Why don't fat transfers stick in breasts?

Question

It seems everyone getting a fat transfer to their chest is unhappy. I only want a little added volume to fill in my bra.

Ronald J. Edelson, MD · Answer

You’re taking the words right out of my mouth.  Plastic surgeons promote fat transfer to the breast as a highly successful procedure.  If that’s the case, why so few photos on their websites.  Fat transfers simply do not take well anywhere on the body.  To survive the cells need to obtain a good blood supply which they simply do not when injected in the breasts.  Patients are buying into the hope that fat transfer to the breasts works and plastic surgeons are more than happy to perform it.  If any surgeon recommends fat transfer to you go their website and look at their photos and make sure the photos are at least one year out.  Then bearing in mind these are probably the surgeons best results, judge yourself if that change is worthwhile.

Rodger Shortt, FRCSC · Answer

Breast fat transfer is an excellent procedure that delivers beautiful, natural results for the right candidate. But what exactly makes someone an ideal patient?

1. Adequate Donor Fat: You must have enough harvestable fat for a successful transfer. While very lean patients may lack the necessary volume, typically liposuction across multiple areas can gather enough fat for the procedure.
2. Existing Breast Tissue: There must be enough "space" to safely receive the fat. As a rough estimate, one can double the breast volume during surgery, but expect about 40% of that volume to be absorbed by the body in the first few months. Patients starting with very small breasts may choose to undergo the procedure more than once to reach their goal.
3. Appreciation for Natural Shape: Fat transfer excels at enhancing your existing shape rather than fundamentally altering it. 
4. Modest Size Goals: This procedure is ideal for those seeking a subtle, natural increase—typically around one cup size.
5. Preference for No Implants: Although final volume is not certain, it is a great choice for someone looking to avoid foreign bodies.

Managing Expectations and Results
While most patients see their size stabilize after the first month, I recommend waiting a full three months to see your final results—provided your weight remains stable.

Factors That Influence Success
1. Weight Stability: I advise against "bulking up" before surgery. If you gain weight just for the procedure, you will likely lose that volume once you return to your natural weight. It is best to be at a weight you plan to maintain for years to come.
2. Surgical Technique: Because there is no single "universal" method, technique matters. A careful, conservative approach is required; over-injecting fat can actually lead to higher rates of fat loss (necrosis).
3. Clear Communication: Success starts with honest expectations. Your surgeon should provide a realistic outlook rather than over-promising results. 
4. Comprehensive Care: Decisions made before, during, and after surgery all impact your final look. Ensure you discuss the entire timeline with your surgeon.

The bottom line is that breast fat transfer is one of the most rewarding procedures in plastic surgery. Providing a patient with fuller breasts and a more contoured body through liposuction—all without an implant—is a true win-win-win.

Dr. Rodger Shortt, Oakville, Ontario

Gary M. Horndeski, MD · Answer

Fat transfers are effective to the chest and approximately 60% survives.  It is good for small volume but large volumes usually will not survive.  The amount of fat capable of survival is proportionate to the recipient site volume.  Unfortunately, you have not provided photographs or told us your bra size.  I would need more information to give you more details.    Best Wishes,Gary Horndeski, M.D.

Kenneth Hughes, MD · Answer

In general, 200 cc per breast is typically the upper limit of fat injection recommended by most plastic surgeons.  It is not that more cannot be injected; but on average, this has been determined to be the most that can be expected to live during one transfer.  Multiple transfers would be required for additional cc's.  In general, the abdomen and thighs are preferred donor sites but fat from other areas can be used.
Some of the retention rate will depend upon the amount of fat transferred, as smaller volumes will likely have a higher survival.  Occasionally, a patient can resorb a great deal of the fat despite optimal transfer procedures. I typically transfer from 250 cc to 400 cc or so per breast.  Thinner patients are outstanding candidates in my opinion, because the fat transferred is extremely resistant.  
Results are largely dependent upon the skill of the surgeon, his/her ability to remove fat without creating contour deformities, and your expectations. You would need a consultation with a board certified PS to determine your available fat stores.

Daniel Barrett, MD · Answer

Dear realbooty98,
fat transfer breast augmentation is a viable alternative for women who desire larger breasts without the use of implants. Fat transfer is also widely used in reconstruction of the breast after a mastectomy or lumpectomy. It can also be very effective in correcting the size and shape of the breasts due to genetic problems such as tuberous breast or Poland Syndrome, two conditions that look like misshapen or underdeveloped breasts.In addition, the following scenarios are also reason to consider breast fat grafting:• If you have chest areas that appear creased and sunken• If you desire more permanent correction than is provided by temporary fillers• If you wish to improve your body contour, revise scars, fill bodily depressions and rejuvenate the natural curve of your breasts• To fill in contour irregularities or hide obvious signs of breast implantsYou should discuss your concerns with a board certified plastic surgeon and make sure your surgeon understands your concerns and your breast augmentation goals. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD

Connie Hiers, MD, FACS · Answer

Not everyone is unhappy with fat transfer, but you do need to be realistic. On average, you may gain one half to one cup in size. If you want larger, I recommend breast implants. If you loose weight, you may loose some volume with fat transfers.

Why don't fat transfers stick in breasts?

Answers (6)

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