What could the firmness/hardness 5 weeks after fat grafting breast augmentation be? (Photo)

Thanks for sharing your concerns with us. Its early to talk about final results.In my practice, after performing a BA I recommend to my patients to limit the movement of the arms for two weeks. After that, you can move your arms taking care and always with common sense. In this regard, it's not advisable to carry heavy weights to prevent the implant out of position, and allow the formation of the physiological capsule around the implant, also to avoid pain and breast swelling.Kind regards,Dr. Emmanuel Mallol.-

Thank you for your question and photograph.  Unfortunately without an in-person examination it is difficult to make definite recommendations as to what the firmness may be but at times after fat grafting some of the transferred adipose tissue does not survive causing temporary areas of firmness.  These tend to get broken down and dissolved by your body's immune system but I would advocate you speaking with Dr. Khouri to have a definite diagnosis and treatment options discussed.  

Best to see Dr Khouri in a follow up for his dx and most likely he will scan the area to rule out any issues. Otherwise try warm compresses and time (with his approval ONLY!).

Almost certainly this firm area is fat necrosis.When fat is transferred from another body region to the breast, it has to have a healthy blood supply.  It is sort of like laying sod in the garden.  Initially the grass gets its nutrients just by lying on the healthy soil and evenually, if it is kept healthy long enough, it grows roots.  The same thing happens with fat - it needs a healthy blood supply to survive.Any fat that doesn't have a good enough blood supply will die (necrosis).  This forms a firm lump.  Over time, this fat liquefies and the lump disappears, but this can take several months.  So yes, this will likely soften over time. We expect some fat necrosis following fat transfer - not all of the fat survives.  The reason the side with the firmness is smaller is that you have lost some of the volume compared to the other side.  Hope that helps.

Thanks for your question. Fat necrosis can eventually become calcified and appear as areas of induration. This issue you shoul keep in mind  for your next routine exams of your breasts. However, you can wait longer and give direct massage in the area. This will help areas become softer.