I am torn between Fat Transfer and Implants, what would you recommend?

Hello and thank you for your question. You are a better candidate
for a breast augmentation using an implant.  I do not think you will have adequate donor sites for a lasting result with fat grafting.  The size, profile, and shape of the
implant is based on your desired breast size/shape, your chest wall
measurements, and soft tissue quality.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.  This entire surgery
can be performed with a small incision technique.  Make sure you
specifically look at before and after pictures of real patients who have
had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a
surgeon you are comfortable with. I recommend that you seek consultation with a
qualified board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D. FACS
Harvard-trained plastic surgeon

While it is possible to do fat injections to the breast as a cosmetic augmentation, currently, it is felt that only up to 50 of transplanted fat successfully survives in its new location. The remainder doesn’t go elsewhere. It is just resorbed by the body. Fat injections to the breasts may be useful in making small modifications and correcting asymmetries, but many plastic surgeons feel this procedure is not as reliable or predictable as an augmentation with breast implants.

The concerns: There has to be adequate fat donor sites, long term results do not yet exist, like any procedure there are potential risks including infection, oily cyst formation, mammographic changes which can be confused with breast tumors, asymmetry, the results are not totally predictable and are inconsistent as compared to breast implants which are the most extensively tested and FDA approved medical devices with a lengthy record of safety and efficacy, it is a lengthier procedure, more costly, may require additional sessions of fat injection, and to optimize the results usually requires a prolonged use of an external device called BRAVA which is uncomfortable and has a poor record of patient acceptance and compliance.

There are an increasing number of satisfactory reports of this procedure being performed, but there are still a wealth of additional unresolved issues: The extent of resorption of the fat, the large volume of fat that is required to produce an improvement, the limitation of the amount of the very modest augmentation that is possible (usually only up to ½ or one cup size), and specifically a concern about long term safety with regard to tumor stimulation (currently has not been a problem), which all need to be further investigated with valid scientific studies before fat injection should be viewed as a standard procedure for cosmetic breast augmentation.

Robert Singer, MD  FACS

La Jolla, California