How to choose between an implant and fat transfer to the breast for breast augmentation.

If you are contemplating breast enlargement (augmentation) then you must make a choice between using an artificial breast implant or using your own fat (autologous fat transfer).  But how do you make that choice?  Here are some guidelines that will help.

Some women don’t want a foreign implant placed under their breast under any circumstances. You may always look after your body and be careful about the food you eat. You may be concerned about the damage implants may do to your body and you realise that breast implants do not last a lifetime. It is therefore likely that further surgery will be required at some stage.  I would explain that saline implants are a lot safer and last a lot longer than silicone gel implants but if you are still adamant that you don’t want anything foreign placed into your body, then the choice is easy:-

You should have breast enlargement by autologous fat transfer. Whatever fat is available is harvested and, after preparation, grafted into the breast.  Usually, at least 1 cup size breast augmentation is achievable – even in thin women.  If more fat is available then it may be possible to achieve even a 2 cup size increase in breast volume.  But remember that the fat cells transferred are living tissue and therefore the breast will increase and decrease in size with weight fluctuations.  Another consideration is that breast size is sensitive to hormone levels (specifically oestrogen) and therefore if, for example, you were to stop taking an oestrogen containing oral contraceptive, then your breasts could decrease in size due to involution of your breast tissue – even though all the fat has survived.

A secondary benefit of breast augmentation by autologous fat transfer is that liposuction is required to harvest the fat so that your hips and thighs will decrease in size.

For some women, the increase in breast size is the overriding concern.  So if you would like at least a 2 cup size increase in breast size then this may not be achievable by autologous fat transfer and breast implants may be the only solution.  This also applies to women who want a more stylised look with fullness in the upper pole of the breasts even when not wearing a bra.  Only a large breast implant can achieve this look.  Once a decision is made to use breast implants then the discussion revolves around safety and longevity.  My own preferences (after having inserted over 6000 breast implants!), in order of importance, are:-

  • to place the implants behind the muscle where they are least visible,
  • to lower the inframammary fold in order to prevent excessive upper pole fullness,
  • to use a smooth-walled implant (as textured implants are associated with a rare but potentially fatal condition known as Anaplastic Large Cell Lymphoma (ALCL)) and
  • to use saline-filled implants rather than silicone gel-filled implants as they are just as soft, last at least twice as long and are far easier to remove and replace in the event of rupture.

It is also possible to use a combination of your own fat and an implant.  For example, if an implant has been placed into a very thin person then the lack of soft tissue coverage can result in the implant being visible and palpable (this is less of a concern if the implant has been placed behind the muscle).  In these cases placing some fat around the implants can greatly improve the result. This is known as a Hybrid Augmentation.

Similarly, if a patient has had breast augmentation by autologous fat transfer but is disappointed by the lack of volume increase, then the options are to graft some more fat into the breasts or, alternatively, to use an implant.

Because of all these choices, the most important step for a women contemplating breast augmentation is to have a comprehensive consultation with a surgeon experienced in all the above techniques.