Breast Implants vs Fat Transfer, which is best for you?
To increase breast volume, the use of breast implants is the most common way ever since the introduction of silicone implants in the 60s. The quality of the breast implants has improved over the years and the silicone inside the implants has changed from the liquid form to the more cohesive gel. To further improve the feel of the implant/ less rippling an alternative can be achieved by using saline solution but is still a less popular option. This may be because an overfilled saline implant is definitely harder and an underfilled one will cause more rippling. With time, saline implants will also slowly deflate.
Problems with Breast Implants:
Breast implants come in different volumes and shapes and in general, volume increment in a single surgical setting is limited by skin tone, footprint of the breast and shape of the patient. Patient wishes are important but excessive increase in volume can lead to symmastia, lateral protrusion and fake appearance.
Breast implants are not without problems and it will need to be changed at certain times due to risk of hardening and rupture. More recently, Anaplastic large cell lymphoma and breast implant illness, even though not both uncommon, have discouraged some patients from having breast implant surgery.
An alternative using fat transfer (lipomodelling)
An alternative option for breast volume augmentation is autologous fat transfer or lipomodelling. Using liposuction technique, fat is harvested from the patient’s abdomen, thigh and areas with excess deposition. Normally with liposuction, the fat is discarded. With lipomodelling, the fat is collected in a container, washed and cleaned and injected into the breast for volume augmentation. Immediately after surgery, the breast will look bigger than expected due to swelling and fluid. As the swelling settles and the fat regains its blood supply, the increment in breast volume will be permanent. Like normal tissue, weight and hormonal changes along with aging will affect the breast size. In order to optimise the revascularization of the fat, excess volume of fat injection is not recommended as more volume is likely to be resorb during the recovery process. Cup size increment is limited using lipomodelling. For those patients who would like a large volume increase, implants remain the best option.
So, why have fat transfer instead of implant augmentation if the volume increment is limited per surgery?
This is a very good question and overall, implant augmentation is still more popular than fat transfer and the result is more predictable in volume increment. Fat transfer is not for everyone Patients who would be interested in fat transfer currently are those that have some excess fat elsewhere they would like to remove and have small augmentation / those who have implants and would like them removed but still have some volume / or those that would like a smaller implants with the addition of fat to contour the shape of the breast- this particular technique is called hybrid breast augmentation and is gaining popularity.
Are there any issues with fat transfer?
Well, more surgical time is needed as fat has to be harvested. There will be more initial discomfort due to bruising, swelling associated with the liposuction.
After the initial period, the breast volume will decrease with some loss of the swelling and fatty tissue. It may not be perfectly symmetrical due to variable fat survival and a secondary smaller surgery may be required. There may be some transient pain and some people may notice small palpable soft lump like oil cysts which is not harmful. With these issues in mind, the gain of fat transfer means there is no breast implant needed and no future exchange surgery required.
Both breast implants augmentation and fat transfer augmentation are well accepted techniques and both have their advantages and disadvantages. It is important to have a full consultation with your plastic surgeon and the end result you would like to achieve.