Is fat transfer into breasts safe?

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.

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.