Can I have Breast Implant Removal + fat transfer in the same procedure?

Yes — breast implant removal and fat transfer can be done in the same procedure, and it’s something many surgeons perform. However, whether it will give you the result you’re hoping for depends on how much lift and skin tightening you need, not just volume replacement.Can explant + fat transfer be done together?✔ Yes, in selected patients.During the same operation:The implants are removedFat is harvested (usually from abdomen/flanks/thighs)Fat is transferred to restore soft volume and contourThis can help:Reduce the “deflated” lookImprove ripplingCreate a softer, more natural breastThe important limitation (this is key)Fat transfer adds volume, but it does not lift the breast or tighten loose skin.Given your history:Very large implants (500–600 cc)Significant stretching of the skinLikely excess lower-pole skin after explantFat transfer alone is unlikely to fill the loose skin envelope or give you a stable, youthful shape — even if enough fat survives.What usually gives the best result in cases like yoursFor patients going from very large implants (DDD) to a C–D range, the most reliable strategy is:Implant removalPush-Up Lift (supportive mastopexy) to reshape and tighten the breastFat transfer (same surgery or staged) to restore volume and softnessA Push-Up Lift:Repositions your own breast tissue upwardRemoves excess stretched skinCreates internal support so fat grafting actually holds its shapePrevents the breast from looking flat or bottom-heavyOne stage vs staged approachOne-stage explant + lift + fat transfer → possible in many casesStaged fat transfer (adding more volume later) → very common and often gives better fat survival and shapeMost patients need more than one fat grafting session to reach a full C or D cup — that’s normal and expected.

Fat Grafting is a great reconstructive option after removing implants and can be safely performed at the same time as the explant. Taking your breasts from a small B to a DDD with 600cc implants causes the skin, fat, and breast tissue to thin and stretch over the implant. When the implant is removed, this thinned out breast will likely collapse "like a circus tent." To prevent this, you may benefit from fat grafting, a lift, or both. Fat grafting adds natural volume to the breasts, can correct asymmetries in size and shape, and prevent unsightly creases. A mastopexy, or lift, is needed if the nipples are pointing downward, or the tissues are so stretched that fat grafting alone with not correct the collapse.

If you have 600 cc implants in place then there is no way possible to have fat transfer to replace them. What I recommend is explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated 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.

For most patients, fat transfers can be safely performed at the time of explantation. There is however a limit to the amount of fat that can be transferred, and it may be inadequate for your goals. Seek a consultation with a board-certified plastic surgeon who can provide realistic expectations and anticipated outcomes.

Dear omnarmnarmnarms,

I understand your concern. It is best however that you consult with a board certified plastic surgeon to determine whether you can have several aesthetic surgeries in one session, as this would depend on various factors including but not limited to your general health condition, the type of anesthesia that will be used, and the type of surgeries that will be performed among others.


Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Omnarmnarmnarms,
In placing 600 cc implants and increasing your cup size from a small B to a DDD you have stretched you skin to reach this new size. When removing your implants, you will need to consider a breast lift for skin tightening and nipple position correction, as well as fat grafting for volume. And these can be done at the same time or staged. Some patients will elect to deflate their saline implants in the office 4 weeks before surgery to allow their skin to tighten some on its own. This may eliminate the need for the breast lift depending on how much your soft tissue envelope contracts on its own once the implant is deflated.
Dr Stein

Before deciding on the right procedure for you there are some considerations. I do not perform fat transfer to the breast as a form of augmentation as the fat can develop microcalcifications which can interfere with future breast imaging studies. Fat necrosis can occur as well asymmetry as all of the transferred fat does not generally "take". In many cases you can anticipate only one cup size of increase from this method and you still may need a breast lift. I encourage you to begin by visiting with a board certified plastic surgeon near you for a consultation to learn more about your options.

Breast fat grafting or transfer can increase the breast size to a limited extent only. Those with cup B minus and lower (A+ and A-), can only expect a half cup size increase while those with cup B+ and higher, may have 1 full cup size increase. The reason for this is that harvested fats require a fat layer where it can be grafted. And the breasts are made of breast tissues with varying amount of fats surrounding it. Therefore the space left for grafting become smaller and limited.Fats also cannot be grafted in bolus amount. It should be dispersed in small volumes to assure survivability.This now leads to the question on "fat transfer" after breast implants removal. The capsule (which holds the implant) left behind and the tissues surrounding this are generally poor in blood circulation. Grafting on these areas may not be a good idea as the risk for nonsurvival or "necrosis" of fats are high, leading to complications like abscess formation.