Saline Implant Or Fat Transfer Procedure? (photo)

I'm 18, 170cm tall, 63kgs and a small build. My left breast (B cup) is a full cupsize larger than my right. I wanted to get a fat transfer procedure to enlarge the right breast to match the left. However, as I live in Australia, the technology/research of the fat transfer hasn't been approved and won't be until at least another couple of years. I didn't want to get implants as I want a completely natural look and feel. So my question is; would saline implants achieve this result?

Doctor Answers 17

Implants or fat grafting for breast asymmetry

Hi there,

You present an interesting question. At 18, and with substantial asymmetry, it is very understandable that you are considering options to correct this.

The first thing to say is that your left breast is perfect, and your desire to increase the right side to match it is the correct strategy.

On the right, there is asymmetry of both volume and shape.  The right side has less skin. Sometimes, if the volume on the smaller side is increased, the skin envelope naturally stretches up to match, as happens with normal breast growth, or with growth in general.  I suspect this will likely happen with you.

Your sense of not wanting an implant is sound.  One sided implants lead to long term differences in feel and naturalness.  However, to increase the volume of the right side without implants is a challenge at the moment.  The options are fat grafting, the Brava, a flap reconstruction (which will leave a scar somewhere else), or a combination of more than one of these.

Fat grafting works, there is no doubt now, but it can be a frustrating road to travel.  It takes more than one procedure. But I think it would be the best technique for you.  The problem is, that in Australia, and the USA, and many other countries it is not accepted practice yet because of the fear that the fat grafting will make mammograms harder to interpret in the future. So, the issue is not a practical or technical one:  It's a medico legal one. So far, studies from Europe on this have not shown fat grafting to be a problem, and we as plastic surgeons feel it is a valuable technique, but all we can do is try to get our regulators and insurers to realise it's importance and value, and allow us to do it.

Currently, we use fat grafting extensively in our practice for breast reconstruction after a mastectomy where the breast tissue has been removed, only.

A flap (ie a free flap from your buttock) would work too, but might not be worth the donor site scar. Most surgeons would probably advise against it.  I think it's a reasonable request, but you'd need to be very well educated about the pro's and cons. 

The Brava is worth considering.  It will give you some increase in volume. It is much more being used in combination with fat grafting to augment the speed and results of fat grafting, but can be used on its own.  Have a look at it on the internet.

It's hard to advise you to wait until fat grafting becomes available.  One option, if you can't, is to have an implant temporarily, and have it removed and replaced by fat grafting later on when we can offer the procedure.

Good luck.

Fixing Asymmetrical Breasts

Dear Kay,


The quick answer to your question is YES; Saline implants could correct the asymmetry you have.

Looking at the photo attached, you could benefit from a lift aside the breast augmentation if you want to achieve perky breasts.

Nonetheless, with the photo alone it is hard to provide you with a definitive solution but submuscular saline implants are to be considered.

As for the autologous fat grafting, there are some limitations:

1. Do you have enough fat to achieve symmetry?

2. Do you have enough fat to achieve the over all desired size of both breasts?


So, I highly recommend that you seek a consultation with a surgeon of extensive experience who can guide you to make a well informed decision.


Thank you for your inquiry and the best of luck to you.

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 196 reviews

Treatment for breast asymmetry

You have a very notable asymmetry and there are several ways to approach the issue. In the end, you need to find a plastic surgeon with whom you feel confident in their approach. Your right breast is short on both volume and skin. Whatever you decide will need to address both of these issues in order to have best results. Your surgeon might suggest implants, liposuction, tissue expansion, or breast lift surgery on the left. I don't think that your situation is as simple as just saline implants vs. fat grafting. 

Wm. Todd Stoeckel, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 84 reviews

Saline or Fat Transfrer to Breast?

Neither procedure will make your breastlook alike. Certainly saline implants of different fills could give you breast that are about the same size in a bra or swim suit, but the sagging of the left breast would persist without some sort of lift. Of course even with a lift there will be a difference in the two breast.

Howard N. Robinson, MD (retired)
Miami Plastic Surgeon
4.7 out of 5 stars 62 reviews

Saline implant or a fat transfer procedure

I would either recommend silicone (not saline) or a fat transfer here in the United States to get the most natural feel and look that works for you.

Jimmy S. Firouz, MD, FACS
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 18 reviews

Saline or Fat Transfer

Choosing a small saline implant would best benefit you and give you the outcome you are looking for. Fat transfers to the breast are not usually condoned by the American Society of Plastic Surgery because it may block the diagnosis of breast cancer.

John S. Poser, MD
Gainesville Plastic Surgeon
3.8 out of 5 stars 11 reviews

Fat transfer is a very versatile procedure

Even in Australia, I don't believe fat transfer requires actual 'approval' more importantly it's about finding a plastic surgeon who is comfortable and experienced with the procedure. Unfortunately simply enlarging the right breast will not achieve symmetry, as the right breast is significantly higher and more to the side than the left, with a different shape to the breast and fold. One of the benefits of fat grafting is that it can be placed where needed to shape the breast so to some degree more fullness can be created in the lower part of the right breast. I think it is quite likely though that it will be necessary to perform some type of lift procedure on the left in combination with fat grafting to achieve the best possible symmetry. I routinely perform combined lift and fat grafting procedures. Of course implants are an option as well, and here is definitely more than one way to approach things.

Jeffrey Hartog, MD
Orlando Plastic Surgeon
4.5 out of 5 stars 60 reviews

Fat Transfer vs Augmentation

Thank you for the photo and the question. From your information it does look like you have a reasonable degree of asymmetry and fortunately have several options to correct this. You could undergo fat grafting to the smaller breast, but because of lack of skin it will still look different that the left side. Also, you could have liposuction of the larger breast, and at your age you will likely have skin contraction to begin to match the smaller side. Adding an implant on one breast is an option, but of you continue to see a difference in shape and appearance since there is an implant on one side only. The best results often come from similar surgeries being performed on both sides. And, in your decision making process, I would highly consider silicone implants over saline to achieve the most natural results. 

You should see a board certified plastic surgeon in your area to get a formal opinion through and in-person consultation.

Best of luck,

Vincent Marin, MD
San Diego Plastic Surgeon

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 47 reviews

Saline Implant Or Fat Transfer Procedure

Saline implant is the better solution to address your breast asymmetry. Consult with 3 - 4 experienced and expert board certified plastic surgeons to explore your options.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 42 reviews

Fat transfer or implant

Dear Australian,

   Your goal is to match the right breast to the left one. From looking at you picture, you have two reasons for the asymmetry. The right breast is smaller and the sub-mammary crease is significantly higher. In my opinion, a saline implant is your best bet. Fat injection, has its problems - absorption, cysts,  irregularities etc, but most importantly, it can not lower the sub-mammary crease adequetely. Saline implants will give the surgeon more flexibility as far as size symmetry and with implant augmentation surgery the surgeon can lower the crease to the right level. Saline implants in the right surgeon hands look and feel very natural. Be sure to selrct an experienced board certified plastic suergeon.

                      Best of luck,

                                           Dr Widder


Shlomo Widder, MD
McLean Plastic Surgeon
4.8 out of 5 stars 126 reviews

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