Fat Grafting vs Saline Implants with no previous pregnancy. Which is better? (photos)

28 yrs old haven't been pregnant before would like to in the future. WAnt to breastfeed as long as possible. Want breasts to have volume and lift. Not looking for something huge. Will fat grafting be better than saline implants or the other way around? I want the fat grafting if I can avoid any implants that would be great Thanks

Doctor Answers 9

Wait until after pregnancy for breast enlargement

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Thank you for your question.  Fat grafting or breast implants are both acceptable always to increase breast size.  However your breasts will undergo significant changes during and after your pregnancy.  In my opinion your better off waiting until you're done having children before considering breast enlargement.  It is very likely that you will need a mastopexy or breast lift after breast-feeding.  To go to the expense and involvement of having surgery now only to need a revision later is not a good idea in my opinion.

Lift first

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Unfortunately, you have not told us your bra size but your breasts are ptotic. I recommend a new technique called The Mini Ultimate Breast LiftTM. Using only a circumareola incision it is possible to reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage. Aligning the areola and breast tissue over the bony prominence of the chest wall maximizes anterior projection without the use of an implant. This technique avoids the ugly vertical scars of the traditional technique, maintains nipple sensation and the ability to breast feed. If, after this is performed, you still want larger breasts then fat grafting can be done, but I do not think this will be necessary.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Fat grafting versus implants

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Both will increase your breast size and both shouldn't have any direct impact on your ability to breast feed.  But what is best depends on what you expect and if you want the round upper poles, implants are more reliable to produce that look.  If you just want larger and are accepting of the risks of fat grafting, then that would be considered better for you.  So find a local surgeon and discuss your concerns with them.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Fat Grafting vs Saline Implants with no previous pregnancy. Which is better?

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Yes the use of fats to increase the size of breasts is becoming a more common option. Best to see an experienced surgeon who has done fat grafting to the n=breasts... 

Neither is best. You need more information.

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With all due respect, your goals are perfectly reasonable, but there are some trade-offs (pros AND cons) to each of these options, as well as one you haven't included in your list, that with more information may induce you to reconsider.

Thanks for including photos--though not ideal views, they provide some information useful in answering. A physical examination by one or more ABPS-certified plastic surgeons would be better, and should be considered soon, as you seem to be asking questions based on your own research trying to replace what 7 years of post-MD surgical and plastic surgical training, plus 27 years of experience in breast surgery (in my personal case) should be providing. So here are my observations.

Your breasts are pretty, though they do have a natural teardrop shape that you have indicated you would like lifted and fuller. But your nipples do face forward, and appear to be well above the position of your inframammary creases. A lift is not required to give you a very natural and beautiful result with implants alone. And breast augmentation with implants will require only a 3.7cm incision and a nearly invisible scar in most cases--I would recommend an infra-mammary (crease) incision for best visualization of the tissue planes, most precise and careful pocket creation in the submuscular plane, least likelihood of damaging the sensory nerve to your nipples, and the lowest likelihood for developing capsular contracture. Other incisions are possible but with additional trade-offs. Every surgeon has their own preferences based on training, experience, or habit.

Silicone gel implants (the latest generation of cohesive implants by all 3 USA implant manufacturers) do NOT require periodic MRIs to look for leak (they are solid and cohesive and CANNOT leak), are softest and most homogeneous with your own breast tissue, have been exhaustively studied and do NOT cause breast cancer or autoimmune illness of ANY kind, and will likely last longer than you will (though implants are man-made and we're not supposed to say that. I happen to think that you will likely require or request revisionary surgery more likely for ANY other reason (size change, position change, or to deal with other rare occurrences such as capsular contracture, symmastia, or ptosis after breast-feeding) rather than for leak, rupture, or manufacturer defect!

SInce the above list of rare things is relatively long, the key here is not saline vs silicone (though I do feel silicone are much better, especially in a young woman who will have them for a lifetime--salines show ripples, leak, and feel less natural), but rather WHO puts them in, where (below muscle for reasons discussed above and others) and how skillfully the surgery is performed.

Implants alone will give you the increased fullness that you desire, and will better "fill" your slightly-moderately "loose" skin brassiere for which you apparently feel you want a lift. Implants do NOT lift breasts. However, increasing the volume of your breasts will give the appearance of more mass below the nipple line, which is why some patients (and surgeons) will say implants can provide a "lift." Not really, but if the breasts look better, more full, and similar-to-lifted "look" with implants, why not avoid the additional scars (visible nude) and cost (probably on the order of an additional $3000-5500)? Scars and dollars--there are a couple of major CONS.

So why ask for a lift if you don't need one? I hope you aren't thinking you like the "Baywatch coconut" high round sharply circular look on top. Because if you do, that's fine, but that "look" is commonly associated with implants above the muscle and capsular contracture. You may like the look, but you would HATE how hard and tight they feel. Patients feel so self-conscious they won't even hug someone with those croquet balls in their chest.

So, I would suggest submuscular silicone gel implants for the soft natural look and the least chance of capsular contracture, and a nice push-up bra or swim top when you want that look. But with soft, pretty breasts when nude, hugging, or being intimate. Sure, you know friends with saline that feel and look great, but the odds are more favorable with silicone, below the muscle, especially for the long term.

As for fat grafting, this is neither "natural" nor recommended, especially in a young woman who wants to breast feed some day, and will presumably want to be able to have good breast exams without hard nodules of dead fat, scar tissue, and irregularities, and mammograms that don't have the microcalcifications that are caused when fat grafts die (50% of fat grafts survive in good surgeons' hands, but that means 50% die!) Surgeons who tell you that 100% of their grafts survive are lying. That's a bold but quite true statement. Don't take my word for it--look it up. Remember, even with a negative maternal family history for breast cancer, you have a 1 in 8 or 9 chance of developing breast cancer in your lifetime. So, if you're my wife or my daughter, no fat grafts in your breasts! The same advice I give to my patients.

I've just given you lots to think about, Please click on the web reference link below for more information and carefully consider that you may actually be asking for the wrong things. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews


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Thank you for the pictures.

To my opinion, breast implants would be much better for your breast to be enhanced. Fat transfer will not give you that round shape that implants give you and also fat will be absorbed by your body and leave a lot of unevenness.

Dr. Campos

Jaime Campos Leon, MD
Mexico Plastic Surgeon
4.4 out of 5 stars 257 reviews

Fat Grafting vs Saline Implants with no previous pregnancy. Which is better?

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Thank you for your question and photos. The question is not which is better, but what is your goal.They are two different operations. Placing an implant in your case would also involve a breast lift (scar around the areola and a vertical scar down the breast). Fat grafting is an operation done without scars. In your case it seems that you need superior pole enhancement. You already have full lower poles of the breasts.Since there's no cutting with fat grafting, your milk ducts are not damaged or cut which can happen with an augmentation/lift. On the other hand, fat grafting can vary from surgeon to surgeon. This procedure is very technique dependent. See a board certified plastic surgeon for an in person consultation/evaluation. Good luck.

Fat Grafting vs Saline Implants with no previous pregnancy. Which is better?

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Breast augmentation with an implant is far more reliable at this date.

Try to research this to find the surgeon who consistently produces the results you would expect. Look at reviews on this site and see who gets the surgery right every time.

Find a board certified plastic surgeon who performs hundreds of breast augmentations and breast augmentation revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD

Los Angeles, CA


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I like implants, they are safe and predicatble. I do see the allure of using fat as it would be great to not have to worry about implant issues and remove fat where you dont want it. I just think its too unpredicatble right now

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