Q: Can I get a fat transfer after breast augmentation?

A: Yes, Fat Transfer Breast Augmentation and Implants Are a Great Combo

You have a few of options if you want to be bigger, one is exchanging your implants for larger implants (I do not suggest this option), second option is fat transfer on top of your current implants (if done well can be a powerful combination), or implant exchange for fat grafting (if you want to be implant free).

Lets review your options:

1) Exchanging your implants.  You will be left with larger breasts due to a larger volume implant, however you will likely have a higher risks for complications.  Capsular contracture, rippling, thinning out of your tissues which will lead to your implant being visible, implant mal position giving you a “uni boob” or “double bubble” or high riding implants.  I can keep naming complications……..  its about 30% likely. Look up complications of implants (link to my webpage that talks about this).

2) Fat grafting on top of your implant.  If done properly it can correct asymmetries and augment different parts of your breasts. However, it can be dangerous if done by an inexperienced surgeon, because the implant can be ruptured with the cannula, and can lead to silicone everywhere.

3) Implant exchange for fat grafting is a great option if you want to be implant free (get rid of the silicone in your body). It is safest, and most incredible option out there.  The procedure is performed by removing your implants via a small incision on the axilla, and then you undergo fat transfer to the breast.  The fat has to be placed very carefully around the capsule where your implant was, which will lead to the obliteration of the pocket where the implant was located.  If done correctly, you can expect to go into a high C and even a low D with no implants!  By this method, you will augment your breasts using your own tissues, which will eliminate all the complications that I mentioned above with implants.  This is my suggestion for you, but make sure you choose a center of excellence, when it comes to this procedure.

Q: Fat transfer instead of lift to breasts?

A: Breast Droopiness After Fat Transfer Breast Augmentation

The best way to perform fat transfer breast augmentation is using multiple small holes all around your breasts.  The holes are placed in the inferior aspects making sure that they are ultimately never seen.  It is truly a scarless breast augmentation if done right.

The key to the multiple holes is to allow the surgeon to evenly distribute a fraction of a cc in a fine mist character.  The fine mist must be placed in a 3D configuration at multiple layers from superficial to deep all along your breasts.  By doing so, it guarantees that the small droplets of fat will have contact with a surface that will help them survive (bring blood supply).

Because it should take 1-1.5 hours to perfectly distribute the fat in both breasts (for good results and prevent fat absorption), it means that there should be hundreds of passes with the cannulas to disperse the fat.  These passes create scar tissue, which is very fine, and cannot be felt in most situations.  The scar tissue also serves as support fibers for your breasts, which help prevent droopiness in the future.  Think of the scar tissue as an internal bra that provides support within.

In terms of how long should your augmentation last?  If done right, whatever fat survives (in my hands I have about 90% volume retention), will remain for the rest of your life!

Q: Fat transfer to breast – when I start working out, will I lose the fat to my breasts as well?

A: How Weight Fluctuations Affect Fat Transfer Breast Augmentation

This is a very good question, and perhaps one of the major reasons results vary so much.

Here is the key to success.  Why do our best results occur with thin patients and not with heavier patients?  The reason is that in thin patients, their fat is mainly composed of cells that are not full of oil.

As the patient gains weight, their fat cells become large and full of oil, which makes them even more vulnerable to rupture during harvesting and transfer, which is the reason the absorption rate and final volume is lower.

Therefore for the same volume (cc of fat injected), the fat of heavier patients will contain more oil and less fat cells per ml.

This is the reason I ask all my patients to not gain weight, but rather stay the same or even loose weight prior to the procedure.  I can then transfer more fat cells per ml that will survive the harvesting and transfer.

This leads to the original question about weight fluctuations after the procedure.  If you gain weight afterwards, the fat cells that survive will enlarge and become full of oil, which will make your breasts bigger.  However, what if you loose weight?  The small fat cells that are not full of oil will remain stable, and will not get smaller, so you can expect the size of your breasts to remain the same.  The fat in the rest of your body that has preferentially larger fat cells with oil will get smaller.  If you go into a state of starvation, then the fat cells will start to break down to provide your body with fuel for survival.

Therefore with weight fluctuations after fat transfer breast augmentation will only lead to you breasts getting larger if you gain weight, but will tend to stay the same if you loose weight.  Unless your body goes into extremes leading to a state of starvation.

Q: What are my options for a breast lift?

A: Breast Lift Options

A breast lift can be achieved with basically three techniques:

  • Augmentation with fat grafting or implant (if you have very mild droopiness)
  • The traditional approach with cuts on your skin (lollipop or just vertical)
  • Percutaneous breast lift without incisions.

A breast lift is one of the most rewarding procedures that you can do, but many patients do not want it due to the scars.  Using the percutaneous lift method you can have your breasts lifted so they feel, look and behave like normal breasts without incisions!  No Scars (Link to the videos of how the scareless breast lift is performed).

This is a minimally invasive procedure with maximum results and leaves no scars, and you don’t have to deal with the complications of implants.

It might take two operations to give you the lift, volume and contour that you will be happy with, but it is possible. The surgeries are spaced 3 months apart.

Q: Will I see a lift with fat transfer?

A: Breast Lift and Augmentation with Fat Transfer

Fat transfer breast augmentation is getting more and more popular.  The concepts of a breast lift and a simultaneous augmentation are important.

The key points are:

1) Breast Augmentation has a vector of force against the skin on your breasts that is outward (you make the breast bigger, and the skin stretches).

2) A breast lift has a vector of force against your breast gland that is inwards (you make the skin tighter to lift your breast, and constricts and lifts the gland).

There are two reasons why not to perform a simultaneous breast augmentation with fat, and a lift.

  • First, with a lift you make incisions on your breasts, which creates spaces (cavities) within your breast. The fat will enter these spaces and will make lakes of fat, which will end up as fat necrosis, and this is really bad.  The fat will die, will get hard, and will lead to all kinds of problems.
  • Secondly, the vectors of force will end up fighting each other, and if you had an implant, there will probably be no real consequences (many plastic surgeons do this procedure).  However, with fat transfer, undo pressure will be placed on the fat, which will lead to decreased blood flow, and space for the newly placed fat to survive.  End results will be absorption of the fat, and you having very little to no augmentation, plus the possibility of fat necrosis.  Again, all kinds of bad stuff.

There is another possibility, which is the percutaneous breast lift, this is a technique which is not widely available, but allows the surgeon to lift your breast with no incision.  NO SCARS.   However, even with this technique, my best breast augmentation cannot be done during a scarless breast lift and vice versa. My best scarless breast lift cannot be done during a fat transfer breast augmentation.  You can achieve perfect results if you separate the procedures within a 3-month span.  However, if you want the scarless breast lift and a simultaneous fat transfer breast augmentation, you can achieve adequate results, but not perfect results.

Q: Second round of fat transfer to breasts….. How much of a size increase can I expect?

A: Fat Transfer Breast Augmentation: Fat Survival

Great question, and it deals with the reasons why the results around the country/world differ so much.

The Key Points are:

  • It is important to understand the principles behind fat graft survival. The best analogy is the person that is driving a Ferrari on a congested highway.  The fat graft is the Ferrari, and your breast is the congested highway.  Does not matter how great your car is, if it will be sitting still in the highway.
  • The highway needs to be bigger.  Your breasts need to be prepared to best accept the amount of fat graft required for the size you would like to achieve.
  • An External Tissue Expansion devices stretches your breast tissues (even after fat grafting) and increases its vascularity to generate a favorable recipient bed for the fat grafts.  This key step is critical for women like you that would like to be much larger, and will certainly help you increase even two-cup sizes with one session of fat grafting.
  • The required amount of sessions depends upon the relative amount of tissue deficiency or excess, and the patient’s compliance with external expansion prior to grafting.
  • There are other techniques that can help enlarge your breasts such as a reverse abdominoplasty (done at the same time as fat grafting, without incisions), which brings tissue from the upper parts of your abdomen into your lower breasts.  This technique can bring by it self about 200 cc of tissue, and will also help sculpt your abdomen and waist (Link to the video of the reverse abdominoplasty technique).

Fat transfer breast augmentation represents a phenomenal incisionless technique, which is safe, and minimally invasive.

Q: Would you recommend fat grafting to the breast? I don’t want implants.

A: Fat Transfer Breast Augmentation

In my opinion breast augmentation with your own fat is the wave of the future.

Performing breast augmentation to give you both the volume and contour using an external tissue expansion followed by fat grafting is a safe and minimally invasive procedure, where all of my patients are extremely satisfied.

Breast augmentation without the use of implants is the superior way! No questions about it.  This is a minimally invasive way with NO SCARS, to provide you with natural looking and feeling breasts without the complications of implants, which are in the 30%.   In addition since I will have to perform liposuction to obtain the fat graft, you will benefit from the secondary benefits of body sculpting, which are amazing.

Q: Stem cell enriched fat grafting to breasts in a very thin patient. Any suggestions?

A: Fat Transfer Breast Augmentation

It is my pleasure to answer your questions.

Performing breast augmentation to give you both the volume and contour using an external tissue expansion device, followed by fat grafting is a safe and minimally invasive procedure. Breast augmentation without the use of implants, in my opinion, is the superior way!

It is a minimally invasive way with NO SCARS, to provide you with natural looking and feeling breasts without the complications of implants. In addition since I will have to perform liposuction to obtain the fat graft, you will benefit from the secondary benefits of body sculpting, which are amazing.

Most of my patients are thin around 100-110 lbs, and typically there is no issues finding enough fat to get you from an A to a C cup.  If you want to be any larger, it is likely you will need a second session of fat grafting, which can be done down the road.

You should choose a center that has lots of experience doing this procedure, to optimizes your results.  This procedure is truly about paying attention to the small details, which are critical to great results.

Q: Is it better to remove implant and scar tissue from capsular contracture and allow time to heal before fat transplant?

A: Implant Exchange for Fat Grafting

Great question!  This is a very important and critical point to understand, and to be honest not many plastic surgeons understand it.

Performing implant to fat conversion to give you both the volume and contour is safely done with fat grafting, with no evidence of risk of breast cancer.

  • [Kronowitz SJ, Mandujano CC, Liu J, Kuerer HM, Smith B, Garvey P, Jagsi R, Hsu L, Hanson S, Valero V. Lipofilling of the Breast Does Not Increase the Risk of Recurrence of Breast Cancer: A Matched Controlled Study. Plast Reconstr Surg. 2016 Feb;137(2):385-93.]

It is a minimally invasive procedure, where all of our patients are extremely satisfied. Breast reconstruction/augmentation without the use of implants is the superior way! Its a unique technique and not many people around the world do it right. In addition, since I will have to perform liposuction to obtain the fat graft, you will benefit from the secondary benefits of body sculpting, which are amazing.

Here is the trick.  When you have an implant, it is functioning as an internal tissue expander.  It is keeping the shape, contour and relative anatomy of your breast in place.   The moment you remove the implant, you will have a cavity (space), which must be replaced with something (either another implant, or fat grafting).

If you remove the implant, and do nothing to the space that is now empty, your breasts will not only be deformed, but they will form scars to your chest wall (or muscle if the implant was paced subglandular).  The scars will contract and pull your nipple/areola into unpredictable locations.  In addition, the central projection of your breast will be lost, and it will be very difficult in the future to release these scars and provide the shape and contour of your natural breasts.

Therefore the best sequence is implant removal and augmentation with fat grafting during the same procedure.  DO NOT, I repeat, DO NOT have your implants removed without addressing proper volume replacement with fat.  It must be done at the same time.

The question over how many procedures, and how to achieve the best results depends on how big your implants are (how big the space will be). It is difficult to replace in one operation a 700 cc implant, and therefore it might take two operations, each time down sizing your implants and replacing them with fat grafting.

Fat survival has to do with many elements, technique, fat harvesting and delivery, understanding pressure gradients within the breast, how you treat and prepare the fat for transfer, and other post operative adjuncts that optimize fat survival.  This procedure is truly about paying attention to all the small details.

Thanks again for a great question on such an important topic that is dominating our field.

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