Extreme discomfort, possible fat necrosis & oil cyst in breast after fat transfer, options?

The pain you are having is not necessarily from the fat because you say you had the pain before. You should get an MRI of the breasts. It might show the source if your pain.

Dear Mecha23,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Breast lumps will not cause any problems with breathing, so I would suggest that you see your medical physician and be checked. I would also suggest having a mammogram and possible ultrasound to check these lumps. It is possible that they are not related to your fat transfer. If they are fat necrosis, they can be removed. You could see a plastic surgeon, a general surgeon, or even a breast surgeon for this.

Your surgeon is responsible for the outcome of the procedure. Your state Medical Board should have a publicly listed address for your provider.
Since your surgery was four years ago at this point you’re probably just as well to find another plastic surgeon.
Other than examining your breast probably an ultrasound would be appropriate. Most plastic surgeons don’t do this but being present while the ultrasound technician does the ultrasound and seeing where oil cysts are located specifically and then marking them with a sharpie is not a bad idea.
If you have oil cysts then those should be drained.
Your plastic surgeon could do that if the cysts are marked or perhaps an even better option is to have a consultation with an interventional radiologist.
The first step is to make a diagnosis and that then determines the treatment.
Delivering consistent quality in Liposuctiona and fat transfer results is more difficult than most people believe.
Patients should carefully vet providers thoroughly and interview numerous providers before choosing anyone surgeon for these type of procedures.
Try to find local plastic surgeons who have a lot of breast fat grafting experience.
You may have to consult with a few of them.
Schedule all consultations as in person consultations avoiding virtual consultations whenever possible.
Best,
Mats Hagstrom MD