Fat Transfer After Botched Breast Augmentation

This review covers both my treatment (fat transfer) and my plastic surgeon (Dr. Lisa Cassileth).
When I was 19 (I am now 27), I had breast augmentation surgery with saline implants performed by a plastic surgeon in Orange County. I began with extremely small breasts and could not fit into a normal A-cup bra. After my surgery, I quickly grew dissatisfied with the results and suffered numerous complications, including the “bottoming out” of one implant, permanent numbness/uncomfortable changes in nipple sensation, and an animation/pec muscle flex deformity. I returned to my surgeon on multiple occasions to express my disappointment, but he insisted that I was being too picky and perfectionistic and that “ten strangers who walked into the room” would all agree that my breasts looked fine. When I was about 21, he told me, “Come back after you’ve had your 10 kids, and I’ll re-do them.”
I continued to be very unhappy and physically uncomfortable with my implants and, after three years, eventually decided to have them removed. I had a consultation with a reputable Orange County surgeon, but this doctor flatly refused to perform the procedure because he felt that breast implant removal would result in additional numbness and a devastating “loss of femininity” that I would not be able to handle. A year later, I consulted two plastic surgeons in the LA area who confirmed that my implants had indeed bottomed out. One surgeon reluctantly agreed to remove them after he unsuccessfully tried to talk me into new, smaller implants.
I had been researching fat transfer/grafting (or “natural” breast augmentation) online since the early 2010s and, at this point, was so unhappy with my small, saggy, asymmetric, and generally sad-looking post-implant chest that I decided to contact Dr. Lisa Cassileth, a pioneering breast expert in Beverly Hills who performs this procedure and also works with breast cancer patients. The long commute to Beverly Hills was worth it, as she said that I would be a good candidate for fat transfer, which involves liposuction to harvest the fat. Since I had unwanted hip, thigh, knee, calf, and ankle fat, this surgery was ideal for me. The procedure involves a level of technical skill that is more advanced than that required for your typical breast augmentation surgery; it is imperative to find a talented surgeon who has a sophisticated, nuanced understanding of how fat transfer works. I was told by Dr. Cassileth that multiple surgeries may be required because I would likely lose some of the grafted fat. I had three fat grafting/liposuction procedures between April 2015 and October 2017.
Dr. Cassileth has numerous positive qualities that make her stand out as exceptional — traits that were especially apparent to me after my less-than-spectacular experiences with other plastic surgeons — including the following:
1. Dr. Cassileth doesn’t just pretend to listen and then impose her own agenda or idea of what the patient should want; she instead actually hears what the patient is saying and tries her hardest to deliver the results the patient has asked for, following the patient’s specific instructions. (For example, I asked her to be extra gentle with me since I am apparently prone to permanent nerve damage, and she did so.) Accordingly, she comes across as respectful, non-judgmental and willing to please, understanding that how the patient feels about her own body is critical to success in plastic surgery.
2. At the same time, she is a leading practitioner in her field and has an impressive academic and professional background. She strikes me as exceptionally knowledgeable, competent, innovative, highly skilled, and “out-of-the-box” in her thinking, as well as satisfyingly perfectionistic and detail-oriented. She seems to have an intuitive grasp of how the human body works and to make decisions based on scrupulous observations specific to each patient’s body. I felt it was easy to communicate with her and like we were on the same “wavelength” since she was so quick to understand my frustrations and future goals with surgery.
3. Even though she is clearly an expert in her field with a “take charge,” “Type A” personality style, she does not come across as arrogant or condescending. She seems to assume that the patient has a certain level of intelligence and takes the time to answer questions clearly and thoroughly, with an appropriate amount of detail. She also has an upbeat personality and a good sense of humor.
4. She seems genuine, ethical, and caring in her approach, definitely not sales-pitchy or high-pressure. She takes effective steps to prevent and minimize pain. Also, she seems to have realistic expectations. In addition, if the patient expresses dissatisfaction or concern with some aspect of her work, she does not become defensive, patient-blaming, or deny that there is a problem (some of which I experienced with my first surgeon). She objectively assesses the situation and seeks solutions. If she doesn’t know something, she will say so. Furthermore, rather than relying on her own subjective impressions, she used a VECTRA imaging system to take 3D photographs of my breasts so that she could have the facts straight about how much fat I retained after each surgery.
5. In regards to my liposuction, we seemed to be on the same page when straddling the fine line between our shared goal to see results and our mutual desire to avoid the risks associated with overly aggressive tactics (what she referred to as the “danger zone”). In other words, her approach is an ideal blend of the conservative vs. the aggressive. I don’t think she would risk jeopardizing the integrity of a patient’s skin just to deliver dramatic results, even if the patient pushed for this. Additionally, masseuses familiar with liposuction have told me that they were impressed with how smooth and even my legs have appeared after my surgeries, which suggests that my liposuction was done with great care and fastidiousness.
There is still more that impressed me about Dr. Cassileth. When I arrived at the (very conveniently located) surgery center on the morning of my first fat transfer, she noticed that I had a poorly healed lower back scar from a prior non-cosmetic surgery. She revised the scar and sent in a biopsy of the tissue beneath the scar to a lab to be evaluated. She did this all at no personal cost to me because she did not want me to walk around looking “wounded” from my unsightly back scar! Also, after my second surgery, I did not see the kinds of results I had hoped for from the liposuction that was performed, so Dr. Cassileth did not charge me for any of the liposuction she did during the third surgery. This saved me thousands of dollars and was greatly appreciated. Furthermore, she can also record a short video summarizing how your surgery went since patients typically have trouble remembering things immediately after waking from anesthesia. Also, after each procedure, I have received a generous bag full of recovery presents and complimentary radio-frequency treatments to help maintain the integrity of my skin after liposuction.
A few points about the staff at Dr. Cassileth’s office: As others have pointed out, Carollee provides outstanding service as a nurse. She seems to genuinely care for the comfort of her patients and provides highly personalized service to make the recovery process as smooth and seamless as possible. She is available to respond to medical questions via text and even replied to a message on a weekend. She visited me daily while I was staying at a recovery center in Santa Monica (once with Dr. Cassileth on a Saturday!) and even drove me to my first post-op appointment. In addition, I have had positive experiences with other friendly and efficient staff members who work cohesively together, including Jane, Sonya, Sari, Claudia, Albina, Dr. Killeen, and Dr. Brown (the anesthesiologist). I always appreciate the thoughtful care, willingness to answer my questions, and attention to detail that have defined my experience at their office.
I am now recovering from my third (and hopefully final!) surgery after having spent most of my adult life dealing with the repercussions of my botched augmentation. Dr. Cassileth also focused on repairing my pec muscle flex deformity and asymmetry during this last surgery, which has helped me to feel more comfortable in my own skin. Even though I did lose a substantial amount of grafted fat after the first two surgeries, Dr. Cassileth was able to double my size each time, making the procedures worth it. Some liposuctioned areas have yielded more dramatic results than others; but overall, I have seen a notable improvement. I feel more confident about my figure and better proportioned.
At three weeks post-op, I am still waiting to see my final outcome, but I am optimistic. I only wish I could tell my 19-year-old self to skip the implants and go straight to Dr. Cassileth for fat grafting! Since we are only given one body, I have a hard time understanding why anyone would choose breast implants -- which have a "shelf life" and are prone to a disconcerting array of complications -- over this more "natural," permanent method. Whether for fat transfer or something else, I would definitely recommend Dr. Cassileth to anyone seeking a skilled and innovative surgeon who doesn’t back down from a challenge and is sincerely invested in her patients’ well-being.