Can I choose where my fat is grafted from for my breast augmentation?

Question

My surgeon has said I'll need fat grafting for my BA. I know most will harvest a small amount from the inner thigh. But I have axillary fat which annoys me so was hoping he could suck out the fat from there instead. Is this possible? I think it would make the overall look of my new boobs nicer too....

Kenneth Hughes, MD · Answer

In general, the abdomen and thighs are preferred donor sites but fat from other areas can be used. The fat must be injected through multiple planes in small amounts to the breast tissue through one tiny incision under each breast.

Daniel Barrett, MD · Answer

Dear beauty395,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ronald J. Edelson, MD · Answer

There probably is not enough fat to transfer from the axillary. But you could have that area suctioned at the same time as the rest of the procedure

Connie Hiers, MD, FACS · Answer

Fat can be taken wherever you have excess. Some axillary fullness is actual breast tissue and not fat and is not useable.  Please discuss this with your surgeon.

Douglas Taranow, DO, FACOS · Answer

You should definitely vocalize your concerns with your surgeon.  The axillary fat is usually suboptimal in volume to aid in augmenting the breasts so your surgeon will undoubtedly use other areas as well.  Let he/she know where you would like the fat harvested and see what their response is.
Best wishes.
Dr. Taranow

Kenneth R. Francis, MD, FACS · Answer

Dear beauty,
It takes quite a bit of fat to perform an adequate fat transfer breast augmentation.  There is likely not enough in your axilla to amount to much breast enhancement.  So, you would likely need other areas harvested.  Good luck!

Mats Hagstrom, MD (license on probation) · Answer

Delivering consistent quality liposuction and fat transfer results is difficult and the number of providers who do these procedures well on a consistent basis is rather limited.
The most common area to harvest fat from is liposuction of the torso. Reducing the torso complements augmenting the breast in an ideal manner. Inner thigh liposuction is technically difficult and often does not deliver the results patients had hoped for. it is also a high-risk area to develop contour irregularities if your provider lacks sufficient skill and experience.
A full torso includes upper abdomen, lower abdomen, love handles, waist, fall back and under arms all the way to the side of the breast. it is basically your entire body without extremities neck and breast. 
Without pictures we can’t make an assessment.
Fat transfer when done correctly still leaves settle results that can generate one and a half breast increase in cup size. Fat transfer does not have an impact on the shape of the breast. patients who want a different shape of their breast should consider better procedures.
In the end there are only two variables that matter when it comes to getting quality results for this procedure. They are patient candidacy and the skill of the surgeon.
Breast fat transfer is in fact two procedures done at the same time. They are liposuction and fat transfer. Patient assessment and the vetting of the surgeon need to incorporate both liposuction and fat transfer.
In other words it’s possible for a patient to be a good or bad candidate for both Liposuction and a fat transfer. It’s also possible for plastic surgeons to be skilled or not so skilled in both Liposuction and fat transfer. The following are some recommendations on how to approach finding providers for Liposuction.
With the addition of fat transfer the only thing I would add is the importance of recognizing patients must be aware of the time frame after pictures were taken to understand fat transfer results.
Early fat transfer results can look extremely impressive but early results do not in any way represent final results.
Do you understand what the final fat transfer results actually look like requires having certainty that after pictures were taken at least 3 to 6 months from the date of surgery.
Do not assume that after pictures shown were taken as final long-term results.
This is especially true for pictures that look really impressive.
Always confirm the exact time frame after pictures were taken in relationship to the date of surgery.
How to find a provider liposuction 
Here’s the process I recommend patient take.
Start by getting pictures of your body the same way plastic surgeons take before and after pictures.
Have someone else take the pictures or use the timer on your camera. pictures should be taken from about six or 8 feet away. Don’t take pictures using a mirror.
Pictures should be taken with the camera at the same height of what’s being photographed. For the abdomen the camera should be at the height of the abdomen. for the thighs the camera should be at the height of the thighs.
Quality pictures require showing your body. Wear loose revealing undergarments that don’t press into your skin. Take pictures of your front, side and back side standing in a neutral position with your arms down by your side.
Print copies of these pictures.
Whenever reviewing before and after pictures whether you’re doing it at home or during a consultation always have your own pictures by your side for a comparison.
Understanding candidacy is key and understanding what the procedure can or cannot accomplish.
When reviewing results look for patients who have similar body characteristics to your own in the before pictures.
If they have different characteristics then what you look like then those results don’t apply to you.
Make a list of all the local board-certified plastic surgeons in your community.
Go to each providers website and document the quantity and quality of Liposuction before and after pictures posted on their website. take a peek at other procedures like tummy tucks etc. for reference. if someone has 25 sets of before and after pictures of the tummy tucks but only has two pictures of Liposuction results and that is probably not The right provider.
This will give you a general idea if providers like doing Liposuction, do a lot of liposuction and get enough quality results to post them on their websites. next choose five of those providers and schedule in person consultations.
There’s no correct number of consultation someone needs to find the best provider but the more consultations you have the better you’ll get at doing consultations including the ability to properly vet plastic surgeons and the higher your chance of finding the best provider.
Considering that a substantial number of plastic surgeons simply aren’t good at Liposuction and the number of providers who are excellent at this procedure is rare so you definitely need to have multiple consultations.
Personally I do not believe it’s possible to find the right provider using a computer or by having a virtual consultations.
Virtual consultations are better than no consultation but in my opinion in person consultations are needed to get a quality assessment and to properly vet the provider.
Take careful notes during each consultation. become familiar with what quality liposuction results look like on people who have bodies similar to your own. Create a rating system for Liposuction results.
Recognize that most pictures available on the Internet either represent some of the best results because that’s what the providers usually put out on their website or disastrous results from patients who are seeking help. most average liposuction results don’t end up as pictures on the Internet.
During each consultation ask each provider to open up their portfolio and show you their entire collection of before and after pictures.
Bring printed copies of your own pictures of yourself.
Ask providers to show you examples of excellent outcomes, average outcomes and outcomes that didn’t turn out as well as they had hoped.
Ask providers to only show you pictures of previous patients who had similar body characteristics to your own.
Again, there’s no point at seeing quality results on somebody who had a different candidacy for the procedure than you do.
Providers may be apprehensive to do this and will generally prefer to show you preselected images representing the best results of their career.
Why this baby more impressive to look at it does not represent average results and it is in your interest to find out what the average results look like and to get a clear understanding of how many of these procedures each provider has actually performed.
For reference an experienced plastic surgeon and should have no difficulty showing you at least 50 set of before and after pictures of commonly performed procedures like liposuction. highly experienced surgeons will in fact have hundreds or even thousands of before and after pictures of commonly performed procedures.
Obviously there are those who are earlier in their career.
Personally I recommend staying with skilled and experienced providers.
When reviewing before and after pictures look very closely at all areas treated with Liposuction. Make sure there are no skin contour irregularities in any of the treated areas. ask the provider to point out exactly what areas were treated with Liposuction and what areas were not treated. then look carefully at transition zones between treated and untreated areas.In regards to Liposuction of the abdomen I view the torso as a single anatomic unit and generally prefer to treat the entire torso as a single unit.
By treating the entire torso as a single anatomic unit patients are left without transition zones between treated and untreated areas.
The concept of treating the torso as a single unit without transition zones is less important and low BMI patients. and chubby people with over an inch of subcutaneous fat the impact of liposuction is dramatic enough that it’s not possible to have a natural transition zone between treated and untreated areas even if the procedure is done well. most people simply get a better result if the entire torso is treated uniformly. A full torso includes upper abdomen, lower abdomen, love handles (all the way down to the top of the hip dip), waist, fall back, under arm (arm pit )all the way to the side of the breast.
You should also take careful notes about the overall thoroughness of the consultation including all aspects of a complete consultation like review of medical history, physical examination, assessment, recommendation of procedures, alternative procedures, risks and benefits, complications including what complications a surgeon is had and how they are managed, preparation for surgery, instructions for recovery, revision rates and revision policy etc. 
Take careful notes about both the quantity and quality of before and after pictures any of the provider showed sufficient number of pictures of previous patient that look very similar to what you look like.
Most people don’t have a lot of experience consulting with plastic surgeons. On the other hand plastic surgeons typically have lots of experience giving consultations.
Recognize that you are the one paying for the procedure and you are hiring someone to do a service for you.
You have all the right in the world to ask for documentation including seeing a variety of results including results that were less than what the provider read hoped for.
If providers fail to cooperate then simply make a note of that and continue to the next provider.
I think you’ll find that the most talented and experience providers will be the most open minded in regards to showing you a variety of results and being truthful about what the procedure can and cannot accomplish in their hands.
Assessing patience for Liposuction candidacy is not easy or straightforward.
Even mild skin laxity can contribute significantly to contour and some areas simply don’t respond to Liposuction because of how the skin drapes especially in certain anatomic positions.
Lower extremity liposuction is technically difficult and often does not deliver the results patients had hoped for.
True saddlebags can respond well but other areas like the upper inner thigh Typically does not give the results patience and hope for and it’s prone to having contour irregularities if the procedure is not done with technical expertise.
If you have any doubts then simply slow down and schedule more consultations.
Nobody has to have liposuction.
Based on your description of yourself a question if the procedure is indicated in the first place.
Recognize that if provider selection is not done well the procedure can leave you permanently disfigured.
Good luck,
Mats Hagstrom MD

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