Most people will have adequate fat stores in certain areas of their body to enhance their breasts, even if they are slender.

A good candidate for breast fat transfer is someone who would like a subtle breast augmentation without large scars and does not like the idea of having breast implants. As well, people seeking liposuction and breast augmentation, can use the removed fat to augment their breasts or buttocks at the same time.

A small number of patients will be too thin to achieve reasonable results. If you feel you could be in this category, you are welcome to email some details of your weight and photographs for assessment of your suitability prior to booking a consultation to simone@drsimonematousek.com

People who have had problems with breast implants such as hardening or capsular contracture or simply do not wish to have multiple exchanges of implants during their lifetime.

Patients who feel their body is disproportionate in one area compared to another as fat grafting works to redistribute fat. Once grafted, the fat behaves like living fat from the grafted area.

Patients with breast asymmetry may not want to have breast implants, especially if one breast is an adequate size and shape. It is rare to be able to achieve a good correction of breast asymmetry with an implant on the smaller side only. A breast implant always sits higher than the non implanted side, therefore the majority of patients who have breast asymmetry corrected with implants end up having one in both breasts.

Patients who are in their teens with a constricted or tuberous breast who have severe asymmetry in clothing and swimwear may benefit from early release and correction with breast fat grafting without committing to a big decision such as breast implants at such a young age.

Tuberous breasts typically present with not only constriction of the breast (especially the lower pole) and a high tight inframammary fold, and usually some breast asymmetry. Fat transfer helps maintain release of the tight fold and lower pole constriction and assist with maintaining this correction much better than an open release alone with reduced rates of double bubble deformity. This is where tight tissues springs back to their original position following release and indent the implant across its surface creating the appearance of two folds.  Tissue lack in the lower pole of the breast and cleavage area and precise asymmetry correction is helped with a fat transfer even if breast implants are used.

Read more here about tuberous and constricted breasts

Usually if people are able to grab a handful above the underwear line and two handfuls below the belly button in the stomach area area a rough guide.

Elite athletes typically have minimal fat stores and are constantly replacing fat with muscle and tend to not have great success with fat transfer.

People who fluctuate a lot in weight are not suitable candidates for fat transfer until they achieve a stable weight.

-Small scars less than 1cm, usually hidden in body creases (typically two  per liposuction site, two in the inframammary breast crease and one in the armpit)

-A breast implant can always be felt and does not feel natural, fat grafting blends in and feels like a natural breast

-Ability to reshape breasts that are constricted or tuberous (a congenital breast condition) with a release with minimal scarring and with the constriction less likely to recur with interposed fat

-Ability to match asymmetry much more precisely than with implants if only one breast requires surgery

-Fat grafting generally allows for a faster recovery (no specific exercise or movement restrictions);recovery is limited only by pain which varies from individual to individual. A recovery from breast implants involves restrictions to upper body exercise for some time.

-Fat is removed from areas where it may be disproportionately deposited or difficult to lose through diet and exercise 

-No need for removal or exchange of devices down the track (an implant is not a lifetime device).

Although a fat graft may not give the same volume as an implant in one session, and is more costly as it is more time consuming, it has the advantage of not requiring removal and replacement in the future which is eventually required  for breast implants which have an average lifespan of 10 years.

Dr Simone Matousek still performs many breast augmentations with implants alone. Current breast implants have improved and are much softer and available in many shapes and sizes. These are still the best option for very slender people who simply do not have adequate fat stores. People wanting a very large size with one operation or those requiring a significant degree of breast lift may also be more suitable for implants.

Ultimately it is up to the patient to weigh up the pros and cons of breast fat grafting vs breast implants. Many patients may be suitable for either and it is up to them to work out why one may work better for them. Dr Simone can advise and present you with the options and show you before and afters which are similar to your body type to help you decide.

The advantage of seeing a surgeon who has extensive experience in both fat grafting and breast implants is that you can be given an outline of what is involved with either procedure and a recommendation as to which is the best choice for you. 

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It is possible to perform a small fat transfer during mastopexy or breast lift, however, even small amounts of fat do not survive as well when performed during mastopexy. This is because a mastopexy reduces the blood supply to the area due to the cuts made to lift and reposition the breast tissue.

However, to try and do a large volume fat transfer and breast lift is not recommended. During a mastopexy, tissues are maximally tightened and lifted to achieve the greatest possible degree of lift. Tight tissues do not provide a good fat graft bed as the looser the tissues, the better the fat survival.

Generally it is better to perform mastopexy first and then fat graft later.  Many patients will be happy with the tissue rearrangement and lift provided by a mastopexy alone and may not need a subsequent fat graft so in most cases the breast lift is done first. This is why a breast lift is also known as an auto-augmentation, as this tissue rearrangement makes the breast appear larger.

Fat graft is soft and does not have the lifting capacity of a breast implant. Breast implants also have limited lifting capacity and neither breast implants nor fat grafting are suitable for correction of significant ptosis.

Whilst the volume of a fat graft may have a subtle lifting effect on the breasts, for patients with significant ptosis (ie nipple-areola sitting well below the breast crease) a fat transfer will not give an adequate lift. In a breast that is significantly stretched out and where the nipple-areola sits low, fat grafting is not able to achieve adequate reshaping and will probably not lead to desirable aesthetic results without the combination of a breast lift.

It is possible to perform a small fat transfer during mastopexy or breast lift, however, even small amounts of fat do not survive as well when performed during mastopexy. This is because a mastopexy reduces the blood supply to the area due to the cuts made to lift and reposition the breast tissue.

However, to try and do a large volume fat transfer and breast lift is not recommended. During a mastopexy, tissues are maximally tightened and lifted to achieve the greatest possible degree of lift. Tight tissues do not provide a good fat graft bed as the looser the tissues, the better the fat survival.

Generally it is better to perform mastopexy first and then fat graft later.  Many patients will be happy with the tissue rearrangement and lift provided by a mastopexy alone and may not need a subsequent fat graft so in most cases the breast lift is done first. This is why a breast lift is also known as an auto-augmentation, as this tissue rearrangement makes the breast appear larger.

Fat graft is soft and does not have the lifting capacity of a breast implant. Breast implants also have limited lifting capacity and neither breast implants nor fat grafting are suitable for correction of significant ptosis.

Whilst the volume of a fat graft may have a subtle lifting effect on the breasts, for patients with significant ptosis (ie nipple-areola sitting well below the breast crease) a fat transfer will not give an adequate lift. In a breast that is significantly stretched out and where the nipple-areola sits low, fat grafting is not able to achieve adequate reshaping and will probably not lead to desirable aesthetic results without the combination of a breast lift.

Early on when Dr Simone was one of the first surgeons in Australia performing fat grafting many patients were misinformed that it was dangerous, did not work or that there was no insurance cover to perform the surgery. This was despite it being standard practice in Europe and the United States. Breast cancer surgeons have since adopted the technique which has been demonstrated to be perfectly safe following lumpectomy, with long term studies showing no increased cancer risk. Here is a  publication on the safety of fat grafting showing no increased risk of breast cancer in a peer-reviewed journal, Plastic and reconstructive surgery. Lipofilling does not increase breast cancer recurrence risk

There is still much misinformation about fat grafting, particularly in Australia where the technique is still not as widely practised as it is elsewhere in the world. Much of this comes from people who have little or no experience with the technique.

In fact the only evidence for a cancer associated with breast augmentation is a very rare cancer (BIA-ALCL) related to breast augmentation with breast implants.

Although there is no evidence that breast fat transfer increases the risk of breast cancer breast screening is done to ensure a clear picture of the breast is gained prior to surgery. 

A pre-operative screening MRI is required for all patients and mammogram or ultrasound (depending on age).  This allows there to be a comparison in the event of any changes to the breast following fat transfer. 

Scientific studies have shown it is easy to identify any concerning lumps in the breast compared to grafted fat. In fact, more abnormal areas due to fat necrosis are found after breast reduction surgery or breast lifting  (common standard plastic surgery procedures) compared with fat grafting. Here is a link to an article in a scientific peer-reviewed journal demonstrating this Mammographic changes after fat transfer to the breast compared with changes after breast reduction: a blinded study.

Fat grafting was rejected by plastic surgeon in the 1980s and earlier as the techniques used then meant the fat ended up lumpy and died. Refinements in how the fat is harvested and handled have led to improved take results and much lower rates of fat necrosis (or death of the fat).

The way the fat is harvested and handled after removal is paramount in achieving good take rates. It is known the fat needs to be harvested as atraumatically as possible, the blood, oil and fluid needs to be removed prior to injection through centrifuging and then it needs to be grafted in tiny amounts (micro-grafts) throughout the breasts.

In order to ensure your fat transfer surgeon has adequate experience, ask how many years they have been performing large v0lume fat transfer and where they learned the technique. Dr Simone is one of the most experienced fat transfer surgeons in Australia and has spent several years perfecting her technique.

Machines that select out stem cells is an ongoing area of fat grafting research, however, these machines have never gained widespread use in breast fat grafting. Fat itself is a rich source of  stem cells, and by centrifuging it, the amount of stem cells does increase in the injected fat. However, currently there insufficient evidence of the safety and efficacy of  fat augmented with large numbers of stem cells by the use of such devices. Most published clinical trials and safety data regarding fat grafting have been done on patients with centrifuged fat, not with stem cell augmented fat. The current method of fat grafting achieves very good results, without needing to do this. No other experienced fat grafting pioneers have adopted such devices in their practices. 

If people are calling a procedure a “stem-cell fat graft” it usually just means a standard fat graft using a centrifuge. In limited experimental centres overseas, they may in fact be using fat that is truly enhanced with a stem cell device.

There is no evidence that platelet rich plasma improves take rates in large volume fat grafting of the breast or buttock. 

Many patients are happy with the modest augmentation achieved with a single fat transfer.

People wanting a large breast augmentation or for breast reconstruction after mastectomy (especially those who have had radiotherapy) will need more than one session.

Constricted or tuberous breasts usually require more than one session as the tissue are abnormally tight and difficult to release and expand adequately with one session.

Some procedures need to be staged (ie a breast lift or mastopexy and breast implant removal) followed by a fat transfer.

The earliest a second fat graft can be performed is at 3 months post the previous fat transfer session. Usually giving the tissues a bit more time to relax is better, and waiting until the 6 months mark at least tends to be better.  

If the same liposuction harvest site is to be used, it is more ideal to wait six to twelve months so it is fully settled.

Current studies suggest with newer techniques of handling the fat, it will last provided a stable weight is maintained and there are no major hormonal changes.

Large changes in weight will affect the results as the breast fat graft once taken behaves like living fat in the rest of the body.  Therefore if weight is gained post-surgery the fat grafted breasts will enlarge; if it is lost, the breast size will reduce.

If patients are planning to lose weight, this should be done prior to surgery.

There is no point gaining weight before surgery as in most people who maintain a relatively stable weight throughout their life, it is likely to gravitate back to the original weight post-surgery, and then volume will be lost from the breasts.

Breast expansion devices have been used to improve results in fat grafting and have significant evidence to show they do improve fat graft take. They are useful in tight breasts, smaller breasts and mastectomies.  They require commitment to wearing the device as instructed.

The first such device was the BRAVA, the Breast Enhancement and Shaping System, invented by Dr Roger Khouri whom Dr Simone Matousek has visited and originally learned fat grafting from.

This device has been superseded by a newer device, the EVE, which allows for more rapid expansion. The disadvantages of the original device were prolonged expansion times and skin sensitivity issues which has been addressed with the newer device.

The EVE is currently not available in Australia, however, more information about this device can be found here.

Making sure you are a stable weight prior to surgery is extremely important. You should be at your ideal weight or slightly less. This way, if there is slight weight gain post surgery, the graft will take better and end up growing.

Exercise habits should be stable and there should be no major plans to drastically increase this following surgery as this risks fat graft loss.

Stability in exercise and diet are essential prior to a fat graft.

Unless you are permanently planning to remain at this increased weight for good, this is not really a good solution to inadequate fat stores. Most patients who are naturally slender will gravitate back to their lighter weight and risk losing the fat graft when this happens.

Eating more in the immediate post-operative period is helpful in maximising take.