Is Breast Fat Transfer a good alternative to implants?

Question

Price is not a factor, safety and results are. After reading about BII/Cancer/Autoimmune diseases, I'm very anxious about breast implants. I'm now considering fat transfer. I read one surgeon say she is against it bc of calcification cysts. Can someone weigh in on this? Also, some before & afters are gorgeous and others very minimal (which I would hate)...I am very healthy and fit (distance runner) so was thinking maybe a lot of fat would survive.

Ronald J. Edelson, MD · Answer

Photos you have seen on the internet are the good ones. And they’re not so great. So imagine how bad the average one is. Then you have to worry about lumps and trying to figure out what might be cancer. I am no fan of fat transfer anywhere on the body or face. Lousy results at best

Jeffrey Lisiecki, MD · Answer

For those anxious about breast implants, or who want a natural increase of about a cup size, fat transfer breast augmentation is a great technique. There are risks of calcifications and mammographic abnormalities which should certainly be discussed in advance, but the rate of these is comparable or less than what is seen other breast surgery procedures such as breast reduction. Oil cysts that are palpable or require any treatment are relatively uncommon. The important thing with this operation is realistic expectations. For good or bad, the result will not be like an implant. It will basically look like your breast, just a little larger. Of all of the fat grafted, about 50% stays. In most women, this translates to about a cup size increase (though cup sizes are not an accurate measure). I have seen some patients go up by two cup sizes, but they are less common.

Alan Gonzalez, MD, FACS · Answer

Hello @Nicolesbox, thank you for your question. It really depends on your expectations with the results. Breast fat transfer or autologous fat lipoinjection is a natural volume technique that can be applied for aesthetic or restorative purposes. It should be noted that lipotransfer does not replace augmentation mammoplasty with prostheses, since each technique has its own indication and requirements. This technique is used to provide symmetry and improve the body contour and therefore does not increase more than one size. The best course of action is to consult one or several board certified plastic surgeon for more information and options tailored specifically to your needs. Best wishes! Alan Gonzalez MD FACS

Daniel Barrett, MD · Answer

Dear Nicole,
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

Connie Hiers, MD, FACS · Answer

Fat has its own set of problems, including fat necrosis and oil cysts and limited volume. Plus, it is usually not the best choice in distance runners because it usually does not hold up well due to the repetitive trauma to the breasts with running.

Douglas Taranow, DO, FACOS · Answer

Nicole,
There is no equal to breast implants when augmenting the breasts.  Fat transfer may increase your breast by 1/2 to 1 cup size larger (at most!).  There are pros and cons to either procedure some of which you included in your question.  
For a fit person who not only has little fat to transfer, one who will most likely burn off much of the transferred fat due to their activity level, an implant is a far better decision.
Best wishes.
Dr. Taranow

Kelly Killeen, MD, FACS · Answer

Both breast fat transfer and breast implants are wonderful options in the right patient.  Each of these procedures has it's own unique set of risks and benefits.  For my patients seeking an augmentation, the most important thing is to do a sizing appointment and exam.  After this I can give the best recommendation for which method would give you the desired result.  The main limitation of fat grafting is that fat lacks the structure of the implant and is less likely to give the round, perky shape many women want.  The best candidates for fat grafting have a reasonably sized breast with good overall shape who want a modest increase in size (a cup or so).  You typically will end up with just a larger version of your existing breast.  Cysts and calcifications are a common outcome of fat grafting procedures, especially when one has very large amounts of fat placed that the native tissue cannot support.  Some studies show 10-20% of women have areas of fat necrosis and cysts.  Unfortunately there are many before and afters on social media which show immediate post-op results of large volume grafting which is what you are likely referring to.  Remember there is a reason these people are not showing their long term results.....These patients, who often have small, droopy breasts followed with large round perky breasts, will not stay that way long term.  Proper grafting will give you a beautiful longterm result, not a social medial wow with a disappointing future.

Mats Hagstrom, MD (license on probation) · Answer

Understanding breast-fed transfer is a fairly complex topic. First and foremost. Patient should understand the breast fat transfer always includes two procedures done at the same time. Those are the fat transfer itself and Liposuction. 
Fat transfer results are generally subtle and can increase breast size by 1/2 cup. This is when the procedure is done correctly by an experienced provider. Rarely the patient achieved 1 cup, and that is it usually in patients who have fairly substantial size breast to start with.
Unfortunately, that transfer results are one of the easiest procedures to cheat when it comes to before and after pictures. Early fat transfers can look very impressive. However, early for transfers do not in anyway represent final results. The majority of volume seen early after the procedure dissipates over the first several months. If results look very impressive, then they most likely represent early results and these are not a representation of final results. When it comes to fat transfer and reviewing before, and after pictures, you need to make absolutely certain that after pictures were taken six months after the date of the procedure. Do not ever assume that providers are showing you final results when displaying before and after pictures. It is your responsibility to confirm and understand exactly when after pictures were taken in order to understand what true results look like. A typical breast-fat transfer. Patient will lose 75% of the initial volume seen immediately after the procedure. Early results represent baseline of breast tissue, numbing solution, swelling, and newly grafted fat. If I graft addressed that the cup as a baseline, the patient will leave the office with at least a D cup size breast immediately after the procedure. The final and outcome will be a full B or small C cup.
Delivering consistent quality, liposuction and fat transfer results is far more difficult than most people believe. The number of plastic surgeons to do both procedures well on a consistent basis is relatively few. The procedure is permanent and irreversible. This is especially true for Liposuction and when things go wrong with this procedure, it is more commonly because poorly done Liposuction leaving people disfigured. 
There are a substantial number of board-certified plastic surgeons, with good intentions, years of experience, and then overall good reputation, who simply are not good at Liposuction. Mastering both Liposuction and fat transfer requires a total commitment to excellence years of experience and doing thousands of cases.
Doing this procedure well including making accurate assessments, and delivering predictable outcomes, is far more difficult and rare than people realize.
Implant breast augmentation will always give better aesthetic outcomes, faster and easier.
Any patient who was the best aesthetic outcome and is open to having implants augmentation should go that route as the best operation.
Fat transfer should be limited to patient unwilling to undergo implant, augmentation. 
Likewise, patients who choose fat transfer, should ideally also be good candidates for Liposuction.
Because fat transfer results are relatively subtle patients who get it excellent outcomes from Liposuction typically have it for higher patient satisfaction than those who are not a good candidate for Liposuction and merely did the procedure to get breast augmentation.
Another important point to mention is that fat transfer while it can increase breast size by 1/2 cup, and in rare instances, one full cup the procedure and does not change breast shape in any significant way. It is very important for patients to recognize the difference between desiring increase in breast size and a change in the best shape. Most patients seeking breast fat transfer, or hoping to increase the upper half of the breast, which is a desire to change the shape of the breast more than it is increasing breast size. Breast fat transfer does not improve the breast shape in any meaningful way.
To get a quality assessment and begin the vetting process of providers I suggest patients start the process by scheduling multiple in person consultations with local board-certified plastic surgeons in their community who seem to have a lot of experience with breast fat transfer.
During each consultation ask each provider to open up their portfolio and show you their entire collection of before and after pictures of the previous patient who have similar body and breast characteristics to your own. 
Patient come prepared by bringing pictures of their own body and breast to use at the reference when reviewing before and after pictures.
Candidacy has major impact on what is possible with both Liposuction and fat transfer so it is important to review pictures of previous patients who were of equal candidacy whenever possible.
Ask providers to show you a diversity of outcomes, including excellent results, average, results and results did not turn out as well as they had hoped. Providers may be apprehensive to do this, and will prefer to show you pre-selected images, representing the best results of their career. As mentioned earlier, it is also imperative, that you confirm the exact timeframe of when the pictures were taken Compared to when the procedure was done. Any pictures taken less than 3-6 months from the date of the procedure are not representative a final results. 
For a reference and experienced provider should have no difficulty showing you before and after pictures of at least 50 previous patients.
Breast implants augmentation is safe predictable and gives quality outcomes. Compared to other high risk activities like driving an automobile taken in context, breast implant augmentation is extremely safe, and the correlation to serious medical illness is not supported by solid medical science especially using non textured implants which is now pretty much the standard. 
In the end the two most important variables are patient candidacy, and provider selection. 
Breast fat Transfer can give increase volume for those seeking a modest improvement, especially women who are content with your current shape.
Provider selection paramount. Patient can do regarding their own candidacy, but with patients do have control over his provider selection.
I encourage patient to be far more selective, and they ever thought necessary. They plan to be critical of plastic surgeons before your scheduled surgery.
Best,
Mats Hagstrom, MD

George Lefkovits, MD - Account Suspended · Answer

Fat transfer is an alternative to the use of implants in some cases. There are some factors to be aware of. Fat transfer can only enlarge the breasts one cup size. Some fat may be absorbed requiring further fat transfer. Although silicone implants are considered very safe , you may want to consider saline implants. You should consult with a Board Certified PS with lots of experience performing breast augmentation. Good luck!

Is Breast Fat Transfer a good alternative to implants?

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