What is a Fat Transfer Breast Augmentation?

Written by Dr Richie Chan

Fat transfer (or fat grafting) breast augmentation is the process of removing fat from one part of the body and injecting the processed fat to the breasts^[1]. As your own fat is one of the safest and most natural filling material, there is no risk of allergy or foreign body reaction. The fat is most commonly grafted from the thighs and flank, especially for people with slimmer bodies. It can be harvested from the belly as well.

The advantages of doing fat transfer augmentation is that it delivers a more natural look and feel to the breast, which has the added benefit of enhancing the areas where liposuction was performed. Below we cover the most commonly asked questions relating to fat transfer augmentation. 

I am quite slim. Do I have enough fat to use for breast augmentation?

Most people who undergo fat-grafting breast augmentation are actually quite slim. The BMI of fat-grafting patients can be as low as 17 to 18, which is classed as underweight^[2]. It is important to note that men and women have very different fat distributions, so the harvesting area can be different based on the distribution and is subject to preoperative clinical assessment.

How much fat can I inject to my breasts?

In theory, you can inject as much fat as you want. However, this may have to be staged over multiple procedures as it is important to ensure fat graft survival since not all of the transferred fat will survive the procedure. To survive, each fat cell needs to develop a new blood supply from the recipient site and the main factor for fat graft survival is the contact surface area within the recipient site. The more contact they have, the higher the survival rate. When you inject too much in one procedure, each fat cell will have less contact surface area. The survival rate of the fat cells lowers significantly when you inject too much volume at once.

When all conditions are ideal and an appropriate amount of fat is transferred, 70 - 80% of the fat cells usually survive the procedure. The fat that does not survive is usually reabsorbed. Less commonly, it may also calcify or turn into a cyst. These will be present as lumps and may lead to further investigation and procedures as a result.

What is the procedure of fat-grafting breast augmentation like?

Liposuction is first performed from the donor area to harvest the fat. This is usually done at the thighs and/or the belly. The surgeon will then close the wounds and process the fat to discard unwanted portions of it. The processed fat is injected into the breasts with small 3mm incisions. Unlike implants that have fixed size and contours predetermined by the manufacturers, the surgeon can inject the fat according to the individual patient’s need to address any asymmetry or contour issues.

Do I need to stay in the hospital for my breast augmentation?

The procedure is usually performed in the hospital under monitored anaesthesia care (MAC) or general anaesthesia (GA). It is technically possible to have the procedure under local anaesthesia but most people will not find this to be comfortable. We recommend either going under sedation or general anaesthesia. Most patients can be discharged on the same day, but the time it will take to fully recover varies from patient to patient.

Are there any benefits of using fat graft over other options for breast augmentation?

There are a few advantages of fat transfer breast augmentation over implants.  Below is the most important benefits over other breast augmentation options.

Fat cells that successfully survive transfer are permanent

After the procedure, your fat cells become a living part of your breasts that is vascularised and there is usually no need for additional procedures in the long run. Once a fat graft is settled, it becomes a living fat tissue and it can grow or shrink like normal fat tissue in your body. This is unlike breast implants that can rupture or develop capsular contracture years after the procedure^[3].

Additionally, most people also have their implants removed after 15 - 20 years for various reasons^[4]. This is especially relevant for women in their 40s and 50s who are considering breast implants. They will need to consider the possibility of removing the implants in 15 - 20 years as the risks of surgery increase as we age. In comparison, any fat that survives the fat transfer is permanent and will become integrated with the area. There are usually only a few rejection issues in comparison to the other options as the transferred tissues are yours to start with.

Fat-grafting procedures can be “tailor-made”

The fat injected is not restricted by any manufacturer’s model and size. The surgeon can inject according to individual needs to address patient-specific issues - e.g. asymmetry, deficiency on the upper poles, depression from previous scarring etc^[5].

There are also increasing concerns over malignancy associated with breast implants. Specifically, textured-surface implants have been found to be associated with BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma).

What is the recovery process like?

Immediately after the surgery, it'll be normal to feel a bit tired from the anaesthesia but you should still be able to manage most daily activities.

Generally, there will be soreness around the thighs/abdomen and breast area. There will also be some swelling and bruises in the first two to three weeks. These bruises may spread a little before they subside. As a result of the liposuction and fat transfer procedure, there will also be small puncture wounds in the breasts and donor sites, each requiring 1 - 2 stitches. Those stitches will be removed in 10 - 14 days depending on the patient's recovery speed.

Patients are advised to wear a pressure garment in the area where the fat has been removed and to avoid putting pressure on the newly augmented breasts. Ideally, it is best to avoid wearing a bra for three months after the fat transfer procedure. As this can cause some social inconvenience, you may want to plan your activities around the procedure accordingly. There are a couple types of bras to wear for occasional events but it is best to be bra-free for the most of the recovery period to maximise the survival of the fat cells. Your surgeon will also be able to provide recommendations to assist your recovery.

How long will it take for the fat graft to “settle”?

The breast will look bigger right after surgery for two reasons. 

1. You will inevitably have some degree of post-operative swelling. 
   
   
2. A certain percent of the fat cells transferred will not survive and will be reabsorbed by the body. This process takes a few weeks. It takes about three months for the breasts to completely ‘settle’ into their new size and shape.

Breast Fat Transfer After 5 Years: What Can I Expect?

Five years post-fat transfer breast augmentation, results and experiences vary. While a significant portion of the transferred fat integrates permanently, expect some natural volume changes as the body may absorb some fat cells. The breasts' appearance can also evolve due to ageing, gravity, and weight fluctuations, potentially affecting shape and symmetry.

Key points to consider:

• Durability of Results: On average, 60-80% of the transferred fat remains viable long-term, but this can vary.
• Aesthetic Changes: Ageing and weight changes can impact breast appearance; maintaining a stable weight helps preserve results.
• Health and Safety: Regular follow-ups are crucial to monitor for potential long-term changes like fat necrosis or calcifications, which could affect mammography results.
• Maintenance: Touch-up procedures might be desired to refine results as your body changes over time.

What can be done to optimise the results of breast augmentation?

Be realistic about the volume increment achievable in one surgery

Overzealous injection can result in decreased fat survival and increase risks of fat necrosis. Extensive fat necrosis can be quite difficult to treat. If you desire for a greater degree of breast augmentation, it is safer and more effective to do staged procedures (i.e. to repeat the procedures with few-month intervals) than to transfer a massive volume in a single surgery.

The method of fat harvest (liposuction) matters

It is important to retain the integrity of the fat cells during liposuction, therefore it is important to adopt a technique that preserves the integrity of the fat harvested. 

The complications of liposuction often arise from improper anaesthesia

Always make sure the procedure is performed in a well-equipped theatre with a qualified anaesthetist specialist present during the whole procedure.

Help at OT&P

Our clinic has a team of experienced plastic surgeons and aestheticians that can help you choose the right treatment for any concern you may have with your appearance. If you have any questions about fat-grafting breast augmentation, breast implants, or other procedures, you will be able to have them answered during a consultation. Book your consultation here. 

References

1. NHS. Surgical Fat Transfer. (2020). Retrieved December 08, 2020, from https://www.nhs.uk/conditions/cosmetic-procedures/surgical-fat-transfer/

2. Chiu, C. (2014, September). Autologous fat grafting for breast augmentation in underweight women. Retrieved December 08, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/25056909

3. Breast Implant Rupture: Causes, Risks, Signs, Symptoms, and Treatments. (2020, October 29). Retrieved December 08, 2020, from https://www.breastcancer.org/treatment/surgery/reconstruction/corrective/implant-rupture

4. Osborn, C. (2019, January 25). How Long Do Implants Last? Saline, Silicone, When to Remove, More. Retrieved December 21, 2020, from https://www.healthline.com/health/how-long-do-implants-last

5. Salibian, A., Frey, J., Bekisz, J., & Choi, M. (2019). Fat Grafting and Breast Augmentation: A Systematic Review of Primary Composite Augmentation. Retrieved December 08, 2020, from https://pubmed.ncbi.nlm.nih.gov/31942362/