Doctor says Liposuction and fat transfer can't be done on my breast because the needle can break the implant - is this true?

Question

Hello,I’m 24, 161cm and 52 kg. I had a liposuction and fat grafting consultation and the doctor turned me down for both. She said I need to have lipolisis instead and for the fat transfer it can’t be done on my breast since I have implants and the needle can break the implant. Are any of this true? My BMI is 22 and since i have fat on my thighs knees and calves that I want to remove I don’t get why I can’t have lipo and the fat grafting I’ve seen people combining with implants all the time?

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding whether it’s possible to do liposuction and fat transfer to the breast with breast implants. One is to understand the history of fat grafting to the breast. Fat grafting to the breast was initially done for breast cancer survivors. Small amounts of fat were injected into the breast to create optimal breasts after breast cancer removal. Many breast cancer survivors have breast implants, so plastic surgeons are skilled at placing fat in the breast and around the breast implants. Therefore, it is not impossible to put fat in the breast even though you have breast implants. It does require a very skilled plastic surgeon with the right instruments. The instrument used to insert fat into the breast is not a needle but a blunt cannula that is not sharp. All in all, the procedure can be done. This just requires an experienced plastic surgeon with the right instruments. Thank you for your question regarding fat transfer to the breast in a patient with breast implants.

Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery, and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery, and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Jason Emer, MD · Answer

It's difficult to say without the benefit of a formal evaluation. Consult another physician who specializes in this. Best, Dr. Emer

Kenneth Hughes, MD · Answer

Fat grafting can be successful after breast implants to improve shape and size discrepancies. Some of the success will depend upon existing tissue available for receiving the fat. In general, 200 cc per breast is typically the upper limit of fat injection recommended by most plastic surgeons. It is not that more cannot be injected; but on average, this has been determined to be the most that can be expected to live during one transfer. Multiple transfers would be required for additional cc's. In general, the abdomen and thighs are preferred donor sites but fat from other areas can be used. Lipo and fat transfer to the breast can be performed during the same surgery. A board certified PS should know where to inject the fat to prevent rupturing the implant.

Erik Miles, MD, FACS · Answer

Autologous fat grafting around implants has become a relatively common procedure.  Of course the cannulas can damage the implants if not done correctly, however this risk is low in experienced hands.  If you have very little breast tissue and the implants take up most of your breast volume, it does make the procedure more challenging.  There may be other reasons that your doctor thought that you might not be a good candidate for the procedure.  My recommendation would be to get a second opinion. Best wishes.

Daniel Barrett, MD · Answer

Dear Charming6581,
it is hard to tell for sure without an examination. Generally speaking, it is probably not the best option to do liposuction of breasts with implants inside. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Arian Mowlavi, MD, FACS (license on probation) · Answer

At Cosmetic Plastic Surgery Institute we utilize Safe California Ultrasound Assisted Liposuction (SCUBA) technology to be able to visualize sensitive areas that require more precision. Similar to your case, we commonly perform fat grafting to breasts with implants by combining this technology with VASER liposuction.

That being said, you would likely benefit from a breast lift with fat grafting or implants. The fat grafting/implants would add volume to your breasts, while the lift would resolve nipple and areola placement. A Skype or FaceTime consultation with a breast augmentation specialist will help you get an accurate recommendation and pricing.

Respectfully, 
Arian Mowlavi MD, FACS
Realself 100 Hall of Fame Inductee

Mats Hagstrom, MD (license on probation) · Answer

Grafting fat with implants in place is very risky and patience are high risk of having implant rupture from doing so. I personally would never consider doing fat transfer while implants are in place. The approach to this problem when it presents is to take the patient to the operating room, remove the implants and put in temporary Sizer‘s which are basically throwaway temporary implants. The surgeon does the fat transfer using the sizers because if those are ruptured there’s no harm done. After the fat transfer is completed the original implants or a new pair of implants are inserted into the pocket and the procedure is complete.

Obviously Liposuction and closing the pocket are part of the procedure.

Make sure doctors you consult with our board certified in plastic surgery.

Different plastic surgeons will have different opinions on the appropriateness of doing breast fat transfer for someone who has implants.

Since the primary reason for patients to get fat transfer is to increase breast size the procedure is often pointless for those who already have implants in which case it would be much easier to simply use larger implants.

Fat transfer does not change the shape of the breast at all and it is only a procedure to increase volume. It can in some circumstances create more tissue between the skin and implant if the implant is palpable in some areas.

I suggest all patients have multiple in person consultations before committing to permanently altering your body.

Delivering consistent high-quality Liposuction and fat transfer results is more difficult than most people believe. For that reason Patience should make a strong effort in finding the most talented and experienced provider in their community.

Doing that typically requires having multiple in person consultations.

It sounds like you’ve just eliminated your first contender now you simply have to continue the process until you vetted enough plastic surgeons until you feel very comfortable you are in the hands of someone who is truly talented and has immense experience.

During consultations ask providers to show you their entire collection of before and after pictures of the procedure you’re interested in. Seeing two or three pictures representing the best outcomes of their career is insufficient to understand what the average results look like or get any confirmation of how many procedures this provider has performed.

An experienced provider should have no difficulty showing 50 or more sets of before and after pictures. Highly experience providers will have hundreds or possibly thousands of before and after pictures for the procedure and body area you’re interested in.

Final note, lower extremity liposuction is particularly challenging to do without leaving contour irregularities and delivering high-quality results that are in tune with patient expectations. This means sometimes patient’s expectations need to be lined up with what can and cannot be delivered.

Find the right plastic surgeon and everything falls into place.

Physicians go to medical school and complete residences typically for the purpose of helping others and it is reasonable to assume that they are serving as patient advocates and telling the truth. That said the temptation to twist reality in the physicians favor happens.

Lead us not to temptation.

Best,

Mats Hagstrom MD

Robert T. Buchanan, MD (retired) · Answer

There is some truth in what you were told. It is possible to damage the implant while fat grafting the breast. However, I suspect this is just an excuse by an inexperienced surgeon. In expert hands, liposuction of the areas you desire is routine. As far as injury to the implant, this should not be a problem for an expert who will just lift the area to be grafted away from the implant and make sure not to move the canula anywhere near the implant. Again, in expert hands, this is routine with minimal risk.

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