Breast Enlargement Fat Transfer Surgery (Fat Grafting) Guide

What can breast enlargement fat transfer surgery achieve?

Patients may choose to have a breast enlargement fat transfer if they are looking to:

• Restore volume to the breasts following ageing, weight loss or pregnancy
• Improve the shape and contours of the breasts
• Balance any asymmetry of the breasts
• Boost self-confidence.

Although a breast enlargement fat transfer can enhance the shape of the breasts, it cannot correct breasts that are severely sagging. The medical term for breast sagging is breast ptosis. A breast uplift also called a mastopexy, maybe a more appropriate procedure for patients with severe sagging. The surgeon may also choose to combine the breast enlargement fat transfer with an uplift in order to achieve the best result possible.

What are the advantages of having fat transfer instead of implants?

Breast enlargement fat transfer is a less invasive surgery than breast enlargement using implants. The surgeon does not need to make many cuts during the surgery. They will inject the fat into the breasts meaning patients should have a minimal amount of scarring if any. Some people also find the results of a fat transfer to be more natural-looking. Furthermore, breast enlargement fat transfer increases the size of the breasts and can help improve the symmetry and shape of the breasts.

The fat grafting technique also has the benefit of removing fat from other areas of the body by using liposuction. This means that patients can improve the appearance of two parts of the body with just one procedure.

What are the disadvantages of having fat transfer over implants?

As with any technique, there are always some disadvantages. Compared to having implants, a breast enlargement fat transfer procedure can take longer to perform and maintain. Some patients may need multiple sessions to have the size breasts they wish. Each session can take around two to three hours to complete.

With each session, there is a limit on how much fat the surgeon can transfer into the breasts. This means that a fat transfer cannot match the same increase in volume that implants can achieve. It is also important to consider that in the first six months after surgery, the body may naturally absorb up to 50% of the fat that is injected into the breast. To help compensate for this, the surgeon will often ‘overfill’ the breasts with the anticipation of reabsorption. It cannot be guaranteed how much fat will be absorbed, and so the size cannot be guaranteed.

Fat transfer breast enlargement is most suitable for patients who want a small increase in breast size and for their breasts to look fuller. Implants are more appropriate for patients wanting a larger increase. Additional ‘top up’ sessions of fat grafting may be used to go up to a larger size.

Choosing a highly qualified BAAPS/BAPRAS surgeon will improve the chances of achieving the best results possible from the procedure.

How much does breast enlargement fat transfer surgery cost?

Breast enlargement fat transfer surgery typically costs between £6000 to £8500. There are a number of variants that may alter the price. Patients can discuss these variants with their surgeon during the initial consultation, after which a personalised procedure package is proposed, tailored to the patient’s wants and needs.

Some of the variants which may affect price are:

• Which hospital or clinic is chosen for the procedure
• Surgeon experience
• Anaesthetist experience
• Surgical techniques or combination surgeries
• The time required in surgery for each patient’s case

Only after the specific details have been agreed upon by both patient and surgeon can a final price be determined. The final price will be set after the initial consultation and will include:

• Surgeon and anaesthetist costs
• Highly rated CQC hospital costs
• Overnight stays (if required)
• Aftercare and follow-up appointments

Not every patient requires top-up sessions, but if they are needed the cost can increase further.

Who are the best candidates for breast enlargement fat transfer?

For patients who are unhappy with the size of their breasts do not want to have breast implants, breast enlargement fat transfer can be an ideal solution. It transfers fat from other parts of the body such as the thighs, buttocks or stomach to the breasts. Thus, the ideal breast enlargement fat transfer candidates are patients who:

• Are unhappy with the size of their breasts.
• Dislike the shape or volume of their breasts.
• Have breasts of different sizes.
• Wish to have a breast enlargement but do not want synthetic implants.
• Have had a reduction in the size and volume of their breasts after weight loss or pregnancy.
• Are at a stable and healthy weight.
• Are emotionally ready for surgery.
• Have enough fat to transfer to the breasts (the procedure is not suitable for very slender patients)

Breast enlargement is a procedure that is individualised to each patient. It is important that you think carefully and research well before choosing to have surgery.

Why have breast enlargement fat transfer surgery?

There are many reasons why some patients wish to have a breast enlargement fat transfer. Lipoaugmentation can also help produce breasts that are more natural-looking than those that have been enhanced with breast implants.

There are two main categories for wanting a breast enlargement:

Reconstructive

This is often for patients who have had treatment for breast cancer and are looking to restore breast shape.

Aesthetic

The majority of patients choose to have breast enlargement for cosmetic purposes. Patients may be unhappy with the shape, size or symmetry of their breasts and may, therefore, want to correct this. Breast enlargement can also help restore breast volume after pregnancy or major weight loss.

How is a breast enlargement fat transfer procedure performed?

The breast enlargement fat transfer procedure usually takes between 60 to 180 minutes to perform.

Consent

Before patients can have surgery, they will need to sign a consent form. To be able to sign this confidently, it is important that patients know details of the benefits, risks, and complications of the surgery. The surgeon will discuss all of these before the day of the operation. On the surgery day, the surgeon will draw lines to mark out the procedure area and clarify any specific goals of the surgery.

Anaesthesia

On the day of the operation, patients will be shown in the anaesthetic room. Here, the anaesthetist will give either a general anaesthetic or a local anaesthetic. The choice of which method they will use depends on what the patient has agreed on with your surgeon.

Method of fat transfer

In the operating theatre, the surgeon will clean the chest area and cover it with drapes. This is to keep the area sterile and reduce the risk of infection.

Breast enlargement fat transfer is a multi-step procedure. Firstly, the surgeon will remove fat from an agreed-upon area of the body. This is done using liposuction. The surgeon will often take the fat from the arms, stomach, thighs or buttocks. They will then purify that fat and carefully reinject it into the breasts to increase their size. Sometimes, breast enlargement fat transfer can take place over multiple sessions.

Liposuction

The surgeon’s area for fat collection (usually your stomach or thighs) is injected with a “tumescence” solution. This solution contains medications that aim to reduce pain and bleeding during the procedure. The surgeon will then perform liposuction and remove the fat from the body, as shown in the diagram below.

This fat goes through a process of purification involving washing, processing and refinement. Next, the surgeon will inject the fat through a small plastic tube into the small natural hollows within the upper portion of the breasts, resulting in the enlargement of the breasts.

Closing of incisions

The surgeon will place some strapping and tape on the small wounds from liposuction and fat insertion.

Return to the ward

Patients will then return to the ward to rest. They may find that you have some small drainage tubes under the skin of the breasts. These help further reduce swelling and bruising. Before patients leave the hospital, the surgeon should may these or patients will return to have them removed.

What to expect from the breast enlargement fat transfer consultation?

The breast enlargement fat transfer consultation will often last between 15 minutes to an hour. Patients will meet the surgeon for their consultation. The purpose of this consultation is to talk through any requirements for the procedure and the patient's expectations. Consequently, in the consultation, the surgeon will consider the following to help determine the best surgical approach for the patient:

• Current breast size and shape
• The breast size and shape
• The quality and quantity of breast tissue and skin
• Areas of the body which the patient would like to remove fat.

Furthermore, the surgeon will want to know the following:

• Past medical conditions
• Current health status
• Any previous history of breast disease
• Any previous chemotherapy or radiation to the breast tissue
• Any medications, including herbal remedies
• Current smoking status, alcohol intake or drug use
• Any allergies.

Once patients have discussed the above, the surgeon will then take the time to examine and measure the size of your breasts. After examining the patient, they will be able to give an idea of the breast size they can achieve through fat transfer. Furthermore, patients can try on a wide range of sizes during the consultation to help patients visualise the size they wish to achieve.

Questions to ask during the breast enlargement fat transfer consultation?

To ensure patients fully understand the procedure and decide if it is the right option, there are a few questions that they may wish to ask the surgeon. These may include:

• Do you think what I wish to achieve from surgery is realistic?
• What do you expect of me to get the best results?
• What scars will I have? And where will I find them?
• Are there any alternatives to lipoaugmentation?
• Have you performed this procedure before? Do you have any pictures?

Finally, it is very important that patients are fully honest and open with their surgeon. This way, they can advise on which is the best surgical approach for the patient and their breasts.

What are the main risks of breast enlargement by fat transfer?

After the initial consultation, the surgeon will give patients a two-week ‘cooling-off period. At this time, patients should familiarise themselves with some of the breast enlargement fat transfer risks.

The potential breast enlargement fat transfer risks and complications include:

Fat necrosis and oil cysts

Fat necrosis can occur when an injury is caused to fat cells and causes them to die. Oil cysts are the result of prematurely dying fat cells. There is a risk that these may occur to the fat transferred into the breasts. However, as these are well-known complications of breast fat transfer, they can be easily identified on ultrasound or mammogram. Because of this, there are treatments that can resolve these. It is worth noting, however, that this only occurs in a very small number of patients. A good surgical technique can reduce the risk of this occurring. Therefore, it is important to choose a professional surgeon with plenty of experience in this field.

Fat migration

Fat migration occurs when the transferred fat cells move from the breast to other parts of the body. This can result in the breasts losing volume and shape, as well as the formation of lumps and bumps in other areas of the body. Fat migration can also cause asymmetry in the breasts, which can be difficult to correct.

Bleeding & bruising

In any surgical procedure, there is always a risk of bleeding. This usually happens straight after the operation. However, very rarely, it may occur up to two weeks later, and the breasts may start to feel very swollen and tender. If this were the case, it is likely patients will need to return to the theatre. This may also require an extra night stay in the hospital. Patients may also find there is an increase in bruising around the area. However, this should settle down over time and is very unlikely to affect the outcomes of surgery.

Infection

After a breast enlargement fat transfer, there is a risk that patients may develop an infection. It is important to take any infection seriously. In the event that infection affects the body, it will become apparent over the first two to three weeks post-op. The symptoms of infection often include the wound not healing as it should and an increase in the redness in the skin around the wound. Mild infections mostly settle down with antibiotics.

Aesthetic

There is always a risk that patients are unhappy with the final result for aesthetic reasons. This may be with the shape, size or symmetry of the new breasts. Therefore, it is advised patients choose their surgeon carefully and make sure they fully understand any desired outcomes. Also, a breast enlargement fat transfer often requires multiple sessions. So, if patients are unhappy after the first session, speak to the surgeon about arranging another session.

General surgical complications

Every surgery comes with a number of common risks. These include:

• Blood clot formation
• Anaesthetic risks
• Allergic reactions
• Nausea
• Vomiting
• Post-operative pain

How to prepare for a breast enlargement fat transfer?

Once patients have decided to go ahead with the procedure, there are a few things that they can do in preparation that will make the recovery process easier after the surgery. Some breast enlargement fat transfer preparation tips include:

Smoking & alcohol

Smoking affects the way the body heals. Therefore, to help with a speedy recovery, most surgeons recommend patients are smoke and nicotine-free for at least six weeks before and after the surgery. It's also recommended that patients cut down on alcohol in the weeks before and after the procedure. Smoking, in particular, can increase the time it takes for wounds to heal. This can also increase the risk of an infection developing.

Household chores

Before coming in for the procedure, they may find that doing the housework, laundry and taking the bins out before the surgery may be helpful. This way, patients can put their feet up and relax after surgery. Patients may also find it useful to take out mugs, plates and food cupboard items onto the work surface. This will ensure they are not needing to reach up and stretch any stitches.

Driving

Patients will be unable to drive themselves home after the procedure. This is because the medications the surgeon uses may cloud judgement, making it unsafe for patients to drive. They should, therefore, ask a friend or relative to take them home. Furthermore, patients will need adult supervision for the first 24 hours at home after the surgery.

Food & shopping

After surgery, patients will not be able to lift heavy bags. Therefore, patients may find it helpful to do a large food shop before coming into the hospital. Some people also find it useful batch cooking some meals for the freezer. Patients should try to maintain a well-balanced and healthy diet after surgery. This should be high in protein and low in sodium, sugars and fats. It is important that patients drink lots of water and caffeine-free fluids.

Post-operative bra & clothing

In the first few days after surgery, patients should wear clothing that opens easily from the front. Patients may also find it useful to wear slip-on shoes, so they do not strain themselves bending down. Patients may need to wear a post-operative bra after the procedure. The surgeon will give you specific instructions on how long to wear this for.

Sleeping

Some people find it more comfortable sleeping propped up after surgery. Therefore, patients may wish to have spare pillows ready. Patients will also need to sleep on their back in the first few days to protect the stitches.

These are just some breast enlargement fat transfer preparation tips; the surgeon will give more specific advice and time-frames in regards to the surgery preparation.

What to expect after a breast enlargement fat transfer?

During the consultation, the surgeon will talk through what to expect after the operation. This will help patients to feel a bit more at ease before coming into the hospital. In this consultation, the surgeon will go through how much time is needed to take off work, driving and exercise. The breast enlargement fat transfer aftercare advice and time frames are different for each patient.

Post-operative consultation

Many patients are able to go home on the same day as the operation, but sometimes a one night in the hospital may be needed. Before leaving, patients will organise a follow-up appointment to take place within the next two weeks with the surgeon. In this appointment, they will check to see how the patient is recovering, replace any dressings and address any concerns. The surgeon will also give advice on any drains that may be left in after the surgery.

Time off work

How long patients need to take off work depends on the kind of work they do. If the work is physically demanding, such as waiting tables, patients will need to take at least a week off work. Furthermore, when patients do return to work, they will need to start slowly. Otherwise, it is recommended that patients just take a few days off. This is to allow patients some time to recover and rest. In every case, patients need to avoid light duties for at least a week. The surgeon will be able to tell patients exactly how much time they need to take off work.

Sports and exercise

During the first week of recovery, patients should be resting. Patients should not do any exercise at all. Aerobic exercise can increase the amount of swelling. Furthermore, starting vigorous exercise too soon after the procedure can increase the risk of bleeding into the breasts. It is therefore vital that patients rest to avoid this from occurring. By the third week, patients can start to partake in exercises that do not involve rigorous movements. This includes cycling and gentle walking. After the sixth week, patients should be able to return to all exercise and sports. Be careful with some contact sports, as the breasts may still be sore.

Post-operative bra

After the surgery, patients may have to wear a post-operative bra to help during recovery and help achieve the best results possible. It can help reduce the swelling and bruising in the breasts. Patients may need to wear this every day and night for at least one week and during the day for a total of six weeks. The surgeon will give specific instructions and time frames for how long patients will need to wear this.

Scar care

To aid scars healing, the surgeon may recommend a number of techniques for you to use. These include:

1. Scar massage – Only start this once incisions have fully healed and the scabs have disappeared on their own.
2. Silicone sheets or scar gels – Patients can use these for six months to a year once any glue or tape is off and the incision has healed.
3. Keeping scars out of direct sunlight decrease the chance of colour difference between skin and scars. If this is unavoidable, patients should wear a high factor sun cream.

Final results

As some patients require multiple “top-up” sessions after their first procedure, it may take a while to see the full results from surgery. After each session, patients may find that their breasts feel over-enlarged and heavy for the first 24 to 48 hours. This is due to swelling, and wearing the post-operative bra can help to reduce this.

Furthermore, patients may find that their breasts feel tender and swollen for several weeks after surgery. This can take several months to fully resolve. During this time, patients may also find that the nipples feel numb or overly sensitive, and the breasts may appear tight, too high or unnaturally round. This is all part of the recovery after surgery and will settle in a few months.

After four to six weeks, the body should have healed enough to see the full permanent results of the breast enlargement and feel well in your new self. However, especially with the potential of multiple sessions, it may take up to 12 months for everything to completely get back to normal.

Strictly following the surgeon’s breast enlargement fat transfer aftercare advice can help you achieve the best results from the procedure.

What effect does weight gain or loss have after a fat transfer breast enlargement?

Significant weight gain or loss may affect the appearance of your breasts in general. Sometimes the new fat in your breasts can still behave as it would have from its original site. In other words, if it would lose volume with weight loss when it was in the abdomen it will still lose volume when it is in the breasts.
Every person is individual and therefore it is difficult to predict how a specific person's breasts will change with weight loss.

Does breast fat transfer affect mammograms?

Fat grafting can cause changes such as calcification that are visible on mammograms. There is a lot of evidence that those changes are the same as changes seen from other breast surgery, such as reductions. Most trained radiologists are able to determine the differences between postoperative changes and breast cancer changes. It is important to inform your radiologist about the procedure you have had when having a mammogram.

Can I still breastfeed after breast enlargement fat transfer surgery?

Although uncommon, some women struggle to breastfeed and may produce less milk after an enlargement procedure. On average, there is a very high chance that you will be able to breastfeed as normal despite your procedure. This is assuming you were able to breastfeed before the surgery.

If you’ve just had a baby and are breastfeeding at present, your surgeon may require you to stop breastfeeding for 3 to 6 months before surgery. This is in order to allow the breasts to settle before your procedure. This is something to consider when timing your surgery.

All of the information found on our website is sourced from highly reputable experts, government-approved authorities and is widely used by healthcare professionals.

• https://www.nhs.uk/conditions/cosmetic-procedures/surgical-fat-transfer/ NHS
• https://baaps.org.uk/patients/procedures/8/fat_transfer_to_breast British Association Of Aesthetic Plastic Surgeons
• https://www.bapras.org.uk/public/patient-information/surgery-guides/breast-enlargement/other-information British Association of Plastic, Reconstructive and Aesthetic Surgeons
• Understand.com Understand

Our content is written by our Medical Quality Managers and Patient Care Advisers, all of who have medical backgrounds and training. Prior to publishing, all the information is reviewed by a surgeon specialised within the relevant field.