Fat transfer for breast augmentation: The ins and outs of this implant alternative

Breast augmentation is one of the most popular procedures in plastic surgery, but when you think of it, you probably picture using implants to enhance the size and shape of the breasts. This is the most common option for breast augmentation, but there is an alternative procedure that is gaining popularity – fat transfer.

While it's a relatively "newer" procedure within the world of aesthetics, breast augmentation via fat transfer has seen a boom in recent years, with some younger women opting for this procedure rather than using implants to achieve their aesthetic goals.

So, what is fat transfer breast augmentation and how does it work? Does it offer the same level of results as breast augmentation with implants? Are there particular patients that one procedure is better suited for than the other?

To answer these questions and gather more insight into the trending topic of fat transfer breast augmentation, we reached out to ASPS Member Surgeons Rukmini Rednam, MD, FACS, and Ravi Somayazula, DO.

Breast augmentation via fat transfer

Often touted as a "more natural" alternative to implants, breast augmentation via fat transfer is one aesthetic procedure that has seen growing interest recently.

"Implant augmentation is definitely more popular than fat transfer, but I've been seeing an evolution in the past few years in which more women are interested in adding fat to the breast than in implants," said Dr. Somayazula. "Implants are more sought out, but fat is increasingly more popular in terms of growth."

Although fat transfer breast procedures may be rising, don't expect to see implants disappear anytime soon.

"It's increasing in popularity – implants are still by far the most common procedure performed at my practice," said Dr. Rednam. "More people are becoming aware of it and interested in it. Some people like the idea of 'all natural,' and there's still a general fear about implants, some founded and some not. You're seeing more people, not just physicians but also on social media, mention it now – it's becoming more visible in everyday media."

This procedure is performed in two parts – first, the harvesting of the fat from another part of the body, and second, the placement of the fat into the breast.

"You liposuction the donor site – typically the abdomen or flank areas, but you can get it from anywhere – and then you take that fat, and you harvest it into a closed, sterile container," said Dr. Somayazula. "There are different systems for how you harvest that fat – mine is within a closed system. The fluid is then drained off, which you have to do when it comes to the breast, and then we take that supernatant (pure) fat and inject it with a very small (less than 3mm) cannula using multiple passes into the breast itself."

Limitations of breast augmentation via fat transfer

Compared to the more traditional use of breast implants, there are some key challenges with breast augmentation using fat transfer.

The biggest is the breast size that can be achieved with fat transfer as compared to implants. Many women believe that they can increase their cup size significantly with a fat transfer, but that's not necessarily true.

"If they want a significant volume, I explain that it will take two to three procedures to get what they want to achieve," said Dr. Rednam. "Fat grafting is almost always going to be more expensive than a single implant surgery."

Another limitation of fat grafting is maintaining the new breast size ad after surgery because of fat resorption. No matter how successful the procedure is, a percentage of the transferred fat will always vanish.

"If I put a 300cc implant in you, you're going to have it in 20 years," said Dr. Rednam. "With fat grafting, we expect a percentage to be lost. There are so many studies out there that show that fat grafting has different retention rates throughout the body, about 50 to 70 percent retention approximately."

Because of these limitations, breast augmentation via fat transfer is often suggested for patients who are looking for a subtle increase in cup size rather than a larger volume change.

"The most ideal patient for breast augmentation fat grafting is a half a cup to a full cup augmentation," said Dr. Rednam. "I can tailor exactly where I'm putting the volume versus with an implant, where the volume will be distributed throughout. In other words, fat transfer gives me more targeted volume creation."

Further applications of fat transfer in breast augmentation

While fat transfer may not prove to be the most effective method for achieving larger breasts, this procedure can be used in combination with implants to achieve the results that the patient wants. Many surgeons will perform an implant augmentation and then use harvested fat from elsewhere in the body to further shape and form the breast for a more "natural appearance." This can give patients the results they are looking for without the need for multiple fat transfer procedures.

In addition to being used in combination with implants, fat transfer can also play a key role in perfecting a breast lift following implant removal.

"A great use of fat transfer is when you're explanting, or removing an implant, and performing a breast lift – you can use the fat to shape the breast and add a little more lift," said Dr. Somayazula. "Increasingly, I'm seeing more women wanting their implants removed and fat is a great tool when you're just performing a breast lift."

Breast reconstruction following mastectomy is another use of fat transfer to the breasts.

"It's great for this because when you do a mastectomy, the skin flaps are very thin," said Dr. Somayazula. "When the skin flaps are thin, you risk rippling of the implant – in other words, you can actually see the folds of the implant through the skin. In these cases, you can actually perform fat grafting to hide the rippling and improve the appearance of the breast."

Opting for breast augmentation with fat transfer

While less popular than implants, breast augmentation via fat transfer has seen a recent boom in popularity among younger women who are seeking out a more "natural" appearance to their bust. This promising procedure can offer subtle aesthetic changes and is most often used in combination with other aesthetic procedures, such as a breast lift or implant augmentation, to create a more pleasing appearance that suits the goals of the patients.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.