Fat is having a moment—both as a viable alternative to filler and as a way to re-shape and re-volumize parts of the body that have lost their vitality due to age or weight loss. While using fat as a means to resize breasts is not exactly a new concept, how we understand its use and value in aesthetics is. To help understand it better, we spoke with plastic surgeons to get their take on fat’s use in breast augmentation.
Featured experts
- Sean Simon, MD is a board-certified plastic surgeon in Miami
- Dr. M. Bradley Calobrace is a board-certified plastic surgeon in Louisville, KY
- Robert Singer, MD is a board-certified plastic surgeon in La Jolla, CA
- Mark Jewell, MD is a board-certified plastic surgeon in Eugene, OR
How is fat used in breast augmentations?
There are really only two ways to add volume to the breasts—one is an implant, the other is fat. “Autologous fat grafting or fat transfer uses a patient’s own body fat to enhance the breasts without reliance on synthetic implants,” explains Miami plastic surgeon Sean Simon, MD. Fat is harvested via gentle liposuction from a donor area on the body, such as the abdomen, flanks or thighs and is then “processed in a way to purify the fat by separating it from the remainder of the fluid aspirate and condensed down to viable fat cells before it is injected into the breast tissues to enhance the volume or aid in reconstruction of deficits or to correct any asymmetry,” he explains further.
Adding fat to the breasts can add 200 ml of fat (making the breasts up to three-fourths of a cup larger), but it may take a few sessions to get to that point, explains Louisville, KY plastic surgeon Bradley Calobrace, MD. “It’s good to help add cleavage or volume at the top of the breast. We tend to use fat in a lot of breast reconstructions after cancer to help improve overall appearance and cover up implant wrinkles that may be present. It’s also valuable in adding volume to the lower poles of the breast in patients with tuberous or constricted breasts.”
Fat is also often used as an adjunct to help shape the breast with implants (composite augmentation) or with auto-augmentation, which is a breast procedure that uses a patient’s own tissue to lift and create an implant-like effect in the upper poles of the breast.
Is fat transfer to the breast permanent?
Yes, but only to a degree. Once transferred fat cells are integrated and established in their new environment and have a new blood supply, they become part of the permanent breast tissue—which is when results can be unpredictable. “As far as how much fat survives the grafting process or the ‘take rate’, it’s usually considered to be approximately 60 to 70 percent whereas the remaining 30 to 40 percent of fat cells that do not survive the process are broken down, and absorbed via the body’s lymphatic system over a three to six month period,” explains Dr. Simon.
Fat will sometimes not survive because of poor blood supply, meaning that if there is a large, dense area of injected fat, it may not allow new blood vessels to reach the inner portion; then necrosis, or death of the fat cells, may occur. Also, Dr. Simon points out that transferred fat cells behave in the same manner as normal fat cells—they too can enlarge or shrink with weight fluctuations.
Surgical aftercare, such as wearing proper post-surgical attire, is important to get optimal results. Avoid sleeping on the area and the use of nicotine as it can be harmful to the process of fat cell survival and integration.
Are there other alternatives to your own fat?
There are some patients who either don’t have enough of their own fat to use or who choose to avoid the fat grafting process. Dr. Calobrace uses a newer product called alloClae, made from cadaver fat, in place of the patient’s own fat to shape and re-volumize the breast. However, more studies and data are needed to understand how it may impact breast imaging and early cancer detection. Dr. Calobrace says that when he uses it, he does not place it in the breast tissue itself; rather, in the upper poles of the breast or along the edge of an implant to eliminate visible wrinkles. With the continued and growing use of GLP-1s, Alloclae is a viable option for those who don’t have enough fat reserves to create a noticeable impact.
However, La Jolla, CA plastic surgeon Robert Singer, MD and Eugene, OR plastic urgeon Mark Jewell, MD note that there are a couple caveats to alloClae. They point to the etraordinary cost of Alloclae, noting it can be prohibitively expensive for many. Additionally, “there is no long term outcome data for it in the human breast” for this treatment, says Dr. Jewell.
