Is it safer to have fat transfer in the subcutaneous plane or the pectoral fascial plane? (Photo)

I had my breast implants removed 6 months ago which has left me with small droopy breasts. I can't face having implants again and so have been to see 2 dr's about fat transfer. The first dr said I should have a mastopexy as one operation and then go back to have fat transfer as a 2nd op. He also said the fat should go under the skin only as this is safer. But the 2nd dr said I could have a mestopexy and fat transfer in one operation and the fat would go around the muscle. Which option is best?

Doctor Answers 4

Fat can be placed at any level within the breast.

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Fat grafting to the breasts is an excellent option to increase the volume without implants. Looking at your photographs though, unless you add a very large volume of fat you will probably need a breast lift as well. In order to add sufficient fat to avoid that you may need to have more than one procedure.The advantage that you have is that your breasts have been stretched by the presence of implants and there is plenty of room within the skin envelope to add the fat grafting without excessive tension.If you wish to avoid the breast lift I would try fat grafting first as much as your doctors thinks can be done in one setting. At that point you can reassess and if necessary either do a lift or further fat grafting with or without the lift as needed.

Cleveland Plastic Surgeon
4.8 out of 5 stars 24 reviews

Breast Fat Transfer/ Breast Augmentation/Breast Implants/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision

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I appreciate your question
I perform a natural breast augmentation with fat. This can be removed from any unwanted areas including the breast itself as part of my lipo-lift procedure. I perform the fat grafting in multiple planes including under the muscle to give the best, most natural enhancement. Fat grafting is a great solution for someone who wants to bring their breast size up a cup or so and use natural tissue vs an implant. However, it can also be combined with an implant or used as a secondary procedure to fill in areas that are flat or thin. It should not affect nipple sensation, mammograms, cancer risk or breast feeding. It can be a little lump or hard at first but tends to soften over time. If you gain or lose weight, the transferred fat can do the same.
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 breast plastic surgery.
Best of luck!
Dr. Schwartz
Board Certified Plastic Surgeon


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You could have mastopexy with direct fat grafting to the muscle during the first session if there was any concern with blood supply to the skin flaps of the mastopexy... And then a second, or third session of fat grafting  alone. The risk is damaging or decreasing the blood supply to the mastopexy skin with the fat grafting if its done too aggressively. Good Luck.

Breast lift and fat grafting

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Breast lift and fat grafting can be done in one stage. To optimize take of grafted fat, it needs to placed in small aliquots in multiple planes, including under the skin, in the breast tissue, and the muscle. Best, Dr. Yegiyants

Sara Yegiyants, MD, FACS
Santa Barbara Plastic Surgeon
5.0 out of 5 stars 20 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.