American Society of Plastic Surgeons
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James8080
one year ago
Answered

Liposuction and transfer to the breast

My Fiancé is getting an explant of her 420cc silicone breast implants. We are going to do liposuction of her mid section and transfer the fat to her breasts. Our question is how much can we safely transfer. She weighs about 145 lbs. we have been to consults with plastic surgeons and cannot get a consistent answer. We are worried about the outcome. Any information would be great.

Procedure: Liposuction
Type: Question

Replies 8

Jacob Gerzenshtein
ASPS Surgeon
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It's not a matter of how much can be safely transferred, you can transfer more than 420 cc to match current size, it's a matter of how much is going to stay. Instant gratification is the hallmark of today's society. Unfortunately when it comes to breasts, you will likely have to stage the transfer, meaning you'll have to do a transfer from the abdomen, then maybe a transfer from the waist. This is because only a portion of what is put in (I mean fat) actually stays. You'll have to wait 4 months to determine how much fat has been retained. Generally 40-50% stays when a large amount is put in.

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Debra Johnson
ASPS Surgeon
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When you transfer fat it needs to be done in very small increments so that the tiny globules of fat are completely surrounded by living tissue that can then nourish the graft and provide blood supply. The amount of fat you can graft will depend on how thick her native breast tissue is. If she has a fair amount of her own tissue, then there is more space in which to place the fat grafts. If she had very little breast tissue then you won’t be able to graft too much at once. And even under the best conditions only about half the fat survives. So she might require more than one grafting session, separated by 4-6 months between each time.

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Aaron Stone
ASPS Surgeon

There are actually a few questions that should be asked. Can you get the equivalent of 840cc of fat out of a 145 pound woman? Unless she is very short the answer is no. Will she be happy with the amount of fat they can find to inject knowing that survival of that fat will likely be between 40 and 70%? Only she can answer that. As for safe transfer that will not cause problems that depends on the surgical technique. The surgeon should be able to clearly state how he/she is going to ensure the transferred fat is in sufficiently small aliquots to maximize survival and minimize problems. If the aliquots are too large and do not survive you are headed for problems. Finally, is it shape or size that she is after. Fat grafting is better for shape improvement than size enhancement. Implants are better for size enlargement.

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J. Gerald Minniti
ASPS Surgeon

There are many variables that affect fat graft survival, but a sufficient recipient site is perhaps the most important. This mean healthy, unscarred recipient tissue with sufficient volume to support the graft. There is no doubt that pre-expansion using a vacuum ‘bra’ can facilitate graft survival (noogleberry.com, a British company that specializes in adult toys, but has a fairly good vacuum bras). An in person consultation with an expert in fat grafting will give you an estimate of how much fat can be grafted. I can tell you that it is very unlikely that her implant volume can be replaced with fat.

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Nelson Castillo

Thank you for sharing your excellent question. For most patients the concern is not how much can be placed, as the skin of the breast can expand significantly, especially en lieu of the removal of implant material. That said the greater skill comes in placing enough to have a good retention of the fat, with a staged procedure most likely needed if a similar look as the 420cc implant is desired. Hope this helps.

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William Rosenblatt
ASPS Surgeon

I am not a great fan of fat in the breasts. Implants are the gold standard. From my point of view the fat goes away, can leave calcified lumps which can mimic cancer on X rays and gives less than adequate results. It works well as and adjunct to reconstruction, but I don't believe it replaces an augmentation with a silicone or saline implant.

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Jon Ver Halen
ASPS Surgeon
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Hello and thank you for your excellent question. In general, it is possible to only go up about 1 cup size with each round of fat transfer. I think that expecting to be able to replace the entire breast implant volume with fat, in one setting, is overly ambitious. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate for that procedure. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. Good luck!

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Lori Cherup
ASPS Surgeon
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Why are you doing this? In an effort to look more natural, less augmented? Is there something concerning with her current implants? If her breast tissue has been compressed by her implants, after an explantation there is a natural filling out of volume and shrinkage of skin dimensions that the breast undergoes. It is unlikely that her 420cc volume can be replaced on each side with her own fat, and the fat survive. It is unlikely that her breasts will have any superior fullness. Another course you could take is have the explantation, and then do a mastopexy and fat grafting at a second surgery. I think the final result will be more desirable, and look more like a natural version of her augmented self.

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