Implants Removed 10 Years Ago. Which is a Better Option Now - Fat Grafting or Implants?

I had the implants(salines place under the muscle) removed after developing a capsule 10 yrs ago and didn't have them put back. I've lost volume due to pregnancy and breastfeeding. I don't want large breasts just ones that look better. I've seen 2 board certified surgeons. One suggests a lift with fat grafting. I'm concerned about uneven results. The other suggests a small lift with silicone implants over the muscle. He wants to go at angle completely different that before. Any thoughts?

Doctor Answers 8

Fat grafting in place of breast implants for breast augmentation revision

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fat grafting after removal of breast implants can be difficult and results can be unpredictable depending of the amount of breast tissue present and vascularity of this tissue. Also, you can not add a large volume with fat grafting, as compared to breast implants.

Breast implants or fat grafting

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From the photos you have shown, it appears that you need to have your breasts lifted in addition to increasing their volume. Using a small saline implant under the muscle would be my recommendation. Overall the incidence of capsular contracture is low and just because it occurred ten years ago doesn't necessarily mean it will recur. As far as fat grafting is concerned, it is a relatively new procedure for breast enlargement, and there are a whole set of other problems and risks involved. Some of these include lumpiness, fat resorption, calcifications, and the inability to add much volume. Although many plastic surgeons have jumped on the fat grafting band wagon for breast enlargement, it has simply not progressed to the point where it can be considered a reliable procedure. All things considered, I would opt for the saline implants under the muscle.

Breast Lift with Implants works Great

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A breast lift with implants is a great combination.  Silicone implants over the muscle are fine, as are saline under the muscle.  Fat grafting to the breasts may be a bit unpredictable, but the use of implants is not.

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Should I choose fat grafting?

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Fat grafting for breast augmentation is a very debatable procedure.  It can be unreliable and uneven with the take.  If this is your choice I would find someone who has a lot of experience with this technique.

Neal Goldberg, MD
Westchester Plastic Surgeon

Implants after Capsular Contractors

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In your situation you have many options.

I agree with your worries about fat grafting. It may produce uneven/unpredictable results.  However, fat grafting does work well in other areas of the body, including breasts, but controversial for  breasts implants.

I do recommend silicone implants.  The new generation silicone implants are less likely to develop capsular contractors.  Implanting these on top of the muscle is reasonable, but putting them underneath the muscle is also an option you may want to explore and discuss with your plastic surgeon.

Breast Implants versus fat grafting.

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I do both of these procedures.  They are both valid and beneficial in the right patient. From your photos, I believe that a breast lift is needed.  Fat grafing will be useful if you want breasts that look very natural.  You will need more than one fat grafting surgery since most of the times, you can only place 150 to 200 cc of fat on each side.  Breast implants will give you a rounder, perkier outcome.  I would entertain performing a breast reduction at the same time on the larger side beofre placing implants.  Thus, it is really ultimately up to you. 

Fat grafting or implants after capsular contracture

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Fat grafting is a promising technique but implants are still the gold standard for breast augmentation. They are not perfect, but with breast augmentation, we have way more data about their safety and efficacy. After you have had a capsular contracture, it is a good idea to use a different pocket for the implant. They were sub muscular before. A new pocket would be either sub glandular or neopectoral. A neopectoral pocket is when your old capsule is separated from the undersurface of the muscle. The implants are placed in this new space between the muscle and the old capsule.

Implants or fat grafting and a lift

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Fat grafting for breast augmentation is still something that has not been perfected, and can require several procedures.  It is your choice to decide which way you want to go.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.