Breast enhancement without implants

Not everyone who wants a change to their breasts wants an implant. There are genuine alternatives, and they achieve genuinely different things. This page sets out what each one actually does - and where it falls short.

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

First, an honest answer about implants

People ask whether breast implants are safe. No implant is risk-free, and no one can promise you a safe outcome. Anyone who gives you an unqualified yes to that question is telling you what you want to hear.

What can be said accurately: modern implants used in Australia must be included in the Australian Register of Therapeutic Goods, materials and shells have improved, and the great majority of people do well. What must also be said:

• Implants are not lifetime devices. Most people need further surgery at some stage - for rupture, capsular contracture, position change, or preference
• Capsular contracture - scar tissue tightening around the implant - can cause firmness, distortion and pain, and may need reoperation
• Rupture can occur, sometimes without symptoms, and may need imaging to detect
• Rippling, malposition and asymmetry are recognised outcomes
• Altered nipple sensation, effects on breastfeeding, and effects on mammogram interpretation
• BIA-ALCL - a rare lymphoma associated with some textured implants - and breast implant illness, a symptom cluster reported by some patients

That is not a reason to avoid implants. It is a reason to make the decision with the full picture. See preparing for breast augmentation.

Option 1: Breast lift (mastopexy)

A lift changes position and shape, not size. It removes excess skin, tightens the envelope, and repositions the nipple and areola.

Suits breasts that have lost firmness or sit low after pregnancy, breastfeeding, weight change or ageing, where you are content with the volume you have.

Does not add upper-pole fullness. If the change you want is "fuller", a lift alone will disappoint you, and a good surgeon will say so.

Costs you a permanent scar - around the areola, usually vertically to the crease, and sometimes along the crease itself. There is no scarless version. Full detail: breast lift incisions and scars.

Option 2: Fat transfer (fat grafting)

Fat is taken by liposuction from the abdomen, thighs or flanks, processed, and injected into the breast. It uses your own tissue, feels natural, and contours the donor area at the same time.

The honest limits, which are substantial:

• Modest increase only. Generally around half a cup to a cup size per session. It will not take you up several sizes.
• Not all of it survives. A significant proportion of transferred fat is reabsorbed over the first months - commonly a third to a half - and the amount varies between people. More than one session is often needed.
• You need donor fat. Very lean people are not candidates.
• Fat necrosis, oil cysts and calcifications can form. These are benign, but they can appear on a mammogram and may require further imaging or biopsy to distinguish from something else. Tell your radiographer you have had fat grafting.
• Weight change alters it. Transferred fat behaves like the fat it came from - it grows and shrinks with your weight.
• It still involves liposuction, with its own bruising, swelling, contour irregularity and recovery.

More: breast augmentation by fat transfer.

Option 3: Doing nothing

A legitimate option, and one worth naming. Breasts change with pregnancy, feeding, weight and age; that is normal, not a defect. A well-fitted bra makes more difference to how clothes sit than many people expect, and it costs a fraction of surgery with no recovery and no risk.

If what is driving the decision is how you are feeling rather than how you look, surgery tends not to fix it. See deciding not to proceed.

Choosing between them

If you want	Then
Higher position, same volume	Breast lift
A modest, natural volume increase	Fat transfer, possibly staged
A substantial volume increase	Implants - nothing else achieves it
Both lift and volume	Lift with implants, or lift with fat transfer
Correction of significant asymmetry	Depends on anatomy - see asymmetry correction

Before you book

Since 1 July 2023: a GP referral, psychological screening, at least two consultations before booking, and a cooling-off period of at least seven days for adults.

Breast surgery at Me Clinic is performed by our Specialist Plastic Surgeons (FRACS). Ask to see before and after images of patients with a similar starting point, and ask what the less-good end of your likely range looks like.

Specialist Plastic Surgeon consultation $350, including GST, as at September 2024; a written itemised quote follows. Me Clinic, 4 Burke Road, Malvern East VIC 3145. Phone 1300 852 050 or (03) 9569 3511.

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.