Fat transfer for breast enlargement vs. breast implants

Dr. Reed, Should I consider fat transfer as a way to enlarge my breasts or do you favor insertion of breast implants for a transgendered woman.?  Lorraine

Hi Lorraine,

Unless performed by a very skillful doctor, or maybe used as a touch up for a non-filled area, I would discourage fat transfer.

The reasons being fluids tend to go into tissue planes of least resistance and can form fibro-fatty nodules.  The modern day breast implants when properly installed produce such beautiful results, especially when placed under the muscle, I believe this approach is unsurpassed.

Here’s an article on fat transfer from a reputable office.  As you can see an advantage is simultaneous liposuction of other parts of your body, but the increase in size of your breast varies from around 3/4 to 1 cup size.  So if you are an A now, at best you’ll be a B cup.  To quote them, if you are looking for “subtle breast enhancement” then you may consider lipo-filling.


Fat Transfer to Breast Augmentation

Fat transfer to breast surgery is a type of breast augmentation procedure that is meant to increase
breast volume without the use of artificial implants. Fat transfer to breast surgery is a two part procedure,
which utilizes liposuction and fat tissue injection. This procedure is an excellent option for women
who are looking for a relatively small increase in breast size, while improving natural breast shape. A fat transfer surgery is an alternative for breast enhancement without the use of traditional implants.

Fat transfer is also known as fat grafting. The beauty of this procedure, is that it offers the
opportunity to enhance the breasts and eliminate unwanted fat from other areas at the same t
me. The fat is grafted from the patient’s own body, which eliminates the risk of rejection of artificial
structures in the body.

First, liposuction is performed to extract fat from the patient’s abdomen, thighs, buttocks and/or flank.
Once the fat is extracted, it is injected into the breasts, creating increased volume and giving a
naturally beautiful shape. A fat transfer procedure can also correct for breast asymmetry.

Benefits of a fat transfer breast augmentation include:

  1. Shaping and sculpting the breasts

  2. Minimal incisions

  3. Minimal scarring

  4. Eliminating unwanted fat from the midsection and lower body

  5. Eliminating the risk of implant leakage or rupture

  6. Eliminating the risk of scar tissue formation around the implant, leading to capsular contracture

  7. Less trauma to the body as compared to traditional breast augmentation

  8. Reduced recovery time as compared to traditional augmentation

  9. Fat transfers are natural and provide long lasting results

Candidates for Fat Transfer to Breast

Women who are good candidates for this surgery are those who are looking for subtle
breast enhancement and would like to reduce unwanted fat in other areas of the body.
Women who want a more drastic increase in breast size will not be satisfied with the
breast enhancement from a fat transfer procedure. It is also important that women have
enough body fat available to sufficiently augment the breasts. Many patients choose to
have this procedure after having unsatisfactory results from an implant procedure, or in combination with a breast lift.

Fat Transfer Procedure

Fat transfer breast augmentation is performed with two surgical procedures on the same day.
The first procedure is to harvest the fat from another area of the body, typically from the abdomen,
buttocks, flank and/or thighs. The fat is extracted using liposuction. First, a small incision is placed i
n the area to harvest the fat. A small cannula is inserted and fat tissue is removed using a vacuum suction.
The liposuction sites are sculpted to give the patient smooth and beautiful contours. Once the fat is collected,
it is prepared for injection into the breasts, removing any fluid waste or contaminants. Then, the clean fat is
placed in a syringe for injection into the breast.

Injection of the Fat into the Breast

The second procedure is the injection of harvested fat tissue into the breasts. The fat is strategically and
methodically injected into the breasts by the surgeon. It is injected in a small thread-like manner to promote
integration into the breast tissues. The fat is injected into all levels of the breast, with a focus under the skin
and above the chest muscle.

Fat Transfer with Augmentation or Lift

Fat transfer can be combined with other surgical procedures, such as traditional augmentation and
breast lift procedures. Fat transfer with augmentation is typically indicated for complex conditions
involving breast shape. For some situations, fat grafting will provide needed volume in a way that an
implant alone is unable to. A breast lift will improve the shape, correcting for breast sagging and excess
skin. When combining a fat transfer to a breast lift, the patient can increase volume, while correcting for breast shape.

What to Expect with Fat Transfer Breast Augmentation

The entire procedure takes 4-6 hours for harvesting and injection. Patients are typically able to return to
light activities and work in one week. Strenuous activity and exercise should be avoided for several weeks.
After a fat transfer to breast procedure, the patient should expect some swelling, bruising and discomfort
at the fat donor sites and the injection sites. This discomfort is easily controlled and are only temporary.

For some patients, 1-3 fat transfers must be performed in order to achieve the desired outcomes. This is
because some of the injected fat may be absorbed by the body and not give the desired results during the
initial procedure. Typically, breasts keep 60-80% of transferred fat volume. It is important that patients follow
post-surgical instructions from the surgeon in order to allow the breasts to heal properly. This will increase
the amount of fat that is retained in the breasts.

With fat grafting, the breast shape is improved, enhancing the cleavage of the upper breasts. The size is
usually increased 1 full bra cup size. It is important that women have realistic expectations for surgery.
If looking for a more dramatic increase in breast volume, a traditional breast augmentation with implants
will be better indicated. The results of the fat transfer is long term. However, breast changes can occur
with natural aging, gravity, and weight changes.

Fat transfer to breast is a newly emerging and growing cosmetic procedure. One consideration is the
impact of fat injection into the breasts and how it affects breast health. Just like any other breast procedure,
when the fat is injected into the breast, lumps, cysts and calcifications may form. The typical adverse event
is formation of fatty cysts within the breasts, which can be suspicious for breast cancer upon imaging.
However, most cysts are easily aspirated during a simple office procedure.

Additionally, the grafted fat looks different and is distinguishable from lesions associated with breast
cancer. It is important to have regular breast examinations, noting any changes to imaging studies.
Research has found no increase in breast cancer prevalence in individuals who have undergone fat
grafting. The concern arises in the ability to properly visualize any unrelated lesions. In actuality,
he adverse effects of this procedure are low, as the body does not reject its own fat cells.

The most common complaint after this procedure is insufficient fat uptake, if not enough fat survives
the transplant. This results in inadequate volume. Unfortunately, the unpredictability of fat grafting
makes it difficult to determine exactly how much fat with take and what breast volume can be expected.
With multiple grafts, more volume and more dramatic results can be obtained.

Further comment from Dr. Reed…In review, this may work for ;people with generalized lipodystropohy .  The operation can last up to 4 hours vs, simple breast implants take about 1 hour. Their increase in cup size varies from 3/4 to 1 cup.  Most patients with A or sub A breasts are looking for at least a C cup.

Harold M. Reed, M.D.

1/3 - Before

Before breast implant

1/4 - After

Post-op after breast implant, patient of Dr. Reed

1/1 - Before

Same patient before breast implant, frontal view

1/2 - After

After breast implants

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