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During the past several months, I have observed an increase in the number of calls and inquiries from prospective patients regarding a fat transfer for breast augmentation. Because of my increased interest in this procedure, I wanted to take this opportunity to discuss this procedure in more detail.

What is fat transfer to the breast?

Fat transfer to the breast involves performing liposuction of an area where there is excess fat, washing the harvested fat, and then reinjecting it into the breast to increase volume.

This procedure is not new. Fatwas the first facial filler — before we had the variety of fillers that we have today, we used to perform fat grafting to the face and lips to increase volume in a natural way. After being used primarily in the face, plastic surgeons quickly incorporated it for the other parts of the body, including the breast and buttocks.

We have been performing the fat transfer, or fat grafting, to the breast for years as an adjunct to breast reconstruction. In women following mastectomy, there is little subcutaneous tissue, so the fat grafting helps to improve contour irregularities and decrease visible rippling from an implant in implant-based breast reconstruction.

Initially, there was some controversy surrounding fat grafting for cosmetic breast augmentation. This controversy was related to the risks regarding mammography and breast cancer surveillance. Unlike women who have had a mastectomy and have no remaining breast tissue, women who desire fat grafting still have breast tissue. The concern is that the grafted fat can appear as calcifications on mammograms, making them more difficult to read. Most of the recent literature has suggested that fat grafting does not interfere with surveillance for breast cancer.

Why are women asking for fat grafting for breast augmentation?

More women are concerned about the safety of breast implants. The FDA issued a black box warning regarding implants last year and textured Allergan breast implants were recalled in 2019. We have also learned more about BIA-ALCL (breast implant-associated anaplastic large cell lymphoma), a type of rare lymphoma associated with textured breast implants (I only use smooth breast implants for breast augmentation). Some women also have concerns that their breast implants are contributing to their poor health (commonly referred to as breast implant illness). For these reasons, more women are asking about fat grafting as a natural alternative to breast implants.

What are the advantages of fat transfer for breast augmentation?

The main advantage of fat grafting to the breast is that it is your own tissue. It is all-natural — your own body — so no implants that can rupture or require replacing in the future are used, instead, your own fat is used to restore fullness to the breasts. Fat transfer to the breast can also help to correct contour irregularities — which is how it has been used for years in breast reconstruction — and correct minor degrees of size asymmetry.

Another advantage is it provides “two-for-one” – if you want liposuction of another part of your body, it provides the opportunity to do that and use the fat that would otherwise be discarded.

What are the disadvantages of fat transfer for breast augmentation?

Despite these advantages, there are also some significant disadvantages to this procedure.

  • The procedure can be unpredictable. All of the fat that is grafted will not “take”. The fat has to be injected in thin layers and get a blood supply from the surrounding tissue since it doesn’t have its own blood supply — if you inject too much fat, it may form oil cysts or result in fat necrosis (painful, hard lumps of dead fat). Typically, only about 50-70% of the fat that is injected will “take”. These issues mean two things: you can’t inject a large amount of fat, and some of the fat that is injected will be absorbed by your body. I usually tell my patients that only about 100-150cc of fat can be injected in one sitting.
  • The procedure will only result in small increases in volume and will typically not provide you with the same degree of fullness along the top part of your breast that an implant will. Since only 100-150cc of fat can be injected in one sitting and since not all of it will take, women can only expect small or subtle increases in volume and may require multiple surgical procedures.
  • The grafted fat may result in abnormalities on mammograms. While most studies have confirmed that fat grafting to the breast does not interfere with breast cancer surveillance, it can still result in calcifications, cysts, or masses which may result in additional imaging or biopsies.
  • You may still require a mastopexy to help restore shape to your breasts. A mastopexy will lift the breast and restore its shape if it has “sagged” due to breastfeeding, weight fluctuations, or age. Fat grafting will not restore shape and volume without a mastopexy if you require a mastopexy.
Who is a good candidate?

A woman who is looking for only a small increase in volume and understands the limitations associated with the procedure. While this may be an option for some women, it is generally not the best or most cost-effective method for breast augmentation for most women since multiple procedures may be required and there is no way to guarantee how much of a size increase you will be able to achieve. If you are looking for a more predictable increase in size or fullness, you may be a better candidate for breast augmentation with implants.

If you would like to learn more about this option or about breast augmentation, please contact us at Bajaj Plastic Surgery.

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