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. Scarring is usually minimal. 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 (does not appear to be a problem so far), 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.Robert Singer, MD FACSLa Jolla, California