Fat Transfer to the breast after removal of implants (Capsulectomy, Enbloc)?

Hello,Fat transfer is an excellent option after implant removal, as long as you have enough fat along donor sites to appreciate a difference.  There is no evidence suggesting the explantation will result in poor fat take, and good technique and experience  will minimize the chances of fat necrosis. Am examination can help determine if you would also benefit from a simultaneous breast lift.Warm regards,Dr. Pedy Ganchi                                                                                                         Village Plastic Surgery                                                                                                    

Great questions!  Here are your answers:
1.  I believe the fat will take very nicely even though you've had surgery to the muscles already.  The surrounding tissues will most likely provide nourishment to the grafted fat.
2.  Necrosis is very rare in the breast after fat grafting because of the great blood supply to the skin and breast tissue. 
During a consultation, all of your questions can be answered in greater detail as a physical exam is part of this.
Thank you for your question!
Dr. Schreiber, Baltimore plastic surgeon

The abdomen is one of the preferred harvest areas for transferring fat to the breast.  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.  The fat must be injected through multiple planes in small amounts to the tissue through one tiny incision under each breast.  If you want fat grafting, this may require multiple treatments to reach the size you desire.   About 50% of the fat obtains permanence.  Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Fat grafting is your only option if you want to avoid the use of implants. The good news is that this is an effective way to add volume to breasts and to correct deformity following previous implantation and explantation. The fat is placed under the skin, and behind the breast tissue and occasionally in the muscle and in the breast tissue itself. Providing that you have sufficient fat to harvest this is an excellent procedure.

Dear Dbbh,earlier position of implants should have no negative effect on fat viability. Generally speaking, fat transfer is a great option after implant removal. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

After
removal of implants, the breasts are esthetically unattractive from lack of
volume and hanging skin.  A lift is
frequently required as well as fat transfers. 
The lift technique I recommend is The Bellesoma Method.  This will reshape your breast tissue creating
upper pole fullness without implants, elevate them higher on the chest wall and
more medial to increase your cleavage. 
Vertical scars are avoided, nipple sensation and the ability to breast
feed are maintained, if not injured during your previous surgery.  At the same time or later, fat transfers can
be performed if additional volume is desired.Best Wishes,Gary Horndeski, M.D.

Fat transfer to your breasts is a great option and any previous muscle operation usually does not cause any problems. I do it all the time for breast reconstructions as well as breast augmentation. The rate of the take is between 50%-60%. The rate of fat necrosis is extremely low. But it depends on the surgeon technique and experience.

Thank you for your question. How much volume are you trying to replace? If you are grafting over 150-200cc in one procedure, you're loss will increase.  In general, a 30-50% loss is not unheard of. Some patients have less, some have more but that is realistic . Fat works well as a supplement to existing volume i.e. after a lift OR with an implant. When you're grafting larger volumes i.e. to replace an implant, you might need a second procedure to reach your desired volume.

Dbbh.   I appreciate your concern, however fat transfer to the breast is somewhat unpredictable, and it is difficult to say if fat necrosis will occur, it’s extent, as well as how much fat will take. Generally speaking, smaller volumes have a better chance of more symmetrical take. Discuss your concerns with a board-certified plastic surgeon in your area. Good luck. 

To answer your question you should do fine with fat transfer and because you have separated your risk of significant fat necrosis is low and should be similar to any other fat transfer patient. Transferring lower volumes sometimes in multiple procedures will also lower necrosis risk and can over time create a much larger breast. I would visit with a few BCPS familiar with the procedure in order to learn more for your specific case. Good luck!  Dr K