Breast Fat Grafting

What is fat grafting?

Fat grafting refers to the transfer of fat from one area of the body to another. It involves removing excess fat from the patient, preparing it, and transplanting it to the desired location. Fat grafting is becoming a popular option amongst women who want to augment their breasts without the need for implants.

What is the history of breast fat grafting?

Fat grafting is considered a safe procedure and has been practiced for decades. It is interesting to note that the fat grafting concept dates back over a century. Fat grafting was first mentioned by a German physician in 1893 where he transferred upper arm fat to the face. In 1895, another physician performed a breast augmentation procedure by transferring a lipoma (fatty tissue deposit) from the back to the breast. There have been several advancements and refinements in fat grafting techniques since then, to the point that it is now a routine method for restoring or increasing breast volume. Breast fat grafting has been a popular method for correcting contour abnormalities in the breast (even following breast cancer removal) and because of its potential advantages, it is also gaining popularity as a primary method for breast augmentation.

What are the advantages of breast fat grafting?

Many modern women prefer not to augment their breasts with implants or are simply looking for alternative methods. The main advantage of fat grafting is that it involves using your own tissue rather than a foreign device (breast implant).

Using your own fat means that your body will accept the fat and you can avoid the potential problems associated with breast implants. Because breast implants are synthetic, the body responds to them by forming a breast capsule. The capsule itself is not harmful but it can cause problems such as capsular contracture or capsular hardening. Please refer to our breast augmentation section for specific factors that need to be considered when considering breast implants as an alternative to fat grafting. It is also important to keep in mind that implants are not life-long devices and surgery will eventually be required again in the future, meaning additional surgery costs and lifestyle interruptions should be expected. On the other hand, fat grafting is generally considered to be long-lasting or permanent.

Because the fat used for grafting is your own, it will not be rejected. The fat will be harvested from another area of your body such as the abdomen, thighs and hips (love handle region). By removing fat from these areas, patients can also enjoy the contouring benefits of fat grafting.

When the fat is placed in the breast, it is typically distributed across various planes within the skin and breast tissue. This means that the breast will have a very natural feel and shape. This is particularly beneficial for those who do like the feel and shape of breast implants.

Because the fat is also placed just under the skin of the breast, patients may experience an improvement in skin quality too. This has been reported in women who have undergone breast fat grafting after radiotherapy treatments for breast cancer.

Breast fat grafting can also be used to enhance and optimise the results of breast implants or breast lift surgery.

What are the disadvantages of breast fat grafting?

Fat grafting requires patients to have enough fat stores available for adequate fat graft harvesting. Typically, the amount of fat required is greater than the amount available for injection. This is because, when the fat is harvested, it contains oils and fluid. Once the fat is prepared (removal of fluid and oils), the amount of true fat available for injection is approximately one half of what was harvested. It is also important to understand that the amount of fat that “takes” (stays) is approximately 50-60% of the amount that is injected.

Breast fat grafting can result in a maximum increase of one cup size. This requires approximately 250-400cc of fat to be injected into each breast. Hence, if the patient’s fat stores are limited, more than one fat grafting procedure may be required to obtain the desired result. Similarly, if an increase of more than one cup size is needed, multiple fat grafting procedures will be required until the desired breast size is achieved.

Who can benefit from breast fat grafting?

Breast fat grafting can effectively address various breast-related changes. The following is a brief overview of what can be achieved with breast fat grafting:

  • Naturally increase breast volume instead of using breast implants
  • Correct a contour abnormality in the breast as a result of cancer or trauma
  • Optimise breast shape after reconstruction
  • Camouflage the breast implant outline in thin individuals
  • Correct implant wrinkling and rippling
  • Improve cleavage
  • Correct double bubble deformities
  • Camouflage visible ribs in thin individuals
  • Achieve better breast symmetry
  • Improve or correct breast shape in women with developmental or congenital breast changes
  • Improve upper breast fullness in women undergoing a breast reduction or breast lift procedure

How is breast fat grafting performed?

Fat grafting involves three essential steps: (1) Fat harvesting, (2) fat preparation, and (3) fat injection

How is the fat harvested?

Fat is extracted using liposuction. After injecting a combination of saline and local anaesthetic into the donor area, narrow liposuction cannulas are used to suction the fat out of small (3-5mm) incisions. Fat can be obtained from areas such as the abdomen, inner and outer thighs, and love handles. While the quality of the fat can vary slightly depending on where it’s extracted, studies haven’t shown any significant difference in the outcome of the procedure based on the donor area. It is important to note, however, that wherever the fat is harvested, the surgeon should ensure that suction pressures are not excessively high to prevent damaging the donor fat. During the liposuction process, the suctioned fat is also collected in special canisters, which are specifically designed for fat grafting. Before the fat can be injected into the breasts, it needs to be prepared.

How is the fat prepared?

Fat graft preparation involves purifying the fat that has been obtained via liposuction. The harvested fat contains tissue fluid, blood, and oils, which needs to be removed before the fat can be transplanted. This reduces the risk of oil cyst formation and more importantly, ensures that the volume of fat being injected is accurate, leading to a more predictable outcome.

There are various methods that can be used to prepare the donor fat. Centrifugation and washing the fat are the two most common methods of fat graft preparation.

How is the donor fat injected?

Once the fat has been prepared, it can be injected into the breast tissues and skin. The fat is collected from the fat collection canister and transferred to appropriately-sized syringes. Fat injection cannulas are then used to inject the fat. The fat injection cannulas are inserted into 3mm incisions that are placed in the breast crease or around the areola if need be. It is important that a multi-planar approach is used in a controlled fashion. By placing the fat in various planes across the skin and breast tissue, it minimises the chance of ending up with large clumps of fat. Large clumps of fat can lead to undesired contour and also fat necrosis (firm deposits of fat that did not survive). The fat graft deposits rely on the surrounding tissues to ensure optimal graft survival or “graft take”. The goal is to deposit small beads of fat in overlapping linear fashions in various planes. This helps achieve optimal contact between the fat deposits and the surrounding breast tissue, which in turn increases the likelihood of fat graft survival and take.

Am I a good candidate for breast fat grafting?

Breast fat grafting is suitable for any woman who wants to augment her breasts or enhance the results of breast augmentation or breast lift surgery. As a stand-alone procedure, it remains an excellent alternative to breast implant surgery, provided the pros and cons of each approach are considered. If you would like to find out more about breast fat grafting, schedule a consultation with Dr Reddy who can take you through this option in more detail.