Why doesn’t breast fat transfer help sagging breasts from volume loss?

Question

I am 5’2” and lost 80lbs. My bra size went from somewhere near 36DD to 30D. At the very least, 2 cup sizes lost (likely more). My nipples are now at the bottom of my breast instead of somewhere closer to the middle like I want. I’ve read that fat transfer does not help with this but if the cause is volume loss, why not? I’m in my early 20s for context. I’m concerned about skin tightening methods because I would like larger breasts and it seems like tighter skin would make future transfer more difficult.

Gerald Minniti, MD, FACS · Answer

Fat grafting can't help you because your breast's experienced more than fat loss. Your 80 pound weight loss (congrats) indicates that your breasts experienced substantial anatomical changes from your original weight gain. No pictures provided, so I'll use my telepathic powers to 'visualize' your breasts: Substantial loss of volume, loss of internal fascial support, tissue and skin stretch with loss of dermal elasticity, and sagging of tissue and nipples below the inframammary fold. Remedy: either fat grafting and breast lift or implant and breast lift, the latter being the most predictable and durable option. As you can see, it's the breast lift that you can't do without.

Daniel Barrett, MD · Answer

Dear Milk and Roses,

fat transfer breast augmentation is a viable alternative for women who desire larger breasts without the use of implants. Fat transfer is also widely used in reconstruction of the breast after a mastectomy or lumpectomy. It can also be very effective in correcting the size and shape of the breasts due to genetic problems such as tuberous breast or Poland Syndrome, two conditions that look like misshapen or underdeveloped breasts.
In addition, the following scenarios are also reason to consider breast fat grafting:
•	If you have chest areas that appear creased and sunken
•	If you desire more permanent correction than is provided by temporary fillers
•	If you wish to improve your body contour, revise scars, fill bodily depressions and rejuvenate the natural curve of your breasts
•	To fill in contour irregularities or hide obvious signs of breast implants
You should discuss your concerns with a board certified plastic surgeon and make sure your surgeon understands your concerns and your breast augmentation goals. 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

Gary M. Horndeski, MD · Answer

At size 30, each 100 cc of fat volume corresponds to 1 cup size change. However, not all fat transferred survives. You would need about 150 cc of fat transferred for 100 cc of fat to survive. It is very difficult to achieve a 2 cup increase in one operation and frequently requires 2 operations and the amount transferred depends on the recipient site, not so much the donor site.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ronald J. Edelson, MD · Answer

Fat transfer to the breasts can’t provide enough long term survival to make it worthwhile for the condition you describe. It is possible that you need a lift with a small implant instead

Why doesn’t breast fat transfer help sagging breasts from volume loss?

Answers (4)

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