Why are so many unhappy with the results of fat transfer to breast?

There is no procedure that is ideal for everyone.  Every procedure has advantages and disadvantages.  The best procedure in the wrong hands or selected for the wrong patient will always result in unhappy patients.  There are limitations in what fat transfers can do such as the maximum volume that can be achieved per transfer session (usually not more than one cup size).  Unless you are willing to maybe have to do more than one session to achieve more than one cup size, then the procedure is not for you.  Also it may cause some lumpiness (but so can implants) but in more experienced hands and for patients who are better candidates, there is less chance of this.  Not all surgeons have the same type of experience or have the same hands or use the same techniques so choosing the right surgeon who knows not only how to safely perform the procedure but who also knows how to select the proper patient is very important.  Being a good candidate is also important.  If you have more good quality fat to give, if you have more breast tissue to begin with and if your breast skin is not too tight, then you would be a better candidate.  Also having the right expectations is key.  If you are wanting to be 2 cup sizes bigger and are not open to having to possibly do more than one fat transfer session, then you should give serious consideration for breast implants.  If you choose fat transfers to the breasts in place of implants, you would be able to avoid inherent risks of implants such as rupture, capsular contracture, rippling, wrinkling and migration of implants.Getting a consultation from some reputable board certified plastic surgeons who have a lot of experience doing this is a good place to start to see if this is a good option for you.Best wishes.

This is one of my favorite procedures.Its hard to tell you how large you will be after because the breast swells a lot and women tend to like this size. Once it settles down they are not as happy which is why it sometimes requires multiple surgeries.The best way to assess and give true advice would be an in-person exam.Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.best of luck!Dr schwartz

Thanks for your question. Achieving the volume you want is more difficult with fat transfer. Breast implants are simply a more reliable form of breast enhancement.All the best,Dr. JSB

Breast fat transfer works well within certain parameters.1) Typically you need to have fat in unwanted places2) There needs to be  tissue where the fat is transferred into.  If you are starting with a small cup size A breast, you can not put more fat than what you have in your breasts.  If you do, the ratio of living breasts cells will be lower than that of the fat cells and the fat cells may resorb.  3) About 50% of the fat will resorb in breasts4) Fat transfer result is surgeon-dependent.  That means, it depends on many factors such as liposuction technique, fat processing technique, and injection technique.  Best of luck

Good question. It would be great if you could clarify what exactly people are unhappy about. I haven't had unhappiness from this procedure personally, but I have some guesses patients could be disappointed. 1. There are a lot of non-plastic surgeons doing this procedure. 2. It often takes more than one procedure to get the desired volume.3. To have success in a one step procedure, you must pretreat with the BRAVA system. Most patients don't want to do this due to expense or comfort issues. Hope that helps!

Some of the happiest patients are those that have had fat transfer to breasts.  The procedure has many nuances that need to be adhered to in order to achieve the best results.  These include how the fat is harvested, how it is processed and how it is transferred.An in-person exam with a board-certified plastic surgeon is the best way to assess your needs and provide true medical advice. Best of luck. Dr. Michael Omidi

According to posting by patients on RealSelf, 94% reported that breast augmentation with implants was worth doing while 77% felt that way about an augmentation using fat transfer to the breasts.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: 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,
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.Keep in mind that following the advice from a surgeon on
this or any other website who proposes to tell you what to do without examining
you, physically feeling the tissue, assessing your desired outcome, taking a
full medical history, and discussing the pros and cons of each operative
procedure would not be in your best interest. I would suggest you find a
plastic surgeon certified by the American Board of Plastic Surgery and ideally
a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you
trust and are comfortable with. You should discuss your concerns with that
surgeon in person.Robert Singer, MD FACSLa Jolla,
California

Thanks for sharing your thoughts.Breast enhancement surgery has certainly evolved.  In just the last few years we have had the introduction of new implant styles which have allowed for more options when deciding on what look and feel patients may want.  This advance has also been followed by an increase in fat grafting to the breast and other parts of the body.The idea of breast augmentation with fat transfer usually sounds great to patients, but there are certain things that the patient should be aware of when interested in this approach.  To achieve significant volume increase with fat transfer alone the patient should be aware that it will likely involve preparation before surgery.  In many cases it is recommended that the patient wear a device around the breast to expand and essentially stretch the breast.  This device is called a BRAVA and it needs to be worn for about 3 weeks before surgery.  Many recommend to use the device at home for 6 hrs a day, 7 days a week, for 3 weeks total.  This is called pre-expansion and sets the stage for improved volume retention after fat grafting to the breast.  When this approach is not followed very well it may lead to unpredictable "take" of the fat graft.  It has been my experience that patients need to be very motivated for this approach, and often they ultimately will decide to undergo augmentation with an implant.In situations where an implant alone may not be ideal it is certainly reasonable to perform fat grafting around the implant to make it appear more natural.  This approach which is referred to as composite breast augmentation can yield very nice results, but it is not an approach that all surgeons are performing.  A visit with a few plastic surgeons in your area is certainly recommended.  I think it would be important to discuss the interest you have in fat grafting to the breast, and determine with your surgeon if you are a good candidate for this.  Ask your surgeon about their experience with fat grafting and make sure you have confidence in the plan suggested.  Last but not least, make sure you are visiting with a board certified plastic surgeon that can give you sound advice.Best Wishes

Fat transfer to the breasts is an exciting way to enhance the size and shape of breasts.  The great thing about it is that it uses a patient's own tissue to create a larger breast size.  Therefore, the downfall of implants are avoided (risks of rupture, capsular contracture, malposition, etc.).  Because the breast is mostly composed of fat cells surrounding breast lobules and ducts, the surgery creates a very "real" feeling breast.  Also, the procedure includes liposuction, usually to the abdomen, hips, and thighs.  The body contouring component can be a very nice bonus.  Therefore, fat transfer to the breasts is often considered a "two-for-one" deal.All that being said, there are some issues with fat grafting that MUST be addressed so patients have appropriate expectations.  Fat grafting alone usually can only increase the breast size by 1 cup (an A cup to a B cup, a B cup to a C cup, etc.)  It can not be used to lift the breast.  The fat that is transferred needs to obtain a blood supply to survive.  If the fat can not get an appropriate blood supply, it can die and cause fat necrosis.  This can occasionally be felt as firm areas. Anyone who is seeking plastic surgery must discuss their expectations with their surgeon.  If these expectations are unrealistic with the parameters of a proposed surgery, than a new or different surgical procedure needs to be discussed.  This is especially true for fat transfer. This type of surgery is only appropriate for patients who are seeking smaller augmentations utilizing their own tissue. These patients usually want to have a very natural, soft result without the worry of an implant.Hope this helps!

I think that this can be summed up in one phrase:  lack of volume.  Most women seeking breast augmentation are not seeking a half cup or even whole cup increase, which is all that fat transfer alone will provide.    Approximately 50% percent of the fat that is placed is resorbed.  After surgery, patients get used to the swollen breast and once swelling resolves and fat resorbs, disappointment sets in.  Additionally, those looking for the more modest volume increase often do not supply a significant amount of donor site to get the volume they are looking for.Breast augmentation with implants is a more reliable, reproducible procedure with less morbidity and in most cases, less cost.   In the future, technology will improve and results will become more reliable.  At the moment, despite soft, natural feeling moderately larger breasts, the procedure still frequently disappoints.