What type of liposuction is best for a breast fat transfer?

Question

I’m considering fat transfer via laser lipo, but concerned about the effects from heat on the reused fat. What are the pros and cons of the different liposuction techniques to get most natural and stable breast result?

Kenneth Hughes, MD · Answer

Many varieties of liposuction are available including ultrasonic, smart lipo, laser liposuction, vaser lipo, power assisted liposuction, and conventional tumescent liposuction. The results depend very little on the method used and very much on the board certified plastic surgeon selected. I prefer tumescent lipo for breast fat transfer; the fat is placed within the subcutaneous fat (underneath the skin, around the gland, and underneath the gland) with one tiny incision under each breast.In general, 200 cc per breast is typically the upper limit of fat injection recommended by most plastic surgeons.  It is not that more cannot be injected; but on average, this has been determined to be the most that can be expected to live during one transfer.  Multiple transfers would be required for additional cc's.  In general, the abdomen and thighs are preferred donor sites but fat from other areas can be used.
Some of the retention rate will depend upon the amount of fat transferred, as smaller volumes will likely have a higher survival.  Occasionally, a patient can resorb a great deal of the fat despite optimal transfer procedures. I typically transfer from 250 cc to 400 cc or so per breast.  Thinner patients are outstanding candidates in my opinion, because the fat transferred is extremely resistant.  
Results are largely dependent upon the skill of the surgeon, his/her ability to remove fat without creating contour deformities, and your expectations. You would need a consultation with a board certified PS to determine your available fat stores.

Mariam Awada, MD, FACS · Answer

Hi, thank you for your inquiry. I would not recommend the laser liposuction. The laser damages the fat and may decrease the survival rate of the adipose tissue because of the intense heat the laser transmits in-order to destroy the fat tissues. Survival rate with use of conventional tumescent liposuction is about 60% which would give you best chances of having achieved your goals.

Justin Yovino, MD, FACS · Answer

It's best not to apply energy to fat that is to be transferred.  I frequently utilize laser and/or radiofrequency (Renuvion) during our liposuction procedures that also include fat transer to the breasts but the energy comes after the fat is removed.  The energy is applied to the remaining space in order to acheive tightening.

Gary M. Horndeski, MD · Answer

I would not recommend the laser liposuction.  The laser damages the fat and may decrease the survival.  The usually survival is 60% with conventional tumescent liposuction.  Also, transferring fat to the breast can be somewhat difficult because of the geometry.  Unfortunately, you have not provided photographs or told us your bra size.  Often times it results in a more pancake looking breast.  It is best to transfer mostly central, a smaller amount peripheral and may need to be done several times to get the projection you desire.Best Wishes,Gary Horndeski, M.D.

Gerald Minniti, MD, FACS · Answer

Nearly 20 years ago Vaser was introduced as the premier fat killer, their proprietary form of 'focused ultrasound' was best at causing 'cavitation' and rupture of fat cells. Fast forward 15 years to the era of fat grafting, and the Vaser company says theirs is the best at preserving fat. Hmm. It is simply logical that any energy source creating thermal injury is not good for fat cells. Further, although Vaser is enjoying a very strong resurgence, possibly due to a single Columbian surgeon who coined the term 'hi def', it has not demonstrated superiority over non-Vaser liposuction.

Daniel Barrett, MD · Answer

Dear Iris16,
Fat viability depends a lot of surgeon technique. The fat has to be placed back into the buttocks as soon as possible so that it has a greater chance of survival. It has to be placed carefully so that not too much fat is placed in only one area.
If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. 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

Robert Cohen, MD · Answer

You need a formal evaluation by a licensed plastic surgeon and expert in breast augmentations to determine what is best for you and your goals.Proper breast enlargement is not a "cookie-cutter" procedure where the same technique is applied to every patient. Every woman who comes to my practice has unique needs and different goals for her breast augmentation. As a board-certified plastic surgeon, I always listen carefully to each woman's concerns and thoroughly discuss the key points of the procedure. For those women who prefer a "Natural Breast Augmentation" without implants, fat grafting is a safe, natural, and minimally invasive approach that offers low-maintenance, long-term improvement in size and contour. After harvesting the fat from your body, we purify and enrich the fat before injecting it in the desired areas to improve volume and shape.
My experience performing thousands of aesthetic breast surgeries in a wide anatomical range of patients enables me to achieve consistently beautiful and natural results that are customized to each patient’s body type and goals. These results are the product of extensive communication, meticulous planning, and skillfully executed surgery.
I suggest consulting with a board-certified plastic surgeon and expert in Breast Augmentation surgeries. - Dr. Cohen

Benjamin Van Raalte, MD · Answer

No one type has been proven better than another for fat harvesting. I do standard tumescent liposuction for the reason you mentioned, it should be less likely to injure cells. Laser lipo, or other power methods dont give superior results, they just make it physically easier for the surgeon. None have been shown to have better cosmetic results in the areas the fat is removed. I agree that in theory, standard tumescent liposuction might be better for the fat cells to be transferred.

Connie Hiers, MD, FACS · Answer

I do not use laser or ThermiTight, radiofrequency, when removing fat for a transfer. Once the fat is removed, the laser or radiofrequency can be used to help tighten the skin.

Erez Sternberg, MD · Answer

Be careful, you cannot transfer fat that has been collected using laser lipolysis. Laser uses high heat to disrupt fat membranes and destroy the fat. This fat is killed and cannot be used for transfer. Tumescent liposuction techniques are best for harvesting fat at lower pressures and then transferring the cleaned and processed fat (removing oils and blood) to the new site. Flanks and thighs tend to have the best fat for transfer but any location can be used. Fat transfer to the breast is a nice way to augment breast volume by a half to almost one full cup size depending on the patient and the availability of fat harvest sites. In general, you really can’t put it more than 200-300 cc of fat at a time (more on larger breasts, less on smaller breasts) as the permanence of the fat decreaseds as more pressure is placed on the delicate tissues. Therefore, if you are looking for more increase in volume than one cup size, fat transfer may not be the best option for you. If you need a second transfer, it will most likely be at a reduced rate but still cost several thousand dollars. In general, fat transfers cost more that implant augmentation because they are more demanding procedures and take more time to complete. Hope that helps. Please ask your PS these questions before signing up for any procedure.

What type of liposuction is best for a breast fat transfer?

Answers (12)

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