Fat transfer to the breast for breast augmentation- Do you have enough fat? 4 things to think about

I have been doing fat transfer to the breast now for almost 2 years.  I think it is a viable option for breast augmentation and enhancement, though there are limitations.  Of the keys to a successful outcome, one of the most obvious is:

DO YOU HAVE ENOUGH FAT??.

For fat transfer to the face, the volumes I need are much smaller.  But for breast augmentation and buttock augmentation, we need volume.  So here are 4 things to think about.

• What is your BMI?     BMI is not completely accurate, but it is a good starting point to help you figure out if you have some extra fat on board.  If your BMI is below 19, you likely have minimal fat.
  • For a BMI calculator, click HERE.
  • If your BMI is lower than 19, you likely don’t have much fat.  As you get higher, you likely have more for us to work with.  If your BMI is 20-24, you may still not have adequate fat.  Remember we centrifuge the fat and only expect a portion of what we transfer to survive.  For small transfers, I frequently do not think the change is worth the risks.
  • If you are low body fat percentage, you likely have less to work with.
  • If you are actively trying to lose weight, get to your goal before evaluation.  We want to transfer the fat which is most diet and exercise resistant.
  • Gaining weight just to do transfer is fraught with issues.  If you do not have a discrete pocket of fat (like your inner thigh, love handle, etc), then the weight gain goes diffusely over the body.  A diffuse fat pattern is hard to harvest.
• Is what you think “fat” really fat? Or is it loose skin?    This seems like it would be obvious, but I see many people confuse loose skin for being fat.  (Your muffin top may seem like it is due to too many muffins, but it is usually a combination of fat and loose skin.)
  • As always, please see someone for a consultation.  I, as the plastic surgeon who has done liposuction for 15 years,  can figure out what is “fat” versus what is “loose skin.”  I can also estimate how much I will be able to harvest.
  • If you have a problem area like your “outer thigh” or “love handles” this generally is good to use for fat transfer.
• How is your skin tone?  If you have cellulite or loose skin before removing fat, those dimples and wrinkles will likely get worse after liposuction.  When doing fat transfer for fat grafting I can’t use ultrasonic or laser.  When you remove fat, you are removing volume,which requires the skin to “shrink wrap” to the smaller size.
  • Liposuction for fat transfer can’t use ultrasonic or laser energy. Some of the smoothness and tightening in formal liposuction surgeries is from using these machines.  I will sometimes use energy after I have harvested to improve the liposuction result.
  • You don’t want to create an issue in a new place (like your inner thighs) when doing liposuction to get fat for transfer.  If we create a new problem, we aren’t helping you overall.
  • More age (the older you are), the more weight fluctuations you have had (pregnancy, weight changes), the more cellulite and dimpling you have, and your genetic skin tone all play factors.
• How big do you want to go?   Simply put, you need enough fat to cover the amount of change you want.
  • I have patients try on sizing implants to see how much volume they want.  (stating “a cup size,” or “I want to be a full B” is not accurate).
  • I combine your desired change in size with an evaluation of how much fat you have to harvest to figure out if you are a candidate.