If fat from breast fat transfer re-absorbs won't it leave a dent or weird looking skin?

Question

I was told worst that would happen with fat breast transfer (only one side and only a little for better symmetry...) was that fat could re-absorb. But can't that leave loose or weird skin or even lumps or a dent?

Rodger Shortt, FRCSC · Answer

There are many myths about fat grafting to the breast. I do a lot of fat grafting and hear them at my office all the time. So let's go over some of them now and try to clear them up:MYTH: Fat will disappear.  FACT: The process of fat grafting requires harvest from another site followed by processing and finally injection.  During the procedure some fat cells can be damaged.  While the goal is to remove all liquid (injected to minimize pain and bleeding), blood, and non-viable fat cells, some will still be injected.   On top of that even some perfectly good fat cells will not obtain proper blood supply in the breast.  So not all of the volume injected is actually healthy fat cells that get good blood supply.  That volume gets absorbed by your body, leaving you with the healthy fat that did survive. In addition you will have swelling from the procedure that will settle over time.  The fat that you have at a couple of months though is likely to be permanent. If, however, your weight goes up or down, so too will the size of your breasts.MYTH: Fat grafting is an easy surgery.  FACT: Fat grafting has many benefits over implants but is a longer and more technically demanding procedure.  Every step of the way needs to be done meticulously or the fat survival rate will go down.  It is time consuming and takes a lot of patience on your surgeon's part.  Not all surgeons have the patience to get the ideal result.  If they are not willing to place the fat drop by drop the result will be limited.MYTH: Fat can not increase the size of the breast much.  FACT:  Because of the importance of blood supply you can essentially double the size of the breast at the time of surgery.  If you over exceed that amount the fat will not have good blood supply and may not survive as well.  After resorption of fluid and cessation of swelling you can expect a 50-60% larger breast than pre-surgery. If a second surgery is done, you can inject even more than the first time leaving your final volume 2-2.5x larger.MYTH: Fat grafting and implants are never done together.  FACT: Fat grafting is an amazing technique to use in conjunction with an implant.  Although many patients do not need this, it can conceal the edge of an implant really well in thinner patients.  This provides patients with a full yet still natural looking and feeling result.  It is also great for enhancing cleavage in patients with wide set breasts.  However, very few surgeons do this.  It is only done by surgeons with a very specialized interest in both breast surgery and fat transfer.  With all that said, the results can be amazing.MYTH: Fat will leave me with lumps or dents.  FACT:  Fat grafting can provide amazing looking results that are natural looking and feeling.  However, the process MUST be done very carefully.  If too much fat is placed or if it is done without precision then you will have a much higher chance of fat loss or oil cysts.  You must go to a surgeon that has a very specialized interest in fat transfer. Not all surgeons provide great result with fat transfer.  It is not as straight forward as placing an implant.MYTH: Fat transfer is better than implants.  FACT: There is no perfect surgery.  I spend a lot of time over several visits with my patients helping them come to the best answer for them.  Fat transfer is great as there are virtually no scars, you get to treat a "problem" area with liposuction, and the results are very natural.  However, it does not do as well to increase volume when you desire a much larger breast.  It also does not enhance the shape of the breast as well as an implant in someone with a less pretty shape to begin with. Your surgeon should go over the pros and cons of all your choices and help you decide which is the best for you.MYTH: Fat grafting can be done in anyone.  FACT:  Although fat grafting can be done in anyone, not everyone is an ideal candidate.  You need to have enough fat to harvest to make it worthwhile.  Sometimes the only fat people have is in the butt.  Not all patients want to give up volume in their butt. You also need to have a place to put it.  If you are so thin that there is little space to place the fat you may need more than one surgery.  Remember, you can double the size of the breast at the time of surgery, leaving you 50%-60% larger in the end.  Your second surgery you can put a fair bit more fat than the first, leaving you between 2-2.5 times larger than you started. For some patients they may simply do better with an implant and some fat grafting to conceal it well.MYTH: There is only one perfect technique.  FACT: Many surgeons that do a lot of fat grafting use vary different techniques for how they harvest the fat and how they process it.  So long as care is taken to minimize injury to fat there are lots of ways of doing these steps.  What virtually all surgeons agree on is that fat must be carefully placed and you must not exceed the maximum volume.I hope that helps.Rodger Shortt, Plastic Surgeon, Oakville, Ontario

Urmen Desai, MD, MPH, FACS · Answer

No is resorbs generally in the entire region that it that was injected.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified Beverly Hills Plastic Surgeon

Justin Yovino, MD, FACS · Answer

I perform this procedure very often and fortunately dents and irregularities are not an issue at all. The fat is placed very evenly throughout the area of need. Yes, some fat is absorbed but it is usually absorbed evenly throughout the area. Placing fat only on one side is not as typical as treating both sides.

Christian Subbio, MD · Answer

Basically, your surgeon should place fat evenly and diffusely, not in a focal lump.  They should be fanning and feathering the fat.  So, when fat reabsorbs, it happens diffusely and does not cause a focal dent.Best of luck!
Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

David S. Rosenberg, MD · Answer

The fat gets reabsorbed in a smooth and even way.  It is unlikely that there would be lumps, dents or loose skin.  With breast implants there can be ripples, hardness and rupture so there is no perfect way to enhance breast volume but I think fat is a better long-term method than breast implants. Good luck! DSR

Steven Turkeltaub, MD · Answer

Fat should be injected somewhat diffusely rather than a large amount focally so when performed correctly, dents and weird looking skin will not result. There can be under corrections which can be easily addressed with additional fat injections.Steven Turkeltaub, MD

If fat from breast fat transfer re-absorbs won't it leave a dent or weird looking skin?

Answers (6)

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