Breast Augmentation with Fat
For a good part of my professional career, fat was the enemy. No one wanted it. We dieted, exercised. We did liposuction and cut out excess skin and fat. Now, all of a sudden, everything has changed. We have a better understanding of aesthetics and aging. We are able to reliably and easily transfer fat from areas we do not want to areas that need the extra volume. First the face, then the buttocks and now the breasts. I do all these procedures in my practice.
The next question is, if you have fat, why bother with implants? This is a very good question, but the answer is better understood if you perform both these procedures. Here are the advantages and disadvantages, as I see it performing both procedures:
Advantages of breast implants for breast augmentation:
- One stage ability to add a precise amount of volume to the breasts
- Can achieve small, medium and larger amounts of volume increase
- Revision rate low (2%) in experienced hands
- Only one surgical site (breasts)
- Short surgery time (45 min)
- Minimal post-operative care required
- Good ability to control asymmetry
Disadvantages of breast implants:
- Mechanical device – will not last forever
- Implant is a foreign body
Advantages of fat for breast augmentation:
- Natural tissue
- No palpable implant
Disadvantages of fat for breast augmentation:
- Unpredictable amount of loss of fat with healing
- Can achieve only modest amounts of volume increase
- Revision rate high due to need for repeat fat transfer
- Two or more surgical sites (breasts and fat harvest site)
- Longer surgery time (>1 hr)
- More post-operative care required
- Potential for creating oil cysts
- May create areas of concern on breast imaging
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What is my take on this?
Every procedure has its advantages and disadvantages. I keep an open mind for anyone who wants either procedure. As long as they are a candidate for that procedure, and understand the risks and benefits, and anticipated aesthetic outcomes, I am certainly flexible. If a woman has minimal donor fat – then in that case I would offer implants alone. For most of my patients seeking breast augmentation, implants are a better option with great ability to control the results. For a woman who has enough donor fat and really does not want a foreign body inside her, fat is a good choice.
For some women, I would even offer a hybrid procedure. When needed, fat can be placed at the time of augmentation to improve contours of the breasts. In this case, much smaller amounts of fat are used than for augmentation with fat alone.
One more thing to think about – sometimes I have a patient for liposuction who would rather use the removed fat to provide augmentation of her breasts as opposed to throwing that fat out. Often there is enough fat to augment the buttocks and still have enough fat left over for the breasts. These are all options to think about. Once the fat is removed with liposuction and disposed of, it will never be available again. Fat is like liquid gold. Think carefully before you get rid of it.