Third Fat Transfer Fail... now what? Would implants be better for someone like me?

It does seem that your fat transfer didn’t work. If you want volume you will need implants but you also need a lift. Or do nothing at all. I would guess by this time you’re pretty frustrated.

I would recommend implants, Galaflex (internal bra), and a lift. This will help restore volume, remove the scarred/tethered areas with direct visualization, and also provide the best long term result.

Dear easycoast,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

First I'd want to know your surgical history to understand the cause of your current issue, but depending on your desired breast volume, I would likely offer you a combined breast lift and breast implant surgery.
This combination would not only bring your nipples into a more youthful position and re-shape your breasts to give them more upper pole fullness, but would allow some of that scarred skin to be excised and, with careful surgical planning and execution, and better symmetry between your breasts to be achieved.

First, your lift is insufficient; nipple placement is too low, and there is residual skin excess in both vertical and horizontal vectors. It appears to be some variant of a lollypop scar, which would explain all of it. You'll have a 'perkier', tighter, and rounder breast once that's accomplished. Next is volume issues. If you're looking for a fuller breast, you should get a great result with fat grafting. However, if those volume needs are significant, it's always best to use an implant. But if you do, there is NO reason to use a saline device, and no reason not to go subpectoral, getting the best result with the lowest risk of capsular contracture. It sounds like you had implants and explanted, which makes me question why you removed them. If it was because of complications like recurrent capsular contracture, then proper subpectoral placement using modern aseptic techniques should give you a 1% risk. If it was because you had systemic symptoms from breast implants, you can be assured that breast implants, saline or silicone, have no real biologic mechanism to do that (all the millions of people who are walking around right now with testicular and facial implants made of the same silicone elastomer without any problems), and the whole fanfare of 'BII' is a manifestation of a history (in this country only) of people, not wanting women to enhance their sexuality. It's good your surgeon is retiring. Get a new and better one.

If you were unhappy with the last two fat transfer procedures, it is likely you will be unhappy with a third. fat transfer usually gives about one cup size increase, but is variable from patient to patient breast implants on the other hand. Give them more guaranteed results and might be a better option in your case.

At this point, I would agree implants to be a better option. Implants volume will remain steady unlike your fat transfers.

You may also need a lift (at same surgery or later) if some of the unevenness, lumps remain and need to be addressed.

This should be discussed in detail with exam and consultation with another plastic surgeon.

Implants placed behind the muscle and a lift will probably give you the best results. The volume is certain with implants. Fat transfers, as you found out, are not.

Yes, implants would be recommended. They are much more predictable as you can control size, shape, and profile. The next step would be to visit with a board certified plastic surgeon near you for a consultation to discuss your surgical goals and learn more. I've included a video that I hope you find helpful.

Thank you for uploading these photos. Fat transfer produces a moderate improvement. Since you haven’t had a major change, you’re seeing the potential for implants and why so many people choose this option