Fat Grafting for Breasts?
Thank you for the question.
No, fat grafting is not “necessary” and your breasts will not appear to be “deformed” effect grafting is not performed. Based on your description it is likely that you will be pleased with breast lifting alone. If, after-the-fact, you decide on more volume or superior pole fullness, breast augmentation may be your best option.
For patients planning on breast lifting surgery it will be very important to communicate your size goals with your surgeon. In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate.
I hope this helps.
Fat grafting for breast lift
Fat grafting is an excellent technique for adding volume to certain areas of the body. Whenever translating fat to one area approximately 20% of that fat will melt away. When this fat melts away it may leave small calcium deposits. This is usually not an issue except in the female breast. A patient who has had this procedure may have these calcium deposits detected at a later date during a mammogram. These calcium deposits may be read as a possible sign of breast cancer by some radiologists who may recommend additional surgery or biopsy to get a final diagnosis on these deposits. Patients must be aware of this risk. At this time, patients should insert other options for the additional volume to their breasts.
Fat grafting and Breast Lift
Depending on your skin elasticity (which is probably lost), as the breast settles after surgery you may develope some emptiness in the upper pole of the breast. If that bothers you then that emptiness can be treated with an implant or fat graft.
Do the lift and then decide if the upper pole bothers you and you want to do something about it. You have not burned any bridges behind you after the mastopexy.
Do not need fat grafting for breast lift.
You sound like such a reasonable person. We use fat grafting only in special situations and you do not need it, going by your description. You should be very happy with a breast lift. In New York City, we do an internal breast lift, which does not rely on tightening the skin, because skin stretches (Lejour technique). You have a lollipop scar.
Don't do the fat grafting
People that get my blog know that I am a huge fan of facial fat grafting. I have even modified my cannulas to 1.2mm for even smaller fat. But this is the key for fat grafting-small product through little cannulas. This is ideal for the face. It is not appropriate for the breasts.
You are experience the loss of upper pole fullness. This is due to the stretching of the tissues, aging, breast feeding etc. If you want to replace that depression in the upper breast it is best done by doing an augmentation mastopexy. I would use a small, low profile implant placed under the muscle then do the Mastopexy. It is a proven procedure to correct your problem.
Fat grafting is always unpredictable. To fill your upper poles a significant amount of fat would be needed. I guarantee you that your surgeon will not be using 1.2mm cannulas to inject the fat-this would take many hours. Therefore, he'll put in as much in as he can and hope that enough will survive to correct the problem. Too many variable. You'll be left with lumpy, very asymmetric breasts. Don't do it.
If you don't want the implant that's fine. You can get the mastopexy done and if you're not happy with the upper pole depression you can always go back and get them at another time.
Fat grafting with breast lift is experimental
A breast implant is often used in conjunction with a breast lift to provide fullness. This is a time proven excellent technique that produces good results.
Recently, a paper was presented at the American Society of Aesthetic Plastic Surgeons meeting in Las Vegas showing fat injections to improve fullness after reduction mammaplasty, a procedure similar to the breast lift.
While these results were good, this technique has to be considered experimental at this time. The doctor presenting this paper was from New Orleans.
I would recommend that if you desire a fuller breast after your lift that you choose the accepted technique of breast augmentation with a breast implant as opposed to fat.
See before and after photos of breast lift and breast augmentation.
Fat grafting in conjunction with a breast lift sounds unusual
It is unlikely that fat grafting is the correct procedure for you. If you lack breast volume then the accepted method for rejuvenation of your breasts would be a breast lift in combination with a breast implant. It sounds like a second opinion is in order.
This smells fishy. Fat grafting is currently not approved for breast augmentation by the ASPS. The problem is that it can obscure future mammograms, and that it is not predictable. The accepted way to augment the breast is with implants, and in your case, it sounds like a breast lift would be in order too.
Check the doctor's credentials to be sure he is certified by The American Board of Plastic Surgery.
You sound like you need a breast lift for sure. If you feel that in a bra, you are large enough and don't need any padding, an implant might not be necessary.
For upper pole fullness, an implant is the best option. Fat grafting is not yet mainstream and concerns are that it can produce problems in breast cancer detection.
Fat graft not yet mainstream
There is literature that supports that when performed properly, fat grafting can be accomplished to the breast. The problem is if the plastic (or any) surgeon is not meticulous, the graft may not heal and in fact cause scarring that the radiologist may be concerned about on a mammogram. If your plastic surgeon has a lot of experience and can show ou photos of patients they have treated, that may be an option for you. Best of luck.