Is breast fat transfer a good option for 315cc bottomed out implants?

Question

I got 315cc under the muscle implants around 5 years ago, and they have clearly bottomed out. My original surgeon says they have dropped an inch or more past where they should be. I’m extremely frustrated as idont really want an internal bra (not a fan of more foreign bodies in my chest) so I’m thinking of explanting and getting a fat transfer in the same procedure. IIs this a good option for me? I’d also like to ask the doctor to pull down my breast skin a bit (if possible) so my nipple will return to the center of my breast. Originally I had small B breasts, currently they’re a full C and my goal following the fat transfer is a full B / small C. Is this realistic?

Gerald Minniti, MD, FACS · Answer

You will be severely disappointed  by replacing an implant with fat. It will not look the same, even if you could keep 315 cc of fat in your breast tissue (which you can't). Instead of a capsulorrhaphy with mesh, aka internal bra, you should have Motiva implants placed into a subfascial pocket. Your fear of breast implants leading to health issues are completely unfounded, and placing Motiva implants above the muscle will make you whole anatomically and will return your pectoralis muscle back to normal function.

Daniel Barrett, MD · Answer

Dear mammothgirl14,

bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.

Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.

If you are concerned, please check it with your plastic surgeon for reassurance and to further discuss your options and possibility of revision.

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

You have a couple of options. You can remove your implants and place smaller ones while repairing the inferior portion of the pocket with sutures as this does not require foreign bodies or mesh. Your other alternative is to remove the implants, do fat transfers and wait several months and go back to do more fat transfers.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Sean Fisher, MD · Answer

It does appear that your implants have settled beyond an ideal position. When implants have bottomed out, and nipple position is higher on the breast than desired, it is a common misconception that skin should be removed. In actuality, this is because the breast fold has lowered over time. Generally, it is advisable to elevate the breast fold back to its original position rather than removing skin. This can be done whether there is a desire to keep implants or have them removed. If you wished to keep your implants, internal capsule work could help accomplish this. This can be done without the use of an internal mesh bra, if patients desire to do so. However, mesh may improve the longevity of the result. 
For patients interested in implant removal and fat grafting, this can be a reasonable option however it is important to educate patients that it is very unlikely that they will have a similar shape and structure that comes with their implants. This often requires a lift as well, due to the lost volume of the implant being removed and the excess skin after implant removal. Their are several other major factor with fat grafting, which are important to discuss. The first is how much fat is attainable. For thinner patients, it may not be possible to harvest enough fat in a single procedure for the volume they are hoping for. The other important factor is that people resorb fat differently- Most surgeons will quote 50% as a general number for the percentage of fat that is retained. 
In short, implant removal and fat grafting can be a good option for patients. But, it is important that your surgeon has an honest conversation about what it can and cannot do to make sure this aligns with your goals. 
Sean Fisher, MDAesthetic Plastic Surgeon Seattle, WA

Is breast fat transfer a good option for 315cc bottomed out implants?

Answers (4)

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