Breast Reduction Too-Small... Fat-Grafting or Implants? (photos)

Hello. I am now 12 weeks post-op after having a breast reduction. I am still unhappy with my "too small" results. My plastic surgeon has suggested fat-grafting after six months to correct the small size, weird boxy shape, and lack of projection. However, after researching... I am now unsure if fat-grafting will provide me with my desired results. I would like to increase from my current "too small" size C to a size DD. I have attached a recent photo of myself dressed wearing a 2-cup pushup bra.

Doctor Answers 16

Increasing breast size with breast implants

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Thank you for sharing your results with us.

Your research has served you well. Although fat transfer is a natural option, it can only increase the breast size by ½-1 cup. Like the rest of my colleagues, I too would advise a breast augmentation with implants after 3 months to allow you to reach your desired goal of a size DD.

Nevertheless, there is some information that I think would help you to know about all your options and the process of selecting the right implant size.

Please note that it is a common misconception that implant size correlates with the bra-cup size. Many patients are often confused regarding that because of reading reviews or hearing about what their friends got.

First, bra sizes clearly vary among manufacturers, and they can label the cup size by any designation they choose. So when you say you want a full DD-cup, it is not much helpful to us surgeons. But if you have specific measurements, and a specific bra, then the discussion can move forward.

Second, there is a confusion over sister sizers which complicates things. For example, a patient wearing a 34C may also fit into a 36B bra.

With so many problems, it is no surprise that many patients are dissatisfied with their outcomes. Thus, establishment of an accurate band-size is important, as is recognition that cup sizes are a range and ever changing.

Even though you may give importance to cup size designation, what should matter most is that the implant looks good aesthetically and that the chosen bra fits and feels comfortable.

This is exactly why patients must have a consultation.

You must have an in-person consultation with a board-certified plastic surgeon, and they will assist you in choosing an implant that is more tailored to your breast characteristics. If you want natural looking breasts, the implant has to fit YOUR body dimensions. The more you deviate from the proper fit, the more fake your breasts will look.

For this reason, please follow your surgeon’s recommendations regarding implant selection during your consultation. Surgeons use what is called tissue-based planning. The planning takes into account the effects of implants on tissues over time, risks of excessive stretch, excessive thinning, visible or palpable implant edges, visible traction rippling, ptosis (Sagging), and breast tissue wasting. To determine the implant size, breast measurements must be made: 1) Base Width of the existing breast tissue, 2) skin stretch, and 3) Nipple-to-Inframammary Fold distance. The combination of these measurements will help determine tissue coverage and the required implant volume to optimally fill the breasts. If the breasts are different in size, then you can symmetrize them by using slightly different sized implants.


If you choose a large implant that exceeds your breast boundaries, or which overly stretches your breasts, or is too round, then it will make your breasts look unnatural. In fact, there is higher likelihood of bottoming out (i.e., an empty upper pole, nipple sitting too high on the breast), double bubble deformity, implant malposition, implant visibility, breast sagging, and breast tissue wasting. So going big is good, but going beyond limits will get you in big trouble…pun intended.

I would also like to add that fat transfer to the breast coupled to implant-based breast augmentation can be helpful in adding volume where it is lacking. It can be used to enhance the cleavage area, improve symmetry, and change the shape of narrow based breasts. Fat transfer to the breast will also improve the skin quality overlying the breasts through a rejuvenation effect.  

Also in cases where there is higher risk of implant visibility and palpability is possible if you are thin, and this can be fixed used fat grafting where areas with less tissue coverage are filled with you own fat to provide better contour and coverage. 

So it is important that you communicate your goals very clearly, but understand that you need to have realistic expectations.

Again, consult with a board-certified plastic surgeon, and best of luck!

Breast fat transfer or implants?

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Thank you very much for your question and photographs. At 12-weeks post-op, it is still too early to seek a revision procedure, as your breast implants have not fully settled and residual swelling may remain. However, as your surgeon suggested, you can consider a revision procedure at the six-month post-op mark. It is important to know that while a breast fat transfer can provide excellent results, however, the technique will not increase the size of your breasts by more than one cup. To achieve your desired size of a DD cup, a breast augmentation with implants will be necessary. I would recommend speaking further to your operating surgeon about your breast augmentation options.

Not too small.

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Your breasts are still going through the healing process and will continue to change shape for several months. However, the reduction was done to relieve your musculoskeletal problems and this should be noticeable already. IMO, you are not too small although there is a mild difference in size, with your right breast slightly smaller than your left breast. If this asymmetry bothers you, fat grafting to the right breast can improve your results.

Fat grafting versus breast implants for augmentation after breast reduction.

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You look to have a good result from the breast reduction and it would be much too early to consider reoperation. Using size is you can determine what additional volume suture. If the breasts are symmetrical, implants are probably preferable to fat grafting.

Fat Grafting with Augmentation

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Fat grafting is a natural option to increase the size of the breast using the patient's own body fat to enlarge the breast size and contour. 

Natural Breast Enhancement (fat transfer breast augmentation) – We offer augmentation using your own fat to add volume and improve breast shape.  This procedure can also sometimes be done under local anesthesia vs. general anesthesia and requires less recovery time

BA vs fat grafting

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With as much breast tissue you have remaining and your desired size, you would get the best result with a BA. It would be very difficult and require multiple surgeries to go from a C to a DD with fat grafting, not impossible, but difficult and unpredictable

Breast Augmentation after Breast Reduction

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I agree with you that an implant-based augmentation will help you get a more rounded, lifted and full upper breast look with a dependable size. You have a great result from your breast reduction but it is true that it can look boxy (square) at the bottom and lack upper pole fullness as well as be a size that you don't want. I think a breast implant will give you great results! Best wishes!

Reduction results

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At 3 months after surgery you have good looking results . The bottom will round out with time as your breasts continue to settle. I think that your breasts are a good size for your stature, but if you truly want DD cup breasts an implant is the choice. Wait till a minimum of six months post op or until you have completely settled.

Barry M. Schwartz, MD
Weston Plastic Surgeon

Breast augmentation options

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Thank you for the question and photos.  Yes, a breast augmentation with an implant or fat transfer can be performed.  There is some chance that your breast reduction and your original breast shape can limit the "perkiness" that can be achieved.  You will certainly have to consider what is most important to your--size vs shape" as well as the possible limitations of having both "perky" and "large" breasts.  Fat transfer may allow your to transition to a larger breast size as well as place the extra volume centrally and in the upper pole as opposed to an implant that requires the volume to also occupy the lower pole of your breasts.

I hope this helps.

All the best,

Dr. Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 170 reviews


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Thanks for the question and the photo. I agree with the others that breast implants are the best bet to increase you to a size you'll be happy with. Waiting 6-12 months before doing anything is also a good option as you want to make sure all of the swelling is gone before undergoing additional surgery. Best of luck

~Dr. Sieber

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.