How is breast fat grafting after a BA? I'm concerned some of the fat will dissolve. What are your suggestions? (photo)

Dear juma1olo,
fat transfer breast augmentation is a viable alternative for women who desire larger breasts without the use of implants. Fat transfer is also widely used in reconstruction of the breast after a mastectomy or lumpectomy. It can also be very effective in correcting the size and shape of the breasts due to genetic problems such as tuberous breast or Poland Syndrome, two conditions that look like misshapen or underdeveloped breasts.In addition, the following scenarios are also reason to consider breast fat grafting:• If you have chest areas that appear creased and sunken• If you desire more permanent correction than is provided by temporary fillers• If you wish to improve your body contour, revise scars, fill bodily depressions and rejuvenate the natural curve of your breasts• To fill in contour irregularities or hide obvious signs of breast implantsYou should discuss your concerns with a board certified plastic surgeon and make sure your surgeon understands your concerns and your breast augmentation goals. 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

Fat grafting after BA usually have great results as grafting adds natural volume to the breasts. Fat grafting is not major surgery and would require a shorter downtime Based on your photos however, you might benefit from a breast lift on the left to reduce the asymmetry before undergoing fat graft.

Fat grafting can be very successful following breast augmentation to improve the overall shape .However in your case your left breast is lower and will require lifting prior to fat grafting

Thank you for your photo. I find that fat grafting is an excellent tool in adding some volume to breasts. It is not very powerful so you cannot get much larger than a cup at a time with fat grafting but it does allow the patient to avoid messing with the implant. That being said, I do feel that your breast capsules are in different positions and you may need the implant position repositione or a larger implant and possible nipple lift on your left side to address the symmetry issue. Fat grafting can change the size, but it is not very useful at changing shape or nipple position. Hope this helps!Johnson C. Lee, MD
Board-Certified Plastic Surgeon

Agree with your observations.  Before you agree to fat grafting to your prepectoral breast implants, do try to understand why the operative plan was changed, at the last minute.  Composite breast augmentation breast implant + fat grafting to camouflage wrinkles, ripples and to camouflage volume discrepancies.  Techniques for fat grafting are varied, however the % of retention is related to the manner in which the fat is grafted, rather than how it is harvested.  Ultimately, having the implants subpectoral would make any fat grafting safer, from inadvertent implant damage.

I am sorry to hear about your concerns after breast augmentation surgery. I would share your concerns about the reliability of fat grafting when it comes to improving your outcome. Although hard to tell, based on the single photograph, it is likely that ( based on your description of concerns) that revisionary breast surgery would involve adjustment of breast implant capsules and re-augmentation with larger breast implants.   You may wish to post additional photographs, with your arms by your side, as well as goal photographs for more precise thoughts. You may also wish to seek second opinion consultations with well experienced board-certified plastic surgeons in your area. Best wishes.