Can fat transfer fix the shape of my breasts after my implant removal? (Photo)

Question

I had 450cc silicone implants that ruptured so I had them removed. I wanted to see if I would look decent without implants so I decided not to replace with implants. I never liked my implants and would never get them again! But now I have misshapen breasts that need some help. I would love to know if a fat transfer can actually fill in my breasts enough to give them a normal shape? I don't care if they are bigger I just want them to look more normal, not looking for perfect!

Gary M. Horndeski, MD · Answer

Your 450 cc implants stretched out your skin and you now have hanging skin.  The technique I recommend is a lift using The Bellesoma Method.  This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained, if not injured during your previous surgery.  Later, fat transfers can be performed if additional volume is desired. Best Wishes,Gary Horndeski, M.D.

Kenneth Hughes, MD · Answer

Breast fat transfer is a great tool to balance breasts, improve symmetry, and gain up to one cup size in volume.  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.
Some of the retention rate will depend upon the amount of fat transferred, as smaller volumes will likely have a higher survival.  Occasionally, a patient can resorb a great deal of the fat despite optimal transfer procedures. I typically transfer from 250 cc to 400 cc or so per breast.  
Results are largely dependent upon the skill of the surgeon, his/her ability to remove fat without creating contour deformities, and your expectations. You would need a consultation with a board certified PS to determine your available fat stores.

Daniel Barrett, MD · Answer

Dear MaryCantDecide,
it is hard to tell for sure without an examination. Based on your photo, it looks like you would benefit from a fat transfer. If you are considering a surgery, I would suggest you to 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

Daniel Zeichner, MD · Answer

Hi and welcome to our forum!
Because of the large implant size, your breast tissue was stretched and thinned over the implant. Following implant removal, the empty pocket collapsed, creating the present appearance. We recommend waiting 6 months after explantation before proceeding with revision to allow for subsidence of swelling and the hypervascularity of healing. In many cases, the deformity lessens over time. 
Fat transfer is limited in the amount transferred in a single procedure (usually 200-250 cc per breast). 60-85% of the fat may survive. Multiple procedures will most likely be required. A breast lift and scar lysis will ultimately be required when satisfied with your size as your breasts are considerably smaller since implant removal and there is now excess skin present. 
Be under the care of a board certified plastic surgeon.
Best wishes...

Connie Hiers, MD, FACS · Answer

You can get improvement with fat transfers over time, but will need more than one procedure. However, it will not restore your look prior to breast augmentation. I would suggest meeting with a board certified plastic surgeon and realistically discussing your options with fat.

Johnson C. Lee, MD · Answer

Thank you for your photo. It is possible that fat grafting can restore some of your lost volume to improve the overall shape of your breasts. You will likely require multiple procedures over time of  fat grafting to the breasts to create enough volume and shape so that your irregularities are corrected. It is best to have an in-office evaluation to determine if you may also need some manipulation or rearrangement of your breast tissue and skin to correct this. Hope this helps!Johnson C. Lee, MDBoard-Certified Plastic Surgeon

Robert Singer, MD · Answer

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: There has to be adequate fat donor sites, 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, and may require additional sessions of fat injection to optimize the results. 
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 (currently has not been a problem), 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.
I would suggest that your plastic surgeon be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.
Robert Singer, MD  FACS
La Jolla, California

Mats Hagstrom, MD (license on probation) · Answer

Your situation is a bit complex. From the pictures you’ve posted it looks like there is scar tissue that’s causing distortion in the shape of your breast. Most likely if you had a previous capsular contraction and the scar tissue is distorting the shape of your breast.When that’s the case simply adding volume may not correct the contour deformity.There’s a good chance that fat transfer alone would simply give you a larger version of the same looking breasts.Depending on what the underlying ideology is you may do better having complete capsulectomy‘s and probably would get the best outcome By staying with implants.Hard to tell by the pictures alone. Most patients who have implants removed we don’t have issues with capsular contraction don’t have the level of disfigurement that you have. I could be wrong and simply adding volume may produce a significantly improved contour.A lot depends on what the condition of your breasts were at the time of explantation.did you have capsular contractions? if so then you may need a different game plan. I don’t like doing a fat transfer and patients with present capsules because fat can build up inside the capsule space leading to a significant amount of necrotic tissue. There are ways of dealing with this during the procedure but it’s much better to do fat transfer on patients who don’t have a potential space(old capsule) under their breast. My preference is for patients to undergo at least a partial capsulectomy at the time of explantation to minimize this. This is at least the case for those considering fat transfer.   you’ll probably find a few different opinions on this. Fat transfer may help improve your appearance but may not deliver enough to have the outcome you desire. A thorough conversation during several in person consultations with a few different plastic surgeons may be in order. Best, Mats Hagstrom,MD

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the question and photos and fat grafting may help so see your surgeon or other expert in the area and become fully informed about the desired procedureDr Corbin

Can fat transfer fix the shape of my breasts after my implant removal? (Photo)

Answers (9)

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