facial lipofilling 20 years ago. Our body of knowledge and the power of fat grafting has expanded exponentially since then, and it is now routinely performed in most facial cosmetics procedures, as well as numerous reconstructive procedures.

Lipofilling is exceptionally useful in breast reconstructive surgery to fill contour defects, fix asymmetries and hide ripples from implants. In fact, a whole breast mound can be created with fat; this is lipofilling to the extreme, and requires multiple small surgeries to get a breast mound. Lipofilling is a very reliable procedure, should it be done appropriately with very little loss of volume.

What is unique to lipofilling and fat transfer is twofold: Firstly, fat it is the ultimate “filler” as it is the patient’s own tissue that is transplanted from one part of their body to another, and once it has “taken” (started to live) in the transplanted area, it will be there for the rest of the patient’s life. It may change slightly with weight change, but if diet resistant fat is transplanted, it will be less susceptible.

Secondly, fat contains a large amount of stem cells. These stem cells can be selectively processed out and then used to revitalise the area that they are transplanted into. They’re very useful to help rejuvenate radiation damaged areas. Lipofilling is also often used, before breast reconstruction is started, to help prepare the chest wall that has had significant radiation damage. If the stem cells do their work well, the chest wall tissues will become significantly softer and more pliable. This will then make the reconstruction of the breast easier for the plastic surgeon to perform.


Liposculpture is the removal of small volumes of fat, in certain areas, to sculpt a patient’s body. It is a type of liposuction that is done very gently with much smaller cannula (tube). A good cosmetic example would be the abdomen; it will enhance the shape of the female abdomen and can be used to accentuate a six-pack.

When it comes to breast reconstruction, it is used to remove extra fat from certain areas of a breast reconstruction, and is often used in combination with lipofilling to turn a good breast reconstruction into an excellent breast reconstruction.

The fat evolution is now the fat revolution and we are fortunate to have these new techniques, to offer our patients, to ensure the best possible outcome.


Dr Charles Serrurier MBBCH [WITS], FC Plast. Surg. SA. is currently in full-time private practice as a breast reconstructive surgeon at Netcare Milpark Hospital. He performs most of his cosmetic surgery at his practice at Netcare Rosebank Hospital. His main interest is prosthetic based breast reconstruction and loco-regional flap based breast reconstruction.

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