How do I find a PS that has good reliable results for a fat transfer to breasts?

What should I look for in a surgeon and what questions should I ask? What percentage of fat survival is common in 2014? How much fat can be safely placed in each breast? Is there a standard best practice?

Doctor Answers 12

Fat grafting to the Breast

Your question about fat grafting to the breast is an excellent one-- here are a few thoughts when seeking the right surgeon for a fat grating procedure:

Is it a procedure they perform regularly? (keep in mind that for most plastic surgeons fat grafting to the breast is not the most common procedure they perform)

Do they recommend the BRAVA system before and after the procedure?

What is their experience with graft survival and how do they handle the fat prior to transfer? (these numbers vary but most surgeons will find that there is a percentage of graft loss as low as 30% and perhaps as high as 60%)

The amount in each breast is also a variable number, but just as important a question is do they feel you would need more than one procedure (another fat grafting procedure several months later)

One other question is to ask them how they handle your donor site (where they take the fat from) to get you the best possible contour there.

Hope that helps and good luck!


Seattle Plastic Surgeon
4.9 out of 5 stars 144 reviews

Finding a PS for breast fat grafting.

Success in breast fat grafting is very dependent on the experience and practices of the surgeon.  The procedure is still under development, so strict "best practices" have not been established. In my practice will use the BRAVA and have special equipment for harvesting the processing the fat. Look for a board certified plastic surgeon that has experience with the procedure and ask to see results of actual patients.  Ask how many breast fat grafting procedure the surgeon does a month, etc. 

Percent fat survival is a tricky question to answer.  The better question to ask your surgeon is how much bigger your breasts can be made with a single procedure.  The amount of volume increase is dependent on the size of the breasts before the procedure. Small breasts can only accept a small amount of fat and large breasts can accept more.

Timothy Connall, MD
Portland Plastic Surgeon
4.8 out of 5 stars 30 reviews

How to find a surgeon for breast fat grafting

You need to make sure that you are going to a surgeon with a good reputation.  Ask your friends and family doctor.  That is a good start.  They should have a special interest in fat grafting to the breast.  
There is no agreed upon best practice. There are several successful methods and each doctor will likely believe theirs is the best.  The one thing all fat graft specialists agree upon is that although it seems so simple, the best result can only be achieved with careful fat harvesting and precision placement one droplet of fat at a time.  The amount of fat does vary and is somewhat patient dependant.  You should expect anywhere from 60-80% as a ball park for survival.

Rodger Shortt, FRCSC
Toronto Plastic Surgeon
5.0 out of 5 stars 52 reviews

Fat grafting

Based on recently published data, when pre-expansion of the breast is done with the Brava device, about 65% of fat will be retained long-term.  This is the best current  method that doesn't involve stem-cell "turbo-charging" of the injected fat -  a research-only method.

The technique is evolving rapidly.  Best practice generally involves gentle harvesting of the fat - with either syringe liposuction, low power standard liposuction or VASER, some sort of fat processing - with either centrifuge or filtration, and then careful re-injection of tiny ribbons of fat into the breast without overdoing it.  It is not used in someone with a positive family history of breast cancer.

Best to see a local plastic surgeon with plenty of experience in fat grafting for a detailed discussion of this option.

All the best,

How do I find a PS that has good reliable results for a fat transfer to breasts?

   I think that you should find a plastic surgeon who offers implants and fat grafting to provide the best advice on which may be better for you.  I fat graft to virtually every area of the body, but fat grafting to the breasts remains one of my least popular among patients.  I use it only in select patients who meet certain criteria and understand the risks involved.

Kenneth Hughes, MD

Los Angeles, CA

More experience needed!

All of the responders here apparently have active fat graft breast enlargement interests. I too have been interested in fat grafting for nearly 30 years, having done some research on fat grafting when I was at the Mayo Clinic during my general surgery residency and plastic surgery fellowship (1980-1987). I presented my data in a panel discussion on fat grafting to the American College of Surgeons in 1987, and more information at a scientific conference in 1988:

American College of Surgeons 1987 Clinical Congress, Plastic Surgery Section--InvitedSpeaker and Panelist: Suction Lipectomy Session, San Francisco, California;10/12/87: "Autotransplantation of Fat."

Scientific Conference on Fat Grafting, (Jack C. Fisher, M.D., Director), University of California San Diego--Invited Investigator/Speaker, (held at) LaJolla, California;
01/16/88 - 01/17/88: "Autologous Fat Transplantation: Comparison of Harvest
Techniques and Report on Clinical Results."

I have more recently published a textbook chapter on fat grafting in an irradiated leg:

Tholen RH, Jackson IT, Simman R, DiNick VD.Recontouring Postradiation Thigh Defect with Autologous Fat Grafting. Chapter 45 in: Shiffman MA (ed), Autologous Fat Transfer; Art, Science, and Clinical Practice. Berlin, Heidelberg, Springer-Verlag, 2010, pp. 341-346.

None of this amounts to a hill of beans except to establish that I know a little bit about fat grafting, and have built upon the work of others that came before me, such as Lyndon Peer, MD, who wrote in the 1950's that fat grafting may not be of sufficient value since 50% of the grafted fat died. Of course, the important second message is that about 50% of the grafted fat actually SURVIVED!

All of this renewed interest in fat grafting was stimulated by fat removal via liposuction, which came into popularity in the mid 1980's, right when I was doing my research in this area. Lots of (often unscrupulous) doctors were sucking out fat and wondering if they could charge patients to reinject their own fat elsewhere in their bodies. Unfortunately, what was usually injected was severely traumatized fat cells, most of which were dead before transplant. For instance, liposuction at the common high negative pressure used to remove fat cells, actually boils those fat cells at room temperature. And if any un-injected fat was "left over" it was commonly frozen for use later. Simply putting the fat into the freezer in the doctor's break room further ensured that ice crystals formed when water freezes, punctured the cell membranes, and expanded like a pop can left in the freezer, making sure there were few to no actual LIVING fat cells to be grafted. These doctors might just as well have been injecting Mazola oil, though this was the patient's own "mazola oil."

But, of course, over time the dead fat cells were reabsorbed, leaving scar fibrosis and sometimes calcifications. And little to no long-term improvement. But it took many months for the patients' bodies to clear the dead fat, cell by cell.

When this poorly-performed grafting is done for breast augmentation, the scar tissue and calcium deposits make mammography more difficult to detect cancers in their early stages, which show up like small dense scars or microcalcifications. To be fair, most radiologists will state that they can tell the difference between microcalcifications from dead fat grafts and microcalcifications from fat killed by cancer cells. I remain unconvinced that dead fat looks different from dead fat by another mechanism in all cases. Maybe SOME, but not all!

But that's not really important either--it's YOUR life and possible delayed or missed diagnosis from breast cancer that could be obscured by elective fat graft breast augmentation. Since 11-12% of women will develop breast cancer in their lifetime, it's a pretty big bet someone is making with their patient's life when they put fat in a normal breast to enlarge it, rather than using implants below the muscle, which have been exhaustively proven to have NO influence on the development or mammographic detection of breast cancer.

BTW, I have absolutely no problem with fat grafting for buttock enlargement, facial volume, improvement after liposuction dents, or the like, and I believe fat grafting can be a fabulous way of reconstructing breasts or enlarging reconstructive flaps after mastectomy. But not in a normal breast that needs lifetime examination, mammography (until something better is developed), and hopefully early detection of the cancers over 11% of women WILL develop.

So, it's not that grafting fat is bad--in fact, it's great--just NOT IN A NORMAL BREAST for elective augmentation. We have a better and safer alternative--breast implants.

BTW, since the dead fat causing scar and calcifications is the cornerstone upon which I base my whole discussion above, there are surgeons who claim up to 100% fat graft "take," perhaps to sound like they are the "expert" in fat grafting, or perhaps to deflect the concerns about dead fat causing scar densities and microcalcifications. Most honest surgeons will tell you that no more than 50-60% or so of the grafted fat will survive; the survival percentage number gets higher the more the doctors think of themselves, or the more they want to "market" their "superiority" (just ask them!), or the more they want to avoid telling you that it takes more than one operation to yield any volume that survives long-term. No one really wants to explain to you that fat grafting for breast enlargement not only costs more, takes more time, and won't all survive, but that it also takes a second session! You can't simply inject hundreds of cc's of fat and expect it to all have adequate circulation and oxygenation. It takes tiny grafts surrounded by living tissue for the grafts to remain viable, and this takes lots of time, skill, placement expertise, and a lot of recipient tissue to support  all of the grafts. Oh wait, that's the reason we're grafting in the first place--the recipient areas (breasts) aren't very large; that's why the patient is asking for enlargement! So injecting larger volumes of fat looks good at first, right up until the dead fat cells start to be reabsorbed and carried away by your body. This takes time, and occurs slowly enough that the unscrupulous doctors usually have time to move on to other unsuspecting, hopeful, and perhaps gullible patients who feel that "natural" just HAS to be better than implants.

Ain't so.

And I will continue to preach this right up until the lawsuits for "missed" breast cancers or "delayed cancer diagnoses" leading to untimely deaths finally expose this practice for what it is--potentially deadly and dangerous for women with normal breasts who have been deceived into thinking that fat grafts are natural and better than implants. BTW, I know implants aren't "perfect" either. But over 50 years of use have made them the most studied and safest medical products in the marketplace, and in the human body! And to answer your question directly--IMPLANTS are the standard best practice. Enough said! Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 239 reviews

Experience

Fat grafting to the breast is an evolving art and science.  You want to find a board certified plastic surgeon near where you live that has experience with fat grafting to the breast, demonstrates an interest in continuing education with it, and who is looking out for your best interest.  Fat grafting to the breast is effective for moderate increase in size and shape with permanent changes to the breast that can affect imaging of the breast. Depending on your age and breast cancer risk, some form of preoperative imaging should be done with follow up imaging after the procedure done and read by the same radiologist at 6 months. Fat graft take and amount grafted is variable and depends on the density of the breast tissue, vascularity of the breast and processing of the fat while purifying. Best results often take a staged procedure.

How do I find a PS that has good reliable results for a fat transfer to breasts?

Hello!  Thank you for the question!   Consult with one, maybe several plastic surgeons, to find one that you are most comfortable to have for your care.  Discuss your goals and desires and decide for yourself which one you agree with the most.  Seek a board-certified plastic surgeon well-versed in the procedure that you are wishing for.  Prior, research his/her education, training, photo gallery...and consider asking others who they are happy with.  

In regards to fat grafting itself, typical published data ranges from 50-100%, with a reasonable and acceptable rate of 60-70%.  An examination would be required to determine some of your questions.  Hope that this helps!  

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 24 reviews

Fat grafting results do vary

by surgeon but most should easily exceed 60% survival and you should see appreciable results from your one session.  I would want to know your motivations for fat grafting, the problems you are trying to resolve, and what donor sites you have.  Technique does matter in the outcome.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

Fat transfer

Thank you for the question.


To best help you, a physical examination or picture evaluation is required in order to determine which procedure and technique would be best for you.


Dr. Campos

Jaime Campos Leon, MD
Mexico Plastic Surgeon
4.4 out of 5 stars 243 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.