Fat Transfer to Upper Breasts to Hide Rippling from Implants?

Due to some reason, I can only have breast implants placed over the muscle. I know that chances that I'll ripple are high, especially since my upper chest is very "bony" with little fatty tissue and thin skin.
I am concerned about the implants being palpable and visible. I'm hoping that while having my breast augmentation, fat transfer could be done at the same time on the tops and sides of the breasts to provide better tissue coverage for the implants, and to camouflage the bony chest. Is this possible? What would be the average cost for this?

Doctor Answers 7

Breast augmentation, fat grafting, silicone implants

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Dear Rainy Rainy

Thank you for your question. Fat grafting at the same time as your augmentation is possible. Certainly you need to have extra fat for the harvesting and injection. The fat grafting can also be done at a later date if you desire,

The recovery from the combined procedure may be a little longer- bruising and swelling but should not inhibit you from resuming normal activities immediately after surgery.

With Warm Regards,

Trevor M Born MD

Toronto Plastic Surgeon
4.9 out of 5 stars 126 reviews

Fat augmentation and breast implants

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Hi, the best way to avoid rippling in this situation is to have silicone gel implants placed. Saline implants placed over the muscle, especially if you are very thin or have very little native breast tissue, will be more obvious and will be more likely to show ripples. Fat augmentation can be done, but this is very controversial in the plastic surgery community. Many of us hesitate to place fat into an organ that is at risk for cancer, as we don't know if this will make your mammograms more difficult to read in the future. We do sometimes place fat for breast reconstruction patients after mastectomy, as they have no breast tissue left that might be prone to cancer. i would discuss this with your plastic surgeon to make sure that you are advised about the risks and benefits. The cost would vary depending upon where you are and how much fat would need to be placed. I personally would recommend using gel implants and then assessing your results once the swelling has resolved. Chances are that you would not need fat grafting that time. Good luck, /nsn.


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Breast Implant Rippling most often occurs when there is insufficient soft tissue coverage due to little overlying body fat and breast tissue. Implants placed beneath the muscle help to minimize this phenomena but the lower and outside breast (as pectoralis muscle is no longer present), towards the cleavage where the muscle thins out or on top of the breast where breast tissue is often lacking are the most common places to see rippling. It is often accentuated with certain positions (e.g. bending over,or leaning). Most of the time, rippling is felt along the outer side of the breast and the inner side of the breast next to the cleavage. Breast implant waviness (rippling) that is felt but not noticeable to the eye is very common and should not be a concern. However, when rippling is visible, patients are often self-conscious about their appearance.
Factors that are associated with increased rippling include:
  • Traditional Saline implants (IDEAL® Saline implants less likely)
  • Textured implants
  • Large implants
  • Thin patients with low BMI
  • Implants placed above the muscle
  • Prior history of rippling
Factors which are less likely to have rippling include:
  • Heavier and larger breasted women
  • Using a highly cohesive form-stabile silicone implants (gummy bear)
  • Smooth implants
  • Smaller implants
  • Submuscular placement
Once rippling occurs it is very difficult to correct. Rippling can be minimized by placing a biologic fabrics (e.g. AlloDerm®, Strattice™, SERI®), submuscular conversion if implants are above the muscle, fat transfer, use of adjacent tissue (muscle or fascia) if available, and in persistent cases implant removal and fat transfer. Seek the care of the best board certified plastic surgeon possible with experience in breast revision surgery.


Yes fat can be used to camouflage rippling

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Fat grafting can be an excellent option to add fullness to the upper pole of the breasts and to cover rippling of underlying implants, and to correct assymetries

However fat grafting is very technique sensitive, and surgeons who do not pay attention to each aspect of the process may not get consitent results. Every component of the procedure  from fat harvesting, to fat purification, to micrografting technique, can make a difference. With careful attention to every step, anywhere from 70-90% take of the injected fat can be expected to survive.

We have installed the first Liquid Gold mini fat bank in the US, and with just one liposuction procedure we are able to successfully store fat, which allows us to save as much fat as needed for one or more procedures.

Fat Transfer

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Fat transfer can be used but it may or may not be advisable at the time of your augmentation surgery. It really would depend on your anatomy. The real question is why can't your implants be placed submuscular. The only patients in whom this is not possible are patients who lack the pectoralis major muscle.

Marc Schneider, MD
Fort Myers Plastic Surgeon
4.6 out of 5 stars 28 reviews


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Please find an experienced Board Certified Plastic Surgeon and member of the Aesthetic Society using the Smart Beauty Guide. These Plastic Surgeons can guide you on all aspects of facial surgery, breast augmentation and body procedures including tummy tucks or mommy makeovers!

Fat grafting is a valuable tool in breast surgery. This technique has gained more popularity over the past 7 years. There are many techniques used to harvest the fat, process the fat and then re-inject the fat. Conventional suction lipectomy is performed with a small diameter cannula, processed by separating the liquid and fibrous tissue from the fat, and then placed into syringes for re-injection or through a closed system.

Breast Enlargement with Fat Transfer AND implants

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In general, placing the implants under the muscle decreases visible rippling, as does the use of silicone gel rather than saline.  I'm not sure why you can only have them placed above the muscle...but, if accurate, you can also have fat grafting, which should help.  Doing it at the original time is also possible, though you may need additional procedures at some point to fully correct the contour and to adapt to whatever changed occur to your implants over time.

I hope that this helps and good luck,

Dr. E

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.