Hybrid fat transfer + implant?

Question

I currently have implants, small 34B naturally to 34D. I’m 4 years posts-op. I want my breasts to have more movement to better mimick the jiggle of natural breasts. Can fat transfer be done on someone with implants to achieve this goal?

Elizabeth Kiwanuka, MD, PhD · Answer

Yes, fat transfer can be performed on someone who already has breast implants to enhance the natural appearance and feel of the breasts. This procedure, often referred to as composite breast augmentation, involves injecting fat around the existing implants. The added fat can provide a more natural contour, soften the edges of the implants, and enhance the overall jiggle and movement of the breasts, making them feel less rigid and more like natural breast tissue.
The success of this procedure depends on a few key factors:1. Sufficient Fat Reserves: You'll need adequate fat from other parts of your body for the transfer.2. Healthy Skin and Tissue: The skin around the breasts must be healthy and capable of accommodating the additional volume without excessive stretching.3. Expertise of the Surgeon: It’s crucial to work with a surgeon experienced in both breast implants and fat transfer techniques to ensure optimal integration and aesthetics.

Daniel Barrett, MD · Answer

Dear GetGab,
it is possible to get fat transfer after breast implants. 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

Gary M. Horndeski, MD · Answer

Yes, fat transfers can be done with implants in place.  However, there is always a risk at the time of fat transfer of injuring the implant, if it is in the pre-pectoral position.

Best Wishes,

Gary Horndeski, M.D.

Sean Fisher, MD · Answer

The desired effect you are describing is dependent on the cohesivity of the implants that are currently in place, what pocket position these are located in (above or below the muscle), and the amount of native breast tissue that you have. Fat grafting can be used to further enhance fullness (especially to the upper portion of the breast, improve cleavage, or camouflage implants. You should be with a well-qualified surgeon who can assess your anatomy to discuss the best plan to give you your desired look.
Sean M Fisher MD

Connie Hiers, MD, FACS · Answer

Yes, fat transfers can be done on women with breast implants. However, you still may not jiggle like someone who does not have implants.

Mats Hagstrom, MD (license on probation) · Answer

This response was dictated using Word recognition.
My apologies and advance for potential grammatical errors.
The simple answer to your question is yes.
The amount of fat that can be successfully grafted is generally based on how much “host tissue” you have available to support the graft.
If implant augmentation brought you from a B cup to a D cup then I’m guessing that 60-80% of your breast is implant.
Successful fat, transfer done by someone who has sufficient skill and experience can potentially double the soft tissue layer of your breast.
This is the tissue between your skin and the implant.
The areas where the tissue is thin like at the bottom of your breast will have much less host tissue to support grafted fat.
This means where you need volume at the most is the the same area where the least amount of fat will survive from grafting. 
Fat grafting, whether you have implants or not tends to be fairly subtle.
It tends to be very subtle in regards to increasing breast size in women with implants.
For that purpose increasing implant size tends to be much better.
The indication for grafting fat on women with breast implants is as you explained to have more natural soft tissue covering the implant.
The procedure can be done repeatedly building up soft tissue, but is inherently limited on how much fat can be successfully grafted in a single session.
Delivering consistent quality, liposuction and fat transfer results is more difficult than most people realize.
The number of plastic surgeons who truly mastered this procedure tends to be relatively small.
Different providers will also have different techniques on how to do this considering that fat should not be placed inside the capsule and care must be taken not to damage the implant.
My personal preferred method is to temporarily remove the implants during the fat transfer process.
I generally place temporary sizers in the implant pocket which causes no harm if they are damaged during the grafting process. 
Once the grafting is completed, the same implants can be reinserted. If they are relatively young or new implants can be placed in the pockets. Grafting fat as a blind procedure with the implants in place is also possible, but has the potential risk of placing fat inside the capsule, and potentially damagingdamaging the implant become potential issues.
Candidacy for this procedure. Various substantially from patient to patient.
Unfortunately, those who needed the treatment the most tend to be the weakest candidates, because fat grafting requires sufficient host tissue, in order to be successful.
Considering how much variation there is among plastic surgeons in both Liposuction, and fat grafting skill I suggest being very selective when choosing providers for this type of procedure.
Recognize that anytime you have fat transfer Liposuction is involved.
I’ve seen too many people left disfigured in the zealous attempt at fat transfer by providers who have no business doing Liposuction.
Unfortunately, the results of this procedure does not show well in before and after pictures.
Breast fat transfer on women without implants can show fairly high-quality results, but the purpose of the procedure on women with implants is not to make the breast significantly larger and increasing the soft tissue coverage of the implant does not show well on before and after pictures.
I still recommend insisting on seeing as many before, and after pictures during the vetting process while consulting with plastic surgeons.
In my opinion and experience plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients for commonly done procedures.
Grafting fat over implants is hardly a common procedure but you need to do your best to get a good idea of what average results are going to look like in the hands of each provider for both fat, grafting and liposuction.
When done poorly, both Liposuction and fat grafting can cause some fairly serious problems.
Best,
Mats Hagstrom, MD

Hybrid fat transfer + implant?

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