Fat transfer vs implants for breast asymmetry
An examination is necessary to determine what exactly is the best options for significant asymmetry. Generally fat transfer by itself nor implants will not correct major asymmetries. Simply adding volume with either implants or fat will not correct differences in the inframammary crease, amount of skin, drooping. The best way to achieve symmetry in significantly differing breasts is to make achieve similar looking breasts and then place similar sized implants or same volume of fat transfer to both breasts. This may require a breast lift or reduction in either or both breasts. A consultation with an experienced plastic surgeon will be fruitful. Best of luck. Dr. Michael Omidi
I believe that fat grafting can be used to treat minimal asymmetry or contour defects, especially in the breast cancer reconstruction population. With the amount of asymmetry you are talking about, you are much more likely to have a lasting and successful volume equalizing procedure if implants are used.
Congratulations on doing your homework. The fact that you recognize that implants means having future surgeries down the road, means that you have thought about this more than most. I will say what you describe sounds like a tough problem if you truly have an almost 2 cup size difference between your breasts.
There are a couple factors to consider. One is how much fat you have to donate. Someone who is very slim to begin with, might struggle in terms of getting enough fat for augmentation. Another question would be are you satisfied with the larger breast and just want the smaller breast to "catch up" in size to larger one? If so, then fat grafting would be a good option as long as there is enough donor fat. It will probably require 2-3 sessions of fat grafting as well since a fat grafting session typically only can increase breast size 0.5-1 cup size at a time. But....it would avoid the need for implants.
Now if you were not satisfied with the larger breast and wanted it bigger, or maybe it needs a lift. Then a composite operation might be more advantageous. This would involve trying to get in the right ballpark in terms of size with implants, and then using fat to contour, shape, and camouflage the breast implant and get it just right.
Most data has shown there is about a 60% retention of fat in breast fat transfer, but this depends on several factors. What does survive, typically lasts forever unless there are drastic changes in weight.
A Plastic Surgeon can help you navigate these decisions with a consultation. Good Luck and please keep asking questions!
Implants are predictable and fat is not
You should consider implants. Fat grafts will not succeed. Not only that, fat grafts can leave permanent mammographic artifacts.
With that much asymmetry in size its best, in my opinion, to get the breast volumes the same then put implants of the same size in each. A hybid procedure combining fat grafting with implants sometimes is an option as well. If you can get the volume of breast tissue and fat the same on both sides, then as the breast ages and changes in size, the symmetry is more likely to be close. With a large implant on one side and a smaller one in the other, any change in intrinsic breast volume (ie weight loss or pregnancy) will cause asymmetry to recur. Discuss with board certified plastic surgeon with experience with these types of cases. Good luck
With a 1.5-2 cup size difference, I think you will get much better symmetry with implants. But sometimes, a combination of implants and fat transfer is an option as well. Discuss both with your plastic surgeon and good luck.
Fat graft to one breast or implants in both
Size asymmetries can be very challenging. The BRAVO fat grafting system for fat grafting to breasts has been very effective in capable hands that have done many cases. For physicians that don't do this regularly, their patients may be better served by asymmetric implants. See a board certified plastic surgeon and ask them directly what their BRAVO experience if any has been. If it is none, consider implants or find someone experienced in BRAVO. Good luck.
With this degree of asymmetry it is more likely would obtain a good correction with implants rather than with fat grafting. Fat grafting results can be subtle and may need to be repeated multiple times for a significant result.