Is fat transfer into breasts safe?

Question

I want my implants removed and to have fat transfer into my breasts and areola reduction Some surgeons are saying it’s safe to do all the above in 1 operation Others are saying you need to wait 6 months from implant removal before putting in the fat transfer Or are there other options? Please let me know as i don’t want to do anything not safe

Alan Gonzalez, MD, FACS · Answer

Hello @annalondon2234, thank you for your question. Keep in mind that when there is an implant removal it is always necessary to adequately remove the capsule and reconstruct the tissue. In my opinion the fat transfer or fat seeding should be given in a later process with a prudent time of 2 to 3 months to ensure the fixation of this to the tissues and minimize the possibility of infection or that the fat dies. 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 .

Gary M. Horndeski, MD · Answer

At the time of explantation, fat transfer is safe. However, if you are doing a simultaneously lift or capsulectomy that may interfere with the blood supply then I recommend you wait 6 months for the fat transfers.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Martin Jugenburg, MD · Answer

Hello, thank you for your question. So you really have the option of combining all those items into one surgery or waiting the 6 months to see how things fall. It also depends on the surgeon and what they feel more comfortable with doing. Some argue that waiting the 6  months until things settle in provide for a better stage two surgery of fat grafting and nipple reduction. Both are completely safe to perform. I would speak to your plastic surgeon to see what the pros and cons are of each way and of course what works best for you.

Richard Baxter, MD · Answer

Some fat transfer can be done when implants are removed, but it won't be anywhere near the volume of a typical implant. The same is true with delayed transfer, even though it could be a higher volume. Without knowing what size your current implants are, from the photo I would guess several sessions would be required and that you would need more than an areolar reduction to avoid having saggy breasts.

Kenneth Hughes, MD · Answer

The breast implant removal and breast fat grafting can be completed during the same surgery. Some of the success will depend upon existing tissue available for receiving the fat. The fat grafting will likely take several sessions to produce a similar result unless the breast implants were extremely small. I usually perform the explant first. The fat grafting I typically perform about 3 months later. This gives the patient and the PS time to assess the chance of the breast returning to the preoperative state if the implants were small and the time since placement.

Rodger Shortt, FRCSC · Answer

Fat transfer after implant removal is becoming a much more common procedure.  The question as to whether it can be done at the same time versus 2 surgeries is disputed.  Like most of plastic surgery there are pros and cons to everything. I generally favor 2 stages.

ONE-STAGE:
The benefit to removal of the implant and immediate fat grafting is that it all happens in one surgery (at least that is the goal).  The downside is that there is only a thin layer of breast tissue between the implant capsule and the skin to put the fat. Since little fat can be placed people are often either left with less volume than they want or are often over-grafted, which can lead to fat necrosis or fat oil cysts.

Because there is a large implant pocket, fat can inadvertently be placed into the capsule where the implant was, where it will not survive.

Also, the breast skin is stretched out from the implant and has not had a chance to tighten up. Often people are advised that they need a lift (this requires costs and scars) that may not actually be required if the skin is given time to contract.  Even if it is still required knowing the best location to put the nipple at that time is a bit harder to know.

TWO-STAGE:
The alternative is to wait a few months after an implant removal.  The downside is waiting and having two procedures.  However, there is significant upside.  The implant removal is a simple procedure (often covered by health insurance) with little recovery.  A partial or complete capsulectomy can be done which will allow the pocket to be obliterated and negate the risk of placing fat into it. That is more likely to have improved fat survival.  The skin will have contracted and if a breast lift is needed then it can more accurately be performed.

I generally suggest two procedures.  An implant removal and partial capsulectomy.  Three months later fat grafting can be done, with or without a breast lift. This is more conservative but I think the results can be more consistent, with less chance of cyst formation and I believe a higher chance of fat survival. It probably also saves a lot of people from having a mastopexy (breast lift) if the skin contracts nicely.

Dr. Rodger Shortt, Oakville, Plastic Surgery.

Wess Cohen, MD · Answer

Thank you for your question. I think you are a great candidate for removing the implants, a mastopexy during which the breast is lifted and the areola size reduced, and fat grafting to provide some volume. You should be aware that your breasts will be significantly smaller without the implants, even with the fat grafting. Additionally approximately 25 and up to 50% of the volume will disappear within six months. After that point the remaining volume will be permanent. This is why many patients need an additional round or two of fat grafting at a later stage. Good luck.

Ronald J. Edelson, MD · Answer

Fat transfer is safe. The more important question is whether it works. I’ve been pretty unimpressed by what I’ve seen. There are plenty of surgeons who love  fat transfer and think it’s great. But I’ve been to their websites where their photos are not so great. ( and of course those are their best cases)

Daniel Barrett, MD · Answer

Dear annalondon2234,
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

Antonios Mitsakos, MD · Answer

Please be advised that there are no right or wrong answers. In my opinion a scan would likely identify any reasons why the fat transfer should be delayed after the removal of your implants. Unless it is indicated fat transfer could be carried out in the same sitting. Please discuss your aesthetic goals but also your concerns on a consultation

Is fat transfer into breasts safe?

Answers (14)

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