Will I continue to have poor retention after a revision? (photos)

Question

Hi, I had FT in 2022 on "virgin" deflated breasts after weight loss (34a). I went to a FT specialist, who transferred 350 ccs fat each but told me that my fat was "fibrous" and that I would not be a good candidate for a second ft. Unfortunately I've been losing my ft gradually over the past 18 months (without further weight loss) and am almost back to the start and feeling defeated. Any insights on why some "ideal patients" still lose? Would R2 still help ?

Daniel Barrett, MD · Answer

Dear Eclectic776862,
based on your photos, it looks like you would be a better candidate for a breast lift as fat transfer won't lift your breasts. 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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Ronald J. Edelson, MD · Answer

Unfortunately fat transfer is not nearly as good as some may have led you to believe. A second round of fat transfer will be no more successful than the first.

Connie Hiers, MD, FACS · Answer

No, round two is not your best choice. First, you need to lift your breasts. Once lifted, an implant can be added for more volume. With your weight loss, fat may not last very long.

Hilton Becker, MD · Answer

Fat grafting is not a one stage procedure, Several procedures are required to achieve a permanent result

Mats Hagstrom, MD (license on probation) · Answer

Delivering consistent quality fat transfer results is more difficult than most people realize.
The number of providers who truly mastered this procedure are in a small minority.
Claiming to be an expert and delivering consistent results are not always one and the same.
Specializing in a procedure generally means not doing other plastic surgery operations. You can’t claim to be a specialist and still practice general plastic surgery.
A Specialist is someone who exclusively focuses their career on anyone topic, or single procedure or groups of procedures.
That transfer tends to be fairly consistent and the results are primarily based on the patient’s candidacy and the scale of the provider.
It’s hard to make a good assessment based on limited information but from the information you provided 350 cc seems a bit conservative by my standards.
In the end it isn’t so much the volume but rather technique used. The fat needs to be stratified and distributed evenly and the patient needs to have sufficient amount of host tissue to support the grafted fat.
Even in the hands of talented providers, the results are always quite subtle.
Unfortunately, some providers have been tempted to show overly enthusiastic before and after pictures. This is quite easy if providers take after pictures shortly after the procedure.
Early fat transfer results can look very impressive, but do not in any way represent long-term final outcome.
When reviewing before and after pictures always Confirm the timeframe of when after pictures were taken in relationship to the date of surgery.
To find the right provider, I suggest patients have multiple in person, consultations with providers who seem to have substantial skill and experience with this procedure.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients, who had similar body characteristics to your own.
An experienced provider should have no difficulty showing you at least 50 sets of before and after pictures.
Highly experienced surgeons should have hundreds or preferably thousands of before and after pictures to choose from.
Like I mentioned earlier, always confirm the timeframe of when after pictures were taken in relationship to the date of surgery.
Never assume after pictures represent long-term final outcomes unless you understand the timeframe.
Pictures begin to be representative at 3 to 6 months after surgery.
 Typically a second round of fat transfer will be more successful than the first one since the first procedure created a greater amount of host tissue to support grafted fat.
On like Liposuction, which gives successfully less of a result with multiple procedures, fat transfer becomes more than cumulative.
Fat transfer typically delivers 1/2 cup increase in breast size per procedure.
This is what the average patient tells me long-term after the procedure.
Occasionally patience will report back getting one cup but most patients think it is 1/2 cup.
Most of my results are slightly better than what you displayed.
Your results are probably fairly typical.
On a patient like yourself my best guess is I would graft over 600 cc per side if sufficient fat was available for harvest.
Finding the right provider for this procedure is not easy or straightforward. Both liposuction and fat transfer has more variation and outcomes, depending who you choose as your provider than any other operation.
Mastering liposuction and fat transfer takes a total lifetime commitment.
One thing that’s important to remember is while fat transfer can increase breast size by up to 50% per procedure, the operation does not change breast shape in any significant way.
It’s very important to differentiate if somebody wants the same breast, but in a larger version or once a different shape. Many patients requesting fat transfer are hoping to restore, volume in the upper half of the breast. fat transfer does not do this very well because the area of concern is grossly lacking and host tissue making over grafting unsuccessful. 
The topic is complex and involved with many different variables to take into consideration.
Provider selection is in the end. The most important variable patients have control over.
Patient candidacy is equally as important, but is something patient don’t have much choice over.
You can follow up with your provider or you can continue searching for other providers, but may be able to get you a better result.
 With connective tissue isn’t much of an issue when it comes to successful fat transfer.
Breast tissue that is highly fiber cystic can be difficult to work with.
Best,
Mats Hagstrom, MD

Will I continue to have poor retention after a revision? (photos)

Answers (5)

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