Can I get fat transfer to breasts even though I have implants? (Photo)

Question

I am 32yo female who has undergone 10 operations on my breasts over the last 10 years. Earlier this year (over 6mo ago), I had my 7yo textured silicone implants removed and replaced w/Mentor Boost smooth silicone, along with a donut lift and GalaFlex for added support and also to help with rippling. I still have rippling on my left side. Would a fat transfer help with this? Also, do implants with GalaFlex still go thru the drop&fluff process, or do they settle differently? Thank you.

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. To answer your question directly, yes, you can have fat grafting to the breast with an implant in place. Sometimes it is required to remove the implant, place the graft, and then replace the implant, so as to protect the implant during grafting. Usually with placement of soft tissue support mesh, there is much less settling with time and with proper use of the mesh, the position should be relatively stable over time. 
Also, not sure of the timeline of the photos you shared, but I would suggest that, depending on your goals, you probably need a more aggressive lift to achieve a more youthful appearance. A "donut lift" cannot remove significant tissue in the horizontal and vertical dimension and is often not adequate to shape the breast. Especially if an implant is used at the same time and the donut lift is over-used, it will lead to stretching of the scar and areola and a poor outcome. 
My suggestion is that if you have really had 10 breast operations in 10 years, then I would consider seeing someone with significant experience in revision breast surgery to have a detailed discussion about your goals and how to safely obtain them. 
Good luck!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Joel Patrick Maier, MD · Answer

The most important question here is what do you want? Ten breast operations with unintended results deserves re-thinking. My opinion is your breasts are too large for your frame, you have asymmetry with some degree of ptosis and stretching of your tissues bilaterally. It may behoove you to remove the implants, let your tissues recover and then carefully consider what you want long term. Thank you for sharing.

Ronald J. Edelson, MD · Answer

Yeah that a new thing that it seems everyone’s doing. Injecting fat around implants. Dies it work? Who knows. There will be the inevitable poorly thought out problems such as the occasional punctured implants. If you send a better photo I could tell you what needs to be done

Daniel Barrett, MD · Answer

Dear libby850,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hilton Becker, MD · Answer

Fat grafts are an excellent method for correcting  and enhancing the shape of the breast after breast augmentation

Connie Hiers, MD, FACS · Answer

If you have donor fat, it can be added for better coverage, even with implants. The purpose of the mesh is to hold the implant in a certain position and avoid more dropping and settling and sagging.

Douglas Taranow, DO, FACOS · Answer

The breast still settle with Galaflex.
The rippling may be reduced by fat grafting to the breasts 
Your left breast may require a revision to lift it up.

Darryl J. Blinski, MD · Answer

Would like more posted photos. Yes fat grafting in implanted breast is fine but by only with a very experienced plastic surgeon. As for rippling with gals flex is very common especially if you already had it. And fat grafts can improve. In your previous question about buttock dents and cellulite it appears your skin forms cellulite and rippling. Best to virtual consult with…

Mats Hagstrom, MD (license on probation) · Answer

It’s possible to graft fat on women’s breasts that have implants.
Different providers have different opinions and each provider will use their own technique.
My approach is to start by removing the current implants since they are at risk of being punctured during the fat transfer process and it is undesirable to end up with fat grafts inside the implant capsule space(sitting between the implant and capsule. 
After the implants are removed a temporary implant called the Sizer is placed in the pocket and filled up. Damage to the sizer it’s not a big deal other than simply having to put in a new one. fat can be grafted from a both internal and external approach which is slightly better than grafting from an exterior approach only.
The presence of foreign body with mesh for example is not ideal both physically and physiologically. Your mesh is observable and depending on how long ago it was placed depends on if it’s still physically present in your breast tissue. if it is then it could be dislodged from the process of grafting fat.
The success of fat grafting is highly dependent and primarily two variables. The first is the presence of sufficient amounts of healthy host tissue to support the graft. If there’s a significant shortage of tissue to graft into the not very much fat is going to stay alive and the graft will not be very successful. With an abundance of post tissue fat grafting becomes more predictable and more successful.
The second variable is skill and experience of the provider.
There are a lot of variables to take into consideration and the information provided is not sufficient especially an assessment of the amount of host tissue which I’m guessing is very thin since you’re having rippling. with a very thin host tissue the amount of graft that will successfully survive may be limited.
Likewise those who have a very thin layer of tissue between the implant and their skin are the ones that benefit augmenting the tissue layer the most.
With that many previous operations both patients and surgeons should be reluctant to do more surgery and only do so when there is a clear indication that this is in the patient’s best interest.
Making that decision well requires an awful lot of skill and experience.
Well Liposuction is not your primary goal it is however critically important patients that plastic surgeons properly for their ability to perform quality liposuction as well.
I’ve seen too many people disfigured from Liposuction for the pure purpose of fat transfer to care for.
If you’re up for moving forward with that transfer you should make absolutely sure the surgeon who is doing it has the skill and experience.
It may be difficult to come up with an impressive collection of before and after pictures of patients who have had fat graft over implants. Hopefully providers your considering will have done that procedure at least a handful of times and I’ve preferably done hundreds if not thousands of breast fat transfer cases.
Ask each provider to open up their portfolio and show you their entire collection of before and after pictures. as always, being shown a handful of preselected pictures representing the best results of a provider‘s career is totally insufficient to get a clear understanding of what average results look like.
In this case you need to see the best results and the worst results.
Honest and experienced providers should have no difficulty showing you those type of images upon request.
I mentioned earlier that finding a surgeon who can show you a significant number of breast fat transfer cases on Augmented patients will be challenging. Four primary breast fat transfer an experience provider should be able to show you at least 50 sets of before and after pictures.
The concept of grafting fat what do you need it the most is correct. Whether it’ll make a significant impact will be worth it in the end is another thing. Every time you operate you take the risk of contamination creating chronic capture contractures or developing surgical infection. should mesh material become contaminated you could potentially lose your breast.
All plastic surgeons are familiar with the expression “ The enemy of good is perfect”. It’s sometimes said as “the enemy of good is better”
Regardless it is something we should all be reminded of on a regular basis.
Good luck,
Mats Hagstrom MD

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