Technique to Get Fat Transfer for Breast Augmentation

I need to know. Someone please help. I keep going back and forth on whether or not to get fat transfer to my breasts for augmentation and that reason is because of some of the answers from the doctors. Here is a better question I hope someone will answer:). I had a very long over the phone convo w/ this new doctor about the new procedure they use.they pretty much tell me everything good and never say that there may be any risks associated with the surgery. 1st- they use LOCAL TUMESCENT ULTRASOUNG TECHNIQUE to remove fat...what is that? arent these two different types of lipo? 2nd- this person is not an actual plastic surgeon persay, but a physician who is a cosmetic surgeon, but claims to have been performing liposuction for more than 20 years. Is this normal? 3rd- BTW, who performed the first liposuction procedure in the US? (dont have to answer but just curious) 4th- this person uses a STEM CELL technique, where the fat is put into a machine and separated.- is this more doable than any other option? 5th- I would not be part of a clinical trial

Doctor Answers 10

Breast Shape Improvement

A lot of great questions here.

1. First and foremost, there are many very good board certified plastic surgeons in the world to choose from. I would have significant concerns about going to someone who "is not a plastic surgeon per se". It is just not something you should compromise. Find a board certified plastic surgeon experienced in breast augmentation.

2. Many doctors have several techniques for breast shape improvement and we perform a lot liposuction and lipotransfer. We do not inject fat into the breast. If for no other reason, it can complicate the ability to detect breast cancer.

3. When we do fat transfer to other parts of the body we do not use ultrasound prior to fat harvest as it decreases the survivability of the fat.

4. "Stem Cell" techniques are marketing and not true stem cell therapeutics (the FDA just approved the first stem cell therapeutic trial for a company called Geron) and there are no stem cell derived therapeutics for use in the US at this point in time).

5. The first liposuction was performed by a French surgeon, named Dujarier. A tragic case that resulted in gangrene in the leg of a French ballerina in 1926 resulting in an amputation. Ilouz et al got liposuction established in 1982 in the US.

I hope this helps.

San Francisco Plastic Surgeon
4.8 out of 5 stars 49 reviews

Strongly suggest you consult a plastic surgeon certified by the American Board of Plastic Surgery


I am glad you wrote Realself for answers. The fact you have so many questions means that you are uneasy with what you have been told over the phone. You have good instincts.

There is no board of cosmetic surgery-many doctors with no surgical training call themselves cosmetic surgeons.

There are positives and negatives about every procedure and you should be told all of them.

By far the most commonly performed procedure for enlarging the breast is breast augmentation with breast implants. Millions of successful breast augmentations have been done, the techniques for an excellent result are well established, and the implants available today are the best in the past 50 years.

Fat injection for breast enlargement in my opinion is still in the research stage. Ways to improve graft survival are still being studied. As much as 60% of injected fat dies.

I recommend that you visit the website of the American Society of Plastic Surgeons, American Society of Aesthetic Plastic Surgeons, and the American Board of Plastic Surgery and consult two board certified plastic surgeons in your area.

Get answers to your questions, and being thus informed you will be able to make a good decision.

Fat transfer for breast augmentation is still experimental

Barbie:  Thank you for your questions.  From the information you recieved you clearly have many concerns, and well you should.  First, there is NO Board of Cosmetic Surgery which is accepted by the American Board of Medical Specialties.  The web is full of doctors with no specific training in plastic surgery who call themselves "Cosmetic Surgeons".  The "Gold Standard" is board certification by The American Board of Plastic Surgery.  I recommend you contact them on the web and get a list of surgeons in your area whom you can consult with. 

Second:  Fat transfer to the breasts for augmentation is still undergoing critical evaluation about its safety and effectiveness ( one concern is greater than 50% of the fat dies) and is not endorsed by the American Board of Plastic Surgery.  It likely will take years before this evolving issue is settled.  The use of stem cells for breast augmentation is still completely experimental.

Third:  No matter how small, all surgeries have potential risks associated with them.

Fourth:  Millions of patients have had breast augmentation with  implants and have done well.  This is a time tested procedure with  predictable results.  

I believe you will get the best information from contacting the American Board of Plastic Surgery or The American Society of Plastic Surgery and taking advantage of the doctors  and the information available on those sites.

I hope my answer is of help to you.

Jeffrey M. Darrow, MD
Boston Plastic Surgeon
5.0 out of 5 stars 99 reviews

Liposuction versus liposuction

Liposuction is a safe, popular, and effective way to contour the body. In our practice, we defined liposuction as the technique that we use to remove large amounts of fat. We describe liposculpture as the technique where the fat is contour to simulate the underlying muscle and bone framework. The emphasis in liposculpture is not the removal of a large amount fat but sculpting this fat to create a more toned appearance.

Pat Pazmino, MD, FACS
Miami Plastic Surgeon
4.7 out of 5 stars 108 reviews

Run the other way from Liposculpture

I would run the other way. This cosmetic surgeon is trying to sell you the Brooklyn Bridge. Stem cells are found in all tissues. No one knows how to use them yet other than in the laboratory. Fat injection to the breast is being proposed by some as an alternative to standard breast augmentation, but it is still controversial and certainly not studied well enough yet. If the doctor is not a plastic surgeon trained to perform breast surgery, I would run the other way. After all, do you want a plastic surgeon to do your brain surgery?

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Excellent questions

You are asked a number of excellent questions most of which have been expertly answered by other surgeons already. I would second the caution regarding fat transfer to the breast. Although a cosmetic surgeon might be an excellent liposuction surgeon, unless you personally know of this doctor's reputation, you are gambling. A good place to start is with a board-certified plastic surgeon.

As for tumescent, ultrasonic liposuction, you have to separate the hype from the reality. Tumescent liposuction is a catch phrase that is used to decribe a specific formula for administering local anesthesia, now thought to be risky because of the volume of fluid and dose of local anesthesia, to a generic reference to a technique that has a connotation of simple procedure without general anesthesia. Most plastic surgeons will use some sort of cocktail of medication and fluid to "tumesce" or swell the area of proposed liposuction often in conjunction with genral anesthesia or sedation. Most will use a form of "superwet" formula that is safer rather than true tumescent formula. The ultrasonic method is quite variable as well with some doctors using is almost exclusively, while other use it sparingly. There are certain, not well substantiated, claims of benefits to ultrasonic liposuction, and also known risks associated with the inappropriate or inexperienced use of ultrasound. I wouldn't focus on the technique, but rather on the surgeon. Once you have found a qualified, trustworthy, and experienced surgeon, let him or her determine what technique would be best suited for your situation. In reality, ultrasonic liposuction is probably helpful, perhaps marginally preferably, in only a few limited circumstances.

Good luck.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

Fat transfer to the breast carries risk

Dear Barbieblonda16,

The question concerning fat transfer to the breast has come up before from followers of the Realself website. The concensis by the American Society of Plastic Surgery members is that fat grafting to the breast is at this stage experimental as to the result and outcome of the procedure. The risks are very great and will cause a lifetime of health concerns if you develop problems from the procedure. Clinical trials are being conducted to help us understand the benfits and risk of this procedure.

As a question reviewer I would be very sorry to hear that you did not carefully consider this advice. The response you have received should raise a red flag. It makes me uncomfortable and you should be too.

Concerning ultrasound in liposuction, the technique uses high energy sound waves to rupture the fat cells and liquify the fat which aids in fat removal and contouring. I use ultrasound frequently, however ultrasound destroys the fat cells and they become unsable as a graft.

I suggest you get an additional or second opinion to help you be sure of your decision. Certification by the American Board of Plastic Surgery is a good place to start.

Best of luck.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 43 reviews

Fat injection in the breasts is experimental

To barbiebionda16,

Hi! Don't get stuck in technical issues that are hard even for a plastic surgeon to sort out. Find a board certified plastic surgeon who does a lot of breast augmentations. Don't listen to telephone consultations.

Don't you think there must be a reason why so few legitimate plastic surgeons inject any kind of fat into the breasts? It is experimental, with major reported complications. The national plastic surgery societies do not recommend it.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

You have a lot of good questions


There different kinds of liposuction. There are also many kinds of pre-treatment of the fat: laser, ultrasound, etc. After the fat cells are destroyed, they are then sucked out through liposuction, which can be traditional or power-assisted. Experience is good for anyone doing liposuction. However, you also want to make sure you are seeing someone who is qualified, licensed, etc.

As for the fat grafting, after the cells are suctioned out, they can be concentrated in a centrifuge before they are re-injected. This is standard technique. One word of caution: if they are using the ultrasound on the fat prior to harvesting it for your grafting, then they are destroying the fat cells. You want to make sure they harvest the fat cells prior to doing any laser or ultrasound lipo. Good luck with your procedure.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 77 reviews

Several liposculpture issues to address

Hi there,

Your question really brings up more than one issue.

As far as fat transfer to the breasts for augmentation purposes goes, what you need to know is that while it CAN be done (meaning that the fat can be transferred and the breasts will be larger), most Board Certified Plastic Surgeons agree that it is probably not responsible to do this procedure right now. This is because in the US, we know that 1 out of every 8 women will be diagnosed with breast cancer at some point in their lives, and the transfer of fat to the breast can create confusion on mammograms that may lead to misdiagnosis or delayed diagnosis of breast cancer. Scary stuff.

This is a big enough deal that The American Society of Plastic Surgeons actually came out with a formal recommendation that its ~6000 Board Certified Members NOT do this procedure over concerns for our patients' safety. You can read about this on the American Society for Aesthetic Plastic Surgery website.

With regard to your other question, there are doctors from many specialties performing all manner of aesthetic procedures nowadays. Board Certification in Plastic Surgery means that we have completed years (not days or weeks) of training in the safe and effective performance of the aesthetic procedures we offer our patients, and it is this that (in my opinion) makes a Board Certified Plastic Surgeon your best bet for your procedure.

Even if you decide to proceed as planned with the provider you speak of, I would suggest you find a Board Certified Plastic Surgeon and get an opinion about your options. Remember- the goal should be not just to achieve the goal you have for breast contour and volume, but to have you be safe throughout as well.

I hope that helps.

Armando Soto, MD, FACS
Orlando Plastic Surgeon
4.8 out of 5 stars 159 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.