Breast Enlargement with Fat (Fat Transfer)

Fat transfer to the breast, also known as autologous fat grafting, uses your own fat to add volume rather than using a manufactured implant. The fat is harvested from another area of the body using liposuction, processed to remove blood and oil, then injected into the breast tissue and the layer behind it in many small parcels to maximise the chance of the fat surviving in its new location.

Some patients are drawn to fat transfer because it avoids implants altogether and uses tissue from their own body, with the additional benefit of contouring the donor site at the same time. Others use fat transfer alongside an implant or as part of a reconstructive procedure to refine shape, fill in upper pole hollowness, or soften visible implant edges. Fat transfer suits some patients well and is unsuitable for others, and the size increase achievable in a single operation is generally more modest than what’s possible with implants.

Fat transfer is most commonly used for modest increases in breast volume, for filling in small contour irregularities, for correcting upper pole hollowness that’s emerged after volume loss, or as part of a combined procedure with implants or following reconstructive surgery. It’s not generally suitable for large size increases in a single operation, because there’s a physiological limit to how much fat can be safely grafted at one time without compromising the survival of the graft.

Patients sometimes ask whether fat transfer can replace the need for implants entirely. For some patients with realistic expectations about the size change achievable, it can. For patients seeking a more substantial increase in breast volume, implants typically remain the more reliable option, and we discuss this honestly at consultation.

Suitability for fat transfer depends on several factors that come together at assessment. The most basic requirement is having enough fat in donor areas to harvest, which usually means the abdomen, flanks, thighs or back. Patients with very low body fat may not have enough donor tissue available to make the operation worthwhile. The skin and existing breast tissue need to be in a condition that supports the graft, with adequate space for the fat to settle and adequate blood supply to nourish it.

Smoking, body mass index, and overall health all factor into the assessment. Smoking in particular significantly affects fat survival and increases complication rates, and we ask patients to stop smoking well before surgery. Fat transfer isn’t right for every patient, and we’ll be honest if we don’t think you’re a candidate.

The operation has three stages, all performed in a single sitting under general anaesthesia in an accredited hospital. First, fat is harvested from the donor area using a liposuction technique that’s gentler than standard liposuction, because the fat needs to remain viable for transfer. The harvest itself produces shaping of the donor site, which some patients consider a useful side benefit of the operation.

Second, the harvested fat is processed to separate viable fat cells from blood, oil and saline. The processing technique used affects the quality of the graft and is one of the technical details that makes a difference to the outcome. Third, the processed fat is injected into the breast tissue and the layer behind it through small entry points, in many small parcels rather than one large deposit. Spreading the fat out like this maximises the chance of it surviving by ensuring each small parcel has access to a blood supply.

Operative time depends on how much volume is being transferred and how many donor sites are involved, and ranges from approximately two to four hours for most patients.

Not all of the transferred fat survives in its new location. A proportion of grafted fat is reabsorbed by the body in the months after surgery, and the amount that takes long-term varies between patients in a way that isn’t fully predictable in advance. As a result, the size increase achievable from a single fat transfer session is generally more modest than what implants can deliver, typically in the range of half to one cup size.

A second fat transfer session is often recommended to build on the result of the first, particularly in patients who tolerated the first procedure well and are looking for additional volume. We’ll discuss whether a staged approach is likely to suit your situation before any surgery is booked, so you have a clear idea of what you’re committing to.

Recovery from fat transfer involves both the breast and the donor sites at the same time, which can mean the donor sites are actually the more uncomfortable part of recovery in the first week. Bruising, swelling and tenderness in the donor area are normal and persist for one to two weeks, with compression garments worn continuously over the donor sites for several weeks to support the healing tissue and refine the contour.

Restrictions on heavy lifting and exercise apply for several weeks, and most patients are back at desk work within one to two weeks. Vigorous exercise and any activity that compresses the breasts should be avoided in the early weeks while the grafted fat is establishing a blood supply, because external pressure can compromise survival of the graft.

Recognised risks of fat transfer to the breast include:

Calcifications and fat necrosis from fat transfer can show up on mammograms or ultrasound and sometimes need to be distinguished from other findings, including findings that may be related to breast cancer. This isn’t a reason to avoid fat transfer, but it is a reason to ensure that any breast screening you have after the procedure is performed by an imaging service that knows you’ve had fat transfer, so that the findings can be interpreted in context. Continuing your regular breast screening as appropriate for your age and risk profile remains important, and your GP can advise on the right schedule.

Dr Henry Shepherd, BMed MD MS (Plast.) FRACS (Plast.) | Specialist Plastic Surgeon | AHPRA registration: MED 0001860545