Surgical implants vs fat transfer vs both – how to ‘naturally’ reshape breasts

With news that more of us are looking to ‘plump up the volume’ with fat transfer injections rather than surgical breast implants, comparethetreatment expert and consultant plastic, reconstructive and aesthetic surgeon, Fulvio Urso-Baiarda, weighs up the pros and cons of both.

Some experts believe that this desire is thanks to a boost in the number of women who desire a more natural-looking enhancement, with smoother, less invasive routes to shapelier breasts.

But we should all understand that the results from surgical implants differ greatly to fat transfer procedures.

The first thing to mention is that both fat injection and implant breast augmentation are surgical procedures done in an operating theatre, and they both give permanent results.

With implants you can select a precise volume and achieve it in one go, whereas after fat grafting some of the volume is lost; I usually quote one-third early loss of volume, the rest being permanent.

However, composite breast augmentation is the use of implants and fat together – but more on that later.

Limits of fat transfer

There are a couple of differences between the two. With fat transfer there is a limit to how much volume increase can be achieved.

Fat cells need to be deposited and surrounded by healthy breast tissue in order to pick up a blood supply and survive for the long term; if too much is injected and it isn't spaced out well, then that simply results in greater early loss of volume and no actual benefit.

Indeed, it could be worse than that – leading to hard lumps and cysts. This limits the volume increase that can be achieved – a rough rule of thumb is 1-2 cup sizes with fat grafting. Conversely it's not unusual to exceed this easily with breast implants. However fat grafting can be repeated, so it's possible to achieve greater size increases gradually.

Pros of fat transfer

Another difference is in obtaining projection, or how far the breasts stick out. Implants can do this very well because the structure of the implant can deform the rest of the breast in whatever shape you choose for it, whereas fat graft does this less well because it doesn’t have its own shape and structure to impose on the breast.

But, a huge advantage of fat grafting is that there are no implants! This means implant related risks, like rippling or capsule formation, are totally avoided. You also get to choose where the fat is taken from.

Fat should always produce a natural look. It’s quite difficult to produce an unnatural result with fat. That said, implants can produce very natural results, too, if that’s what you ask for – but that shouldn't really be the deciding factor.

If you want a small volume increase and hate the idea of implants, then fat grafting may be for you.

If you want to achieve a large volume increase with high projection at one stage then you almost certainly need implants.

Pricing

In the short term, fat grafting works out a bit less expensive for one stage because there is no implant cost to factor in, even with the costs of the fat grafting equipment which is generally single use.

On the other hand, if you need several stages, fat grafting works out more expensive in the short term.

In the long term though, fat grafting almost always works out cheaper, because most women with breast implants will have more surgery in the future, to exchange them, address a capsule, remove them or some other adjustment.

Fat ages naturally so if you gain or lose weight so would your breasts, and ageing will take place more normally. You should not really need to have further surgery.

Composite breast augmentation

Composite breast augmentation is really interesting.

Traditionally, women asking for a natural-looking breast enlargement with reasonably large implants were often advised to have teardrop shaped implants for a more natural shape, placed under the muscle to conceal the implant better.

This can produce superb results but has its own disadvantages. Firstly, any implant can rotate, but if a teardrop implant rotates it can create a strange-looking breast, whereas if a round one rotates, it doesn’t matter, as it looks the same any way up. Secondly, placing an implant under the muscle means powerful arm movements can cause a breast to flatten, which can be embarrassing in the gym!

Composite breast augmentation is a way of achieving natural-looking results without those disadvantages. A round implant can be used combined with fat graft at the top of the breast to ‘anatomise’ it (make it look like a teardrop implant).

Additionally, instead of placing the implant under muscle to conceal it, the overlying breast can be thickened with fat graft. The result is a very natural appearance –without the risk of movement deformity or problematic rotation.