Breast lift: fat graft vs implants: two surgeons two different techniques?

I have fairly small (B) asymmetrical droopy breasts. Surgeon 1 is against implants saying that they exacerbate the scars of the breast lift (anchor technique) and I should just have fat grafted to create upper pole fullness. Surgeon 2 says that implants behind the muscle is the right technique for me as 1/ I don't have enough skin tissue for the lift to look full b/ I don't have enough fat to fill them up. I'm a bodybuilder and the subpectoral technique might be very uncomfortable. Opinions?

Doctor Answers 3

Art vs Science : Breast lift, with implants vs fat graft: two surgeons two different techniques?

A difference of opinion between the 2 surgeons that you consulted with is not necessarily a bad thing. Plastic surgery is significantly more art than science. There is usually more than one way to arrive at an aesthetic outcome. 

Breast implants do not necessarily exaggerate the scar of the lift. Fat grafting could provide a modest increase in volume of the breast, particularly if upper pole fullness is all that is desired. Large increases in the volume of the breast with fat grafting usually require multiple surgeries. Assuming you have low body fat content, adequate volume for fat graft harvesting could be an issue.

Breast augmentation with implants can provide nearly unlimited choices for increasing volume of the breast. Of course, careful consideration to appropriate size and shape implants to achieve your desired outcome is essential. In most cases, I feel, subpectoral implants are the better compromise. The one consideration in your case however, is body building.  Subpectoral implants will animate more than subglandular implants (implants just below the breast).  Animation is excessive implant movement when the pectoral muscles are flexed forcefully, as in posing during a body building competition.  However, subglandular implants, can be more prone to being visible especially when a larger volume implant is chosen or when the patient has very little breast tissue or subcutaneous fat.

If your breasts are saggy enough to require a lift, inadequate skin is not usually an issue. Breast implants alone, via any technique, are unlikely to produce an esthetic result if you need a breast lift.  A breast lift with an implant is a very technique senstive surgery but can provide excellent results.  The breast lift decreases the skin envelope while the breast implant increases the volume and stretches the skin envelope. Breast augmentation with a lift is a challenging operation. This is where the Art of plastic surgery is paramount. Maintaining balance between the increased volume of the breast with implant and decreasing the skin envelope of the breast with the lift requries a discerning eye and experience in your plastic surgeon. 

Mastopexy implant

The decision regarding fat graft vs implant is mainly based on the volume you wish to achieve and the pros and cons of both long term. Often in body builders you won't have much fat. Might be worth you posting some photos to be able to give you an informed opinion. 

Gary L. Ross, MBChB, FRCS
Manchester Plastic Surgeon
5.0 out of 5 stars 138 reviews

Implant vs Fat Grafting

Thank you for your question.  Fat grafting will typically only add 1 to 1.5 cup sizes per treatment, at most.  In addition, any fat that doesn't survive grafting may result in lumpy, hard, and possibly painful, fat necrosis.  Although there are potential problems with an implant as well, an augmentation mastopexy is a very common procedure with fairly predictable results.  I have yet to do a breast augmentation in a bodybuilder who has regretted placement of the implant beneath the pectoralis muscle.  I suggest you get a third/fourth opinion to make sure you are making the right decision for you.  Hope this helps.  Best wishes!

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