I would like to increase one cup size (B to C). What to try first - fat transfer or implants?

Given your desire for a natural, modest enhancement and your sensitivity to foreign materials, fat transfer sounds like a very reasonable first step. It’s a great option for patients who are looking for a subtle increase (typically about one cup size) and want to avoid implants, at least initially.
A few key points to consider:-Fat transfer is safe, natural, and uses your own tissue, so there's no risk of implant-related complications or concerns like BII (Breast Implant Illness).-You’ll also benefit from liposuction in donor areas — often abdomen, flanks, or thighs — which can enhance overall contour.
That said, fat transfer does have limitations:
Some of the fat may be reabsorbed by the body over time, especially in leaner patients.Achieving a full C cup may require multiple sessions or a high volume of donor fat.As for your second question:No, getting implants after a fat transfer is not necessarily more complicated. In fact, some surgeons find that the added tissue from the fat grafting can help provide better soft tissue coverage over an implant later on — particularly if you're thin-chested.
If you're open to the idea, starting with fat transfer allows you to see how your body responds, with the option to explore implants later if desired — in a staged, thoughtful approach.

Hello, the two operations have very different risks and benefits, so one procedure isn't necessarily better than the other. As you mentioned, fat is your own natural tissue so you don't have to worry about implant problems (controversial ones like BII, or well-known problems like rupture, contracture, malposition, etc). However, fat transfer has its own risks and limitations (injury where the fat was harvested, fat necrosis/oil cysts/calcium deposits where it is injected, unpredictable absorption, etc). Your surgeon will be able to tell you the unique risks/benefits in your case, as they are different for each person depending on the fatty deposits that area available to harvest, the size and shape of the breasts, patient's goals and expectations, etc. Regarding your other question, it is possible to have breast implants after fat transfer, and conversely it's possible to have fat transfer after implants are inserted. Thanks for your question.

At size 32 or 34, each 100 cc corresponds to 1 cup size change. At size 36 or 38, each 200 cc corresponds to 1 cup size change. However, with fat transfers approximately 1/3rd of the fat does not survive. So, if you want to go up 1 cup size you will need 150 cc of fat for size 32 or 34 OR or 300 cc of fat for size 36 or 38. Fat transfers will not adversely effect future implants, if necessary.

Best Wishes,

Gary Horndeski, M.D.

Based on your breast size, weight, medical history and your expectation, I would recommend fat grafting.

Fat transfer can add a modest amount of volume to your breast.
Must patient claim it’s about 1/2 cup.
With the procedure does not do is change the shape of your breast.
That transfer is good for patients who are content with the shape of the breast and just want a slightly larger version.
Overall, the results are fairly subtle, even in successful outcomes.
There’s no way fat transfer can compete with what breast implants can accomplish.
If you’re good with having implants I suggest you go straight for having implants.
Getting consistent quality, liposuction, and fat transfer results also has a fairly steep learning curve.
The number of providers who approach mastery for this procedure is not all that great.
With experience comes more consistency with outcomes and ability to predict outcomes well.
Best,
Mats Hagstrom MD