How permanent are the results after fat transfer to the breast, and what determines the success of the procedure?
What is fat transfer? “Can you transfer fats from my tummy to my breasts ?”
As determined by the American Society of Plastic Surgeons Task Force to be a safe procedure with a low rate of complications (1), fat transfer, or Autologous (using your own) Fat Grafts (AFG) is an increasingly popular procedure among my patients. Fat grafting for breast or face augmentation is ideal as it allows the patient to take fat from stubborn areas and transfer it to the desired areas, hence killing two birds with one stone. AFG has also shown favourable results for patients undergoing breast reconstruction after cancer surgery.
How permanent are the results after fat transfer?
Fat transfer to the breast has good potential to be completely permanent once the fat survives. There is also potential for the breast volume to increase over time as the fat cell grows. One of the critical questions is how permanent the results are, ie. how much fat survives after transfer. Studies have shown that survival rates in the breast range from 34% to 82%(2). While fat transfer to the face has been commonly done for quite some time, it is only in recent years that advancements have allowed for reliable and successful breast augmentation using your own fat. Improvement in techniques in fat harvest (suction of fat from the body), fat preparation and fat injection have improved the survival rates of fat grafts and it is common to get survival rates of 50-60% reliably in experienced surgeons.
What determines the success?
Fat harvest. Gentle harvest of the fat grafts using atraumatic techniques with low suction is critical to ensure that the harvested fat survives. Studies have shown that there is no difference over the commonly used donor sites - abdomen, thighs or flanks (3). However, I have found that long term storage areas such as the inner thigh tends to be more effective for removing fat, and transferring to the breasts.
Pure yellow fat without sediments obtained from using the Pure-graftTM system. (Photo: Dr. Terence Goh)
Fat preparation. There have been many different methods of fat preparation including sedimentation, filtration, and centrifugation. Some studies have shown that centrifugation may damage the fat cells and methods of sedimentation and filtration are the best for fat graft survival (1). A novel technique known as PuregraftTM allows for rapid preparation of the fat grafts using both sedimentation and filtration techniques to give high quality fat in a short period of time. I have used this method and found that the survival rate of fat grafts to the breast to be very high.
Tulip curved cannulas used for breast fat grafting. (https://www.tulipmedical.com/tulip-curved-cannulas.html)
Fat injection. Meticulous injection using fine cannulas to ensure that the parcels of fat are carefully placed is critical to ensure that there is good supply to ensure graft survival. It is not the amount of fat that is injected that matters but the amount of fat that actually survives. We have moved away from injecting large amounts as this causes ‘overcrowding’ and leads to an increased loss of graft survival. Instead carefully planned, and staged surgery at 2-3 month intervals is advised to ensure maximum graft survival during each session. As a guide, most patients can tolerate 200-300 cc of injection per breast, giving an increased of 120-150 cc which is equivalent to 1 cup size.
Have a great weekend ahead!
Dr. Terence Goh
1. Landau MJ, Birnbaum ZE, Kurtz LG, Aronowitz JA. Review: Proposed Methods to Improve the Survival of Adipose Tissue in Autologous Fat Grafting. Plast Reconstr Surg Glob Open. 2018 Aug 3;6(8)
2. Yu NZ et al. A Systemic Review of Autologous Fat Grafting Survival Rate and Related Severe Complications. Chin Med J (Engl). 2015 May 5;128(9):1245-51
3. Rohrich RJ, Sorokin ES, Brown SA. In search of improved fat transfer viability: A quantitative analysis of the role of centrifugation and harvest site. Plast Reconstr Surg. 2004;113:391–395.
Transferring fat to your breasts involves harvesting the fat cells from other areas, such as thighs, tummy, or back, processing the fat and grafting the fat into your breasts.
If the fat grafts survive, the results are permanent. Surgical technique and processing are important factors. Every surgeon has their own way of doing things. There is very little evidence to prove one way is better than any other.
I will take fat from areas that my patients find difficult to get rid of on their own. This stubborn fat will usually not reduce even if my patients lose weight. I find this gets the best results.
Some patients ask if they should put on weight before the procedure. I advise them against this because weight that is easily gained is also easily lost and when they lose the weight their breasts will also shrink.
Although the fat grafts are permanent, your breasts will still age naturally. Meaning that your breasts may droop with time, they will not stay as perky as implants will. Personally I think this is good, as they will look natural forever.
Hope this answers your question.