Fat transfer to breast
The concept of transferring fat from one area of the body to another is not a new one, however it is only in the last decade that surgical techniques have developed sufficiently to allow for relatively predictable results. There are a huge number of applications for this technique, such as improvement of facial and body contours, rejuvenation of hands, improvement of the appearance of scars, and enhancement of the breasts.
FAT TRANSFER/ FAT GRAFTING/ LIPOFILLING
Type of anaesthetic
General or local anaesthetic
Length of surgery
1 to 1.5 hours
Nights in hospital
0 nights (day case)
Minimal scars at donor and recipient sites
1-3 days off work
4 weeks gentle exercise
6 weeks strenuous exercise
The advent of effective techniques for fat transfer is one of the most exciting developments in the field of plastic surgery in recent years. This explosion in popularity coincided with my years in training as a plastic surgeon, meaning that I have ‘grown up’ with the technique. During the course of my fellowship training, particularly during the time spent with Dr. Jeroen Stevens in Holland, I gained extensive experience in the nuances of the technique; in particular methods to improve graft survival and novel applications for the technique.
Some of the indications for which I perform fat transfer to the breast are:
- As part of a breast augmentation procedure, to enhance the result
- Following previous breast implants (cosmetic or reconstructive) to disguise visible implant edges or rippling
- To improve contour deformities (dips or hollows) due to the natural shape of the breast or previous surgery
- To improve the contour of a reconstructed breast
- To improve the appearance of scars and skin quality
- Improvement of contour defects following previous gynaecomastia surgery
Although fat transfer can be used on its own to increase the size of the breasts, I feel that this is not the best way to either use fat, or to increase breast size. This is because most patients who require breast augmentation want more than the increase of one bra cup size that this procedure can offer, and the number of procedures (typically three) required for this small increase is prohibitively costly both financially and in terms of down-time for patients. Most importantly, while fat transfer is regarded as an acceptable, effective treatment for the conditions listed above by the American Society for Aesthetic Plastic Surgery, this same expert group does not yet recommend it as an option for breast augmentation.
The surgery is usually performed under general anaesthetic, although in certain cases, e.g. where the area to be treated is limited, it may be performed under local anaesthetic. Fat is removed/ harvested from the donor site – usually the outer thighs or abdomen, using very gentle suction. This is different from the more powerful suction used in traditional liposuction, as the aim is to avoid damaging the fat cells as much as possible. Other donor areas may be used, and this can be discussed at the pre-operative consultation. For more information on the donor site, see the liposuction section. The fat is then prepared for injection into the breast (recipient area). These injections are done via tiny incisions, which usually heal well of their own accord, without the need for stitches.
The success of the procedure depends on the injected fat cells being placed beside tissue with a blood supply, which they can then connect to in order to survive. In practice, this means that multiple tiny tunnels are made with the injection needle, with the fat cells evenly spread throughout the tissue. Simply injecting a large blob of fat into a single area will inevitably lead to failure. A useful comparison (at least to my mind!) is to compare carefully spreading a load of seed evenly over a prepared field, compared to dumping the entire lot in the middle of the field and expecting a bumper crop. In practice, this means that there is a limit to the amount of fat that can be injected at each procedure, and that optimal results usually require a second, and often subsequent procedures. Another point to bear in mind is that a little over half of the transferred volume is expected to survive in the long term, even with best technique, and that because of this, it may initially appear that too much fat has been transferred (overcorrection). Combined with the swelling seen in the early post-operative period, this may cause concern to patients who are not expecting it. This swelling will settle and final results can be expected at about a year post-operatively, with the result obtained at that stage regarded as permanent.
Until relatively recently, fat transfer to the breast was regarded as a bad idea: this was because of concerns about formation of oil cysts, scarring and calcification that could lead to difficulty interpreting mammograms, and worries about breast cancer risk. In 1987, the American Society of Plastic Surgeons imposed a moratorium on fat injections to the breast. Following renewed interest in the technique, and research demonstrating its safety, this moratorium was lifted in 2008, and extensive research published since then confirms the safety of fat injections to the breast. Based on this, I am happy to offer this procedure to my patients, however, as with all the procedures I perform, I review the evidence for its safety and efficacy on an ongoing basis.