Breasts are too small after breast reduction. What are the risks of getting a fat transfer? (photos)

Your breasts have a nice size and shape to them. I would do nothing. Although fat transfer is an option it is very much hit or miss. The biggest risk is that it doesn’t work

Hello and thank you for your question. You are still very early post op and I would recommend to go through the entire healing and tissue/scar maturation process for at least 6-9 months before you start contemplating a significant revision surgery! It is very hard to promise a specific cup size after breast surgery, especially because different stores make inconsistent bra sizes. In general, risks of fat grafting to the breast include asymmetry, scarring/fat necrosis, fatty oil cysts, and need for revisions/repeat fat grafting.

Hello @Ibi22, thank you for your question. A fat transfer surgery to the breasts is always safe when performed by an expert. All surgical fat transfer procedures involve reshaping the body's shape through the extraction of adipose tissue that is then treated in order to enhance the breast. Technique, experience, and technology used by the plastic surgeon determine the success of the surgery. For more information, you should consult one or several board-certified plastic surgeons. 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)

Dear Ibi22,
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

Ideally, a plastic surgeon would be able to exactly deliver a desired breast size during breast reduction or mastopexy. This being said, there are a lot of variables that go into bra size. This includes patient chest diameter, brand of bra, and overall natural shape of the patient's breast and body proportions. It is in fact common for patients to feel a difference in their body proportion after breast reduction surgery and therefore it is important that the surgeon explains the limitations of the procedure.
Breast fat grafting is a safe method of contouring breast shape. The procedure can help fill in areas like the cleavage area as well as the overall volume of the breast. The amount of volume that can be grafted at one time is also variable, and usually multiple rounds of fat grafting are required for the desired outcome. There are risks of benign cysts showing up on mammogram, however and experienced mammographer and radiologist should be able to delineate between these benign cysts and more worrisome findings.
Breast reduction as well as fat grafting to the breast for aesthetic and reconstructive reasons are common procedures that I perform. Please see the attached length for more information from our practice.

Right now, you need time to heal and let all the swelling subside. At 6 months, if you want to be fuller, then consider going with fat or implants. Not all fat takes, sometimes there is uneveness between the two breasts, and you might have hard knots from areas where the fat died.

The reduction left you asymmetrical... Best to revise the reduction with fat grafting in different volumes. Best to virtual consult with.......

Honestly your breast reduction is very conservative.
The total change in volume or size is not drastic at all. what is the procedure done using medical insurance or did you pay cash?
For insurance based procedures insurance companies typically require the surgeon remove a certain amount of tissue in order for the procedure to be qualified. definition is companies have different ways of calculating the amount of tissue that needs to be removed in order for the procedure to be covered by insurance.
Cup size is very subjective and it’s not an accurate way of communicating breast size. I find pictures as a far better way when it comes to discussing breast size in regards to what patients are hoping for when it comes to breast surgery.
One suggestion I have for you is to get a copy of your operative report. Your medical records will indicate exactly how much tissue was removed from your breast during surgery. It’s standard for breast tissue removed during breast reductions to be weighed in the operating room and also to be a valuated by pathology who also give a second weight of the tissues.
Knowing how much tissue was removed would put a lot of things into perspective.
Also knowing what your discussion was before surgery with your provider.
You can certainly increase breast size with fat transfer and having at a previous reduction should not limit that in any significant way.
Recognize that breast-fed transfer is a subtle increase in breast size. Most patients get 1/2 cup volume increase.
Bigger breasts can have a greater amount of fat successfully survive the grafting process because there’s more host tissue to support the graft.
In your breast you could probably tolerate having 700 cc of fat grafted per side with about a third of that surviving long term. breast tissue is not ideal as a source of host tissue for grafting fat. firm breast parenchymal tissue does not support fat graft all that well. The success of fat grafting to the breast relies more on the fatty tissue as host tissue to support the graft and potentially sub glandular planes.
It is also important to note that fat transfer is a poor choice for anybody who is looking to change the shape of their breast. grafting fat can definitely increase volume by up to 50% or about 1/2 cup. occasionally patients will claim the breast size increased by 1 cup but I would say from my experience most patients feel that the final outcome was about 1/2 breast cup size.
Fat transfer does not change shape.
For example women who are looking to have more volume in the upper half of the breast or to develop projection will not get this from fat transfer.
Implants are far better for improving shape and contour especially breast projection.
There are lotta variables to take in consideration and a lot of information is needed for full context of your situation, your needs and what you’re trying to achieve.
Delivering consistent quality liposuction and fat transfer results is more difficult than most people believe and the majority of plastic surgeons are not particularly good at it.
On top of this even when done well the procedure is subtle.
It’s critically important that you choose a provider who knows how to do liposuction competently or the harvesting of fat can leave people disfigured for life. i’ve seen this far too many times to not make a point of it and answering questions like yours.
If you want to consider fat transfer to your reduced breast then start scheduling in person consultations with local board-certified plastic surgeons who seem to have a lot of experience with the procedure.
During each consultation ask each provider to open up their portfolio and show you their entire collection of before and after pictures. For fat transfer it is imperative to understand how long after the procedure after pictures are taken.
Fat transfer results can look very impressive early after the procedure but these do not represent the final results. after pictures should be taking six months after surgery or three months at the very earliest.
Anything earlier than that it’s not representative of final results.
For reference and experience provider should have no difficulty showing you at least 50 sets of before and after pictures of commonly performed procedures.
Being shown a handful of preselected images representing the best results of a provider‘s career is totally insufficient to get a clear understanding of an average results look like in the hands of each provider.
For that reason ask each provider to open up their portfolio and show you as many pictures as possible a patient with similar breast characteristics to your own. since fat transfer requires liposuction you need to do the same for liposuction results. ask the provider to show you examples of excellent outcomes, average outcomes and less than outcomes. we all have a variety of outcomes and it’s fair game for patients to ask to see different types of results. look for patients who have the most similar breast and body characteristics to your own in the before pictures. it’s important to recognize the different people have individual cans of disease and candidacy for surgery has a big impact on the potential outcome.
In your case I would say your candidacy for fat transfer is excellent. you also appear to be an excellent candidate for Liposuction.
Please make sure you vet plastic surgeons properly for both operations. Fat transfer is always to operations done at the same time.
You should also be open to implant augmentation as an option and at least learn the advantages and disadvantages of that approach.
Familiarize yourself with what quality breast fat transfer pictures look like. A word of warning is that the Internet is full of super exaggerated breast fat transfer pictures either from taking pictures early after the procedure or patients, providers or social influencers enhancing photographs. There are far too many unrealistic fat transfer results floating around the Internet so keep that in mind.
Once you familiarize yourself with what realistic quality results look like create a reading or grading system for breast fat transfer results as well as liposuction results. take proper breast and body pictures and have those printed and bring them with you during consultations. You should use pictures of your own breast and body as a reference pictures when reviewing before and after pictures so you choose pictures of patients who look as similar to you as possible.
It is equally as important for Liposuction as it is for the fat transfer. if anything assessing the surgeons skill for liposuction is perhaps even more important.
When things go wrong with breast fat transfer it’s more likely to be poorly done Liposuction than anything else.
Continue having consultations until you feel quite certain you found the right provider for your needs. I have no idea how many consultations that may require but I suggest you start with five and simply keep scheduling more until you feel very confident you found the right provider.
Avoid virtual consultations whenever possible and avoid traveling long distances for elective surgical procedures.
Best,
Mats Hagstrom MD