Breast augmentation with fat transfer

Breast fat transfer - also known as breast fat grafting, fat augmentation or autologous fat transfer - is an option for increasing breast size without implants. Fat tissue is removed from elsewhere on the body by liposuction and grafted into the breast area.

Me Clinic has been performing fat transfer to the breast since the 1980s, and has over 35 years of cosmetic surgery experience. The effectiveness of the procedure varies between individuals.

How the procedure works

The procedure has two stages performed in the same operation:

1. Harvesting. Fat tissue is removed from a donor area by liposuction - commonly the buttocks, stomach or thighs. A thin tube called a cannula, attached to a suction device, draws the fat out through a small incision.
2. Grafting. The harvested fat is processed and then injected into the breast area to increase size and refine contour.

Fat occurs naturally in the breast, so grafted fat adds to the fat already present. Because the tissue is the patient's own, there is no foreign material involved and no implant to replace later.

The procedure is performed under anaesthesia; whether local or general depends on the extent of treatment and your circumstances. Major surgery is performed under general anaesthesia in an accredited private hospital.

Fat absorption and how long results last

This is the most important thing to understand about fat transfer. Some of the grafted fat is absorbed by the body. How much is absorbed cannot be determined in advance for any individual patient, and this is the main factor determining how long the result lasts.

Some patients retain volume long term; others experience a reduction in breast volume as fat is absorbed. Outcomes vary significantly between individuals, and further procedures may be required if you want to maintain or increase volume.

Because absorption is unpredictable, fat transfer generally produces a more modest and less predictable size increase than implants. It is better suited to a subtle change than a substantial one.

Fat transfer compared with implants

The two approaches trade off differently:

• Predictability. Implants give a defined, predictable volume increase. Fat transfer does not, because absorption varies.
• Size increase. Implants can achieve a larger increase. Fat transfer is generally suited to a smaller change.
• Foreign material. Implants are a manufactured device with their own risks, including capsular contracture, rupture and BIA-ALCL. Fat transfer uses your own tissue.
• Longevity. Implants do not last a lifetime and replacement is commonly considered around the ten-year mark. Grafted fat that survives is permanent, but how much survives varies.
• Donor site. Fat transfer also involves liposuction of a donor area, with its own recovery and risks. Implants do not.
• Feel. Fat transfer uses the patient's own tissue, which is often described as feeling more natural.

Your surgeon will discuss which is more appropriate for your anatomy and what you are seeking.

Combining with other procedures

Fat transfer necessarily includes liposuction of the donor area, so patients often treat that as a dual benefit - contouring the donor site while adding volume to the breast.

It can also be combined with implants in a hybrid breast augmentation, where the implant provides the main structure and fat transfer softens transitions and refines contour. Hybrid augmentation surgeon's fees start at $16,500.

Suitability

A good candidate is physically and mentally healthy with realistic expectations, and has sufficient fat at a suitable donor site to harvest. If you are very lean there may not be enough fat available to achieve a meaningful increase.

A stable weight matters, since grafted fat behaves like the fat it came from - significant weight loss after the procedure can reduce breast volume. Smokers have an increased risk of complications from any surgery, and smoking can affect the survival of grafted fat.

Preparing for surgery

• Provide your full medical history, including medications, allergies and previous operations.
• Stop smoking well in advance, as nicotine inhibits recovery and affects graft survival.
• Avoid aspirin, anti-inflammatory drugs and herbal supplements, which can increase bleeding.
• Arrange for someone to drive you home and stay with you for at least 24 hours.
• Prepare a comfortable area at home for your recovery.

Recovery

The first 24 hours. You may feel drowsy from the anaesthetic. You cannot drive yourself - you need someone to drive you home and stay with you overnight, and you should rest that evening. An after-hours direct number is provided in case you have questions or concerns.

The first week. You return to the clinic for your first post-operative check the next day or within a few days. Expect swelling at both the donor site and the breast, which settles gradually. A compression garment is generally required for the liposuction donor area. Pain is managed with prescribed medication.

Weeks two to six. Most people return to work after two to three weeks. Strenuous activity is generally avoided for the first two to three weeks, with gradual return afterwards. Domestic flights are usually fine at around two weeks.

Six weeks onward. Most people are back to their usual level of exercise by around six weeks. Wait six to eight weeks before swimming and before international or long-haul flights.

Three to six months. The final result becomes clearer over the following months as swelling resolves and the body absorbs a portion of the grafted fat. Do not judge the result in the first weeks.

Follow-up. Most patients are seen at seven to ten days, then at six to eight weeks, three months, six months and twelve months.

Wound care and signs of a problem

Clean your hands before touching the wound area. Clean gently with mild saline or as directed, pat rather than scrub, keep the area dry, and change dressings as advised. Do not apply ointments or creams unless prescribed.

Contact your medical team immediately if you notice increased redness or warmth around the wound, persistent or worsening pain, discharge or pus, a foul smell, or fever and chills.

Risks and complications

All surgical procedures carry risks and potential complications. Fat transfer involves both a liposuction component and a grafting component, each with its own risks.

• Unpredictable absorption - the volume increase may be less than hoped, or reduce over time, and further procedures may be needed.
• Fat necrosis - grafted fat that does not establish a blood supply can die, sometimes forming firm lumps or oil cysts that may need investigation or treatment.
• Calcification - areas of fat necrosis can calcify, which may complicate the reading of future mammograms. Tell any radiologist that you have had fat transfer to the breast.
• Asymmetry - the breasts may not be perfectly symmetrical afterwards, particularly if absorption differs between sides.
• Infection, bleeding, bruising and swelling at both the donor site and the breast.
• Contour irregularity at the donor site from the liposuction component.
• Changes in breast sensation.

General surgical risks include pain, scarring, seroma, haematoma, nerve damage, anaesthesia complications, blood clots (DVT and pulmonary embolism), psychological impact, and unsatisfactory results. Liposuction specifically can be traumatic for internal organs, and visceral perforation, while rare, can occur.

Risks are discussed with you in detail during the consultation process, and you are given written information to take home. Please read our information on the risks and complications of cosmetic surgery before proceeding.

Outcomes vary depending on individual anatomy and the rate at which your body absorbs the grafted fat. Individual results may vary.

Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.

Referral and cooling-off period

Since 1 July 2023, all patients are required to have a GP referral before seeing a plastic surgeon or doctor about cosmetic surgery. A valid referral is also needed if you wish to claim a Medicare rebate on medically essential surgery.

For any cosmetic surgery there is a compulsory one-week cooling-off period after your second consultation before surgery can be booked.

Costs

Cost is tailored to each patient and varies with the complexity of the procedure, the extent of liposuction required at the donor site, anaesthesia and aftercare. A consultation is required to determine what is involved in your case, after which you receive a quote.

As at September 2024 and including GST, a consultation with a Specialist Plastic Surgeon is $350. For reference, body liposuction ranges from $6,000 to $8,000 per hour, and hybrid breast augmentation surgeon's fees start at $16,500.

Payment for major surgery is due four weeks before the procedure. Cash, EFTPOS, direct deposit and major credit cards are accepted, with surcharges applying to cards. Independent medical finance companies are available.

Medicare and health insurance

Fat transfer performed for cosmetic reasons is not covered by Medicare or private health insurance. Where it forms part of breast reconstruction following mastectomy, a Medicare item number may apply. Confirm current item numbers and criteria with your surgeon and on MBS Online. Me Clinic is not a no-gap provider, so a significant out-of-pocket payment remains even where cover applies.

Where surgery is performed

Me Clinic surgeons operate at accredited private hospitals around Melbourne, including Masada Private Hospital (St Kilda East), Epworth Geelong (Waurn Ponds), St Vincent's Werribee, Sir John Monash Private Hospital (Clayton), Peninsula Private Hospital (Langwarrin) and Linacre Private Hospital (Hampton).

Related procedures

See breast enhancement without implants, augmentation with implants, hybrid breast augmentation, or all breast surgery procedures.