Unevenness 1 month after breast fat transfer - is there any way to correct this?

Question

I had breast implants explanted about a month ago with a fat transfer to my breasts. I noticed today that my left one is maybe a half cup larger than the right and hangs a little lower. Is there any way to correct this or stop it from continuing? I'm worried that the difference is going to keep getting worse

Alan Gonzalez, MD, FACS · Answer

Hello @Compassionate29491, thank you for your question. It depends a lot on the fat seeding technique used by the doctor performing the surgery. By evaluating the patient, it is possible to gain a better understanding of what can be achieved through a surgical process. In addition, it is possible to set expectations according to what the specialist can accomplish. As well as to allow sufficient time after the event to recover. Best wishes! Alan Gonzalez MD, FACS. International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP)

Derek Fletcher, MD · Answer

Unfortunately, there is nothing you can do at this point but wait out the final result which typically takes at least 6 months. At 1 month, your breasts are still in the most intense phase of managing swelling, inflammation, and fat graft evolution.

Daniel Barrett, MD · Answer

Dear Compassionate29491,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

right now, you are early in your healing and may still have some swelling. At 6 months from surgery, you can address any concerns you have at that time safely.  Please discuss your concerns with your surgeon now.

Mats Hagstrom, MD (license on probation) · Answer

Grafting fat at the same time as doing explantation makes a lot of sense for multiple reasons.
It does also create some major negatives or drawbacks.
The biggest issue is that patients do not have a baseline reference of what their breast looks like without implants before the fat transfer.
Since you have no baseline and don’t know what your breast looks like without the fat transfer you don’t have anyway to judge the impact of the fat transfer procedure.
Even if the surgeon was insightful enough to have you sit up in the operating room after explantation and take pictures before grafting it still isn’t quite the same as healing up over time without implants in regards to what your breast actually look like without implants.
Since you opted for having the two procedures done at the same time you’ll have to have faith that the procedure was done adequately and your new baseline will be the way you heal up in about 3 to 6 months from the date of surgery.
If that point you can make an assessment and determine if further surgical intervention is indicated or if you’re content with the appearance of your breast.
Women who desire breast augmentation especially volume in the upper half of the breast should consider keeping breast implants.
Fat transfer cannot create the shape or volume that implants can and this should be clearly taken into consideration when making the decision to have explantation.
Unless there are issues that cannot be resolved with implants patients are generally better off keeping implants in place.
Fat grafting when done correctly can increase breast size by about 1/2 cup. it does not make a big impact in regards to shape of the breast on the volume.
If your nipple position is below your inframammary fold then you’ll need a breast lift to correct that.
With limited information and without the pictures we really can’t make an assessment or give you any quality advice.
Follow up with your provider and share your concerns with him or her.
Delivering consistent quality liposuction and fat transfer results is more difficult than most people believe. The number of plastic surgeons who can do these procedures well consistently including the ability to show accurate before and after pictures and deliver similar results based on the quality assessment is less common than people think.
Personally I recommend patient be highly selective before choosing providers for liposuction or fat transfer procedures.
To do that I recommend patients have multiple in person consultations to find the best provider.
There is no correct number of consultations patients need but the more consultations you have to vet plastic surgeons the more likely you are to find the most talented provider.
I generally recommend starting with at least five consultations and consider having many more before choosing a surgeon.
During each consultation ask providers to open up their portfolio and show you their entire collection of before and after pictures.
Ask providers to show you examples of previous patients who have similar body characteristics to your own.
As providers to show you examples of excellent outcomes, average outcomes and outcomes that did not turn out as well as they had hoped.
Obviously if you’re doing an explantation and fat transfer at the same time it is very difficult to anticipate exactly what that will look like because women have implants of different sizes and there are simply too many variables.
You can however decipher which surgeon gets the best results from primary breast fat transfer. Knowing that somebody has mastered breast fat transfer and can consistently deliver quality results including making accurate assessments and predictions is probably the best you’re going to get but that is far better than having a procedure without confirmation of this surgeons skill or experience.
Mastering fat transfer requires years of experience doing thousands of cases.
It is unfortunately seen as a simplistic procedure by too many plastic surgeons who intern failed to deliver consistent quality results or have the ability to accurately make assessments and predict exactly what breast or body areas would look like after the procedure.
People should be particularly selective when it comes to liposuction and fat transfer because the variation and outcome of these procedures vary more than any other plastic surgical procedure I’ve ever seen based purely and who does the operation.
Best,
Mats Hagstrom MD

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