Can a fat transfer be done to the breasts if implants are present? 230 CC, hoping to enhance volume and cleavage area (photos)

Question

I already have small breast implants 230cc, but want slightly bigger volume and enhancing the cleavage area. Will I have enough fat to harvest from my flanks to transfer? How many ccs is it possible to get from my flanks based on the photos?

Alan Gonzalez, MD, FACS · Answer

Hello @Linn87, thank you for your question. Yes, you can have lipoinjections to the breast if you have implants. Depending on where the implants are placed, fat seeding can be accomplished. The surgical plan would depend on what you want to improve. It would also depend on whether this procedure or another will help you achieve greater harmony in the body as part of your surgical plan. The most appropriate course of action is to consult one or several board certified plastic surgeons. This will allow you to get more information and options tailored specifically to your needs. Best wishes! Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS),International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP).

Irena Karanetz, MD · Answer

Hello,
Thank you for the question.
Based on your photos, you have sufficient donor site fat in your flanks and abdomen for the fat transfer procedure.
Fat grafting is great option to help increase the breast volume but may require a few sessions (surgeries) to achieve a fuller cleavage, which is an important consideration for many patients. This is done usually through tiny incisions which heal with minimal scarring.
Compression garment using a surgical bra will help minimize swelling after surgery and is typically recommended to wear for 4-6 weeks after the procedure.
I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Breast Surgeries in order to discuss your goals and concerns for the best cosmetic results. 
Best wishes and good luck. 
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon

Zoran Potparic, MD · Answer

Actually, that is a very good indication for fat grafting; to improve cleavage and add fulness to the upper pole of breasts usually works well with fat grafts. In your case, this can be combined with liposuction of abdomen, flanks and lower back. In person or telemedicine consultation with a board certified plastic surgeon with experience with this procedure is recommended. Good luck.

Daniel Barrett, MD · Answer

Dear Linn87,
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 implantsYou 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

Connie Hiers, MD, FACS · Answer

If you want more than a half cup increase in size, you will need to exchange your implants instead of trying to use fat. An examination is needed to be certain, but you probably have enough fat in your flanks for the transfer.

Manuel Diaz, MD · Answer

EXCELLENT QUESTION. answering this you should not add fat to your implants. In your case, the ideal would be to change some implants for larger ones. remember that like all fat you can lose 30% after being placed and if you lose weight or if your metabolism is fast it can also be consumed more quickly. I do not recommend this type of procedure.

Hilton Becker, MD · Answer

Fat grafting  can be very successful for   enlarging breast volume after breast augmentation, provided there  is sufficient  fat  available .

Mats Hagstrom, MD (license on probation) · Answer

Each plastic surgeon will have their own review and technique when it comes to grafting fat into breasts on patients who have implants.
In my opinion the best approach is to remove the implants during the grafting process and then re-insert them at the end of the procedure. during the actual grafting the implants should be removed to minimize the chance of damaging the implants with the grafting cannula. 
Temporary breast implants called sizers are inserted to keep the breast Space expanded during the procedure.
So, it’s definitely possible to graft fat into your breasts if you have implants.
That said if your goal is to go bigger and have more cleavage than increasing the size of your implants with possible increasing the implant diameter and bringing the implants closer to the midline may be a far better way to get that accomplished.
You did not include the breast pictures so we can’t make an assessment. we know you have some fat that can be removed from your torso but you are not seeking this procedure for the purpose of having Liposuction. Or perhaps you are?
The topic and decision making is quite complex and to get an accurate assessment and at the same time begin the selection process of choosing the right provider I suggest scheduling multiple in person consultations with local board-certified plastic surgeons in your community who seem to have a lot of experience with both Liposuction and fat transfer.
Delivering consistent quality liposuction and fat transfer results is more difficult than most people believe.
There is a significant variance and outcomes depending on who does the surgery.
Simply going to a board-certified plastic surgeon with overall good reputation and years of experience is insufficient to confirm that they have mastered both liposuction and fat transfer.
Delivering consistent quality results with these procedures is more difficult and the number of plastic surgeons who have truly mastered this procedure is relatively few.
My recommendation is that patients be far more selective than they think they ever needed to be when it comes to both Liposuction and fat transfer procedures.
I recommend you begin the process by scheduling at least five in person consultations.
Personally I do not recommend virtual consultations though a lot of providers offer them.
Most patients have limited experience consulting with plastic surgeons and vetting plastic surgeons and getting the information that you really need to know to confirm the providers skill and experience is not always straightforward.
Start the process by getting quality pictures of your own torso the same way plastic surgeons take before and after pictures. If you have before and after pictures from your previous procedure and those would be a good scent to start off with.
Always bring pictures of your own body for reference during consultations.
During each consultation I asked each provider to open up their portfolio and show you their entire collection of before and after pictures.
Providers may be apprehensive to do this and may instead prefer to show you a handful of preselected images representing some of their best work. While these may be more impressive pictures they do however not tell you what average results look like or how many procedures each provider has actually done.
For a reference and experience surgeon should have no difficulty showing you at least 50 sets of before and after pictures of commonly performed procedures.
Highly experienced surgeons will have hundreds or even thousands before and after pictures of procedures they do on a regular basis.
Recognize that breast-fed transfer is two procedures done at the same time. Do you need to get assessed for both Liposuction and fat transfer. Likewise you need to vent to plastic surgeon regarding their skills for both Liposuction and fat transfer.
Ask providers to show you only pictures of previous patients who have similar body characteristics to your own.
Ask them to show you examples of excellent outcomes, average outcomes and outcomes that did not turn out as well as they had hoped for.
For fat transfers specifically it is imperative that you have a clear understanding of the timeframe between the procedure and when after pictures were taken.
You should specifically ask for each picture how many months after surgery the picture was taken.
Early fat transfer results can look very impressive(even better than implants) but early results do not represent final results.
The majority of volume will dissipate the overtime and final results are very different than what you see at 2 to 3 weeks. after pictures should be taking a minimum of three months but preferably six or more months from the date of surgery
When reviewing Liposuction results look very carefully at every area treated to make sure there are no skin contour irregularities anywhere.
Ask providers to point out exactly what areas were treated and what areas were not treated and look carefully at transition zones between treated and on treated areas.
I personally view the torso as a single anatomic unit and generally treated the entire torso when doing liposuction if I’m going to treat any part of the abdomen.
A full torso includes upper abdomen, lower abdomen, love handles (generally all the way down to the top of the hip dip), waist, full back and under arm (armpits) areas all the way to the side of the breast.
In the end that transfer is a subtle procedure that adds only small amounts of volume in comparison to implants.
For patients who are agreeable to have implants or already have implants without complications increasing the implant size or converting to an improved contour implant is probably far easier and more straightforward way of getting what you’re trying to achieve.
There is inherent risk any time somebody has liposuction.
If you do not properly vet plastic surgeons and choose a provider who lacks sufficient skill and experience you can be left with contour irregularities they can border on disfigurement.
Liposuction results are permanent and irreversible.
If done poorly it’s very difficult to improve upon Liposuction results.
Ask plastic surgeons what they recommend based on what you’re trying to achieve and see what they have to say.
The topic is simply too big to give you any real recommendations without having a good understanding of what your motives, wishes are including what you’re willing to go through and what you’re trying to achieve.
My best word of advice is to be more selective than you think you ever needed to be when it comes to Liposuction and found a transfer.
If you’re up for having these procedures then make very sure you’re in the hands of someone who has sufficient skill and experience and has enough documented cases to convince you that they can deliver consistent quality results on a regular basis.
When in doubt slow down and schedule more consultations.
Find the right plastic surgeon and everything falls into place.
Best,
Mats Hagstrom MD

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