Implant Reinsertion Vs Fat Transfer For Revision?

I have a single silicone implant (above the muscle) that was placed in 1979 for asymmetry at age 13. In 1983 I had a reduction on the other side. The implant was discovered to be ruptured - intracapsular - a few years ago and I am now considering removing it, but cannot decide whether to replace it with a silicone implant or try a fat transfer. What do you feel the pros and cons of each?

Doctor Answers 10

Breast Implant or Fat Injection?

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Thank you for the question.

What will work best for you will depend heavily on your physical examination and your goals. Generally speaking,  breast implants allow for the most predictable increase in breast size with a single procedure.  Fat transfer,  in the hands of plastic surgeons who utilize this technique frequently,  may help improve symmetry.

Again, I would suggest in-person consultation with well experienced plastic surgeons.

Best wishes.

Implant exchange

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The most reliable solution would be to have an implant exchange. If fat were to be injected( which may not be relaible), you wouald have to wait for the pocket to settle down and heal.  Fat injection may require a series of treatments as well.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Implant Revision: New implant or Fat Transfer?

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Both have pros and cons.  There is simplest solution is to replace the old implant with a new one.  This would restore your normal appearance right away.  Fat be used as a supplement to that to cover the edges of the implant and make you appear more natural.  However, using fat alone will require more work.  In most cases it takes at least 2 or 3 sessions depending on the volume to achieve and maintain the desired volume for the breast.  While there are still some concerns about the long term consequences of fat transfer to the breast, the advantages are that you will not have to worry about maintenance and complications that may ensue from another implant like capsular contracture or another rupture.

Adam Hamawy, MD
Princeton Plastic Surgeon
4.8 out of 5 stars 57 reviews

Old silicone breast implant rupture-what are my options?

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 A capsulectomy with implant removal is a must. I usually discourage any significant amount of fat transfer to breasts as these can become calcified or absorbed. Calcifications in breast area not a good idea with future mammography as they can appear as cancer. A small silicone gel implant behind the muscle sounds like a more reasonable alternative. Best wishes, Dr. H

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Implant Replacement vs Fat Transfer?

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There are number of important issues to be considered in your situation. First, you have an old ruptured Gel implant which has not leaked extracapularly - which is good for you. But there is a real risk that you could develope extracapsular gel  leakage, and should you should strongly consider having your old implant removed. This should be performed as an "En Bloc" capsulectomy to minimize the chance of getting gel material into your breast tissues. Besides, you likely have significant capsular contracture (so called hardening of the implant) and therefore probably not a very aesthetic breast shape, so removal of the old implant makes sense on multiple fronts.I

If you wish to consider replacing the implant that is removed, a new generation Gel implant could be a reasonable choice. Whether this is done under or on top of the muscle is dependant on a number of issues, but if your tissues are thinned, certainly possible after a capsulectomy, then under the muscle would be better.

I think it is unlikely that autologous fat transfer would be successful for you, particularly if done at the same time as implant removal. In order for the fat to "take" it has to be placed in an area of healthy, well vasularized tissue. If your tissues are thinned after implant removal, then the fat transfer will not likely take well and the amount of fat successfully transfered will not be enough to replace what is lost with the implant removal. If you were to try fat transfer, then it would probably best be done at a secondary procedure


Fat grafting will depend on the volume that you need

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Please send pictures for better evaluation. Fat grafting can be used in combination with implants if you need soft tissue coverage and large volume .

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 153 reviews

Implant Reinsertion Vs Fat Transfer For Revision?

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All three experts present valid outlooks. If the original implants were not over 300 cc's and you have over 1,000 cc's for liposuction I might consider Fat grafts with implant/capsule removal. I also might consider a combo of fat + smaller implant. Best to be seen in person. Over the internet very hard to advise. 

Options for breast symmetry

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In your particular situation, with a history of a previous implant, replacement of the implant seems like the best option.  Fat grafting can be very beneficial but it depends on the volume you need and the size of the existing implant.  A full examination would be needed to determine your best options.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Breast surgery revision with fat transfer

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Fat transfer to the breast is controversial.  The larger the volume of fat that is transferred the more likely is the need for revision secondary to unequal (and unpredictable) fat resorption.  Adding stem cells to transferred fat improves the reliability of the graft but adds an unknown: how do stem cells in the breast affect breast cancer development and/or breast cancer screening?

The most reliable source of volume for a breast is an implant.

Fat grafting may be an excellent option

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Particularly as you only had an implant on one side, and asymmetry is the main issue, fat grafting may be the perfect option for you. The beauty of fat grafting is that the fat can be placed exactly where needed to improve both size and shape, in order to make the breasts as symmetrical as possible.


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.