When is fat grafting to the breast not a good option?

Yes, yes. I am writing a lot about fat grafting to the breast.  I have started doing cases and am excited by what I see.  As I have said before fat grafting is not new- I have done it for years to other parts of the body- I have just started to do it now to the breast.

So when is fat grafting to the breast not a good option?

• When you want to go a lot bigger. You likely can’t go from an A to a C  in one session.  Why is there a limit on the amount of fat you can move?  There is a limit on the amount of fat you can graft at one time due to the amount of space we have to graft into and just technical things.  If you are willing to do serial grafting procedures (multiple surgeries, spaced about 3 months apart) you could likely go larger.
• If you are young and/ or your breasts are small and tight AND you are not willing to do BRAVA.  BRAVA is the pre surgery breast expansion system.  It helps soften up your breasts and  open up the spaces to graft into.  If you do not do this, your tight skin will not stretch to accommodate the fat during surgery.  This tight skin will cause pressure which will cause the fat to die.  So you can do the surgery, but it just won’t be successful.  Can you get a preview of how you will look?  Dr. Khouri who champions the BRAVA system says you can’t add more fat and volume than how big you look in the BRAVA.  So the more you expand and open up the tissue ahead of doing the fat grafting, the better the fat will live and the more which will take.  Oh yes- you also need to wear the BRAVA after surgery as well.  It keeps increased blood flow and helps keep pressure off the newly transferred fat.
• If you have a strong history of breast cancer or are BRCA positive. There are new studies coming out showing radiologists can tell the difference from calcifications from breast fat grafting for cosmetic breast augmentation versus the calcifications seen from breast cancer, but if you have a strong family history, there is no reason to add issues to your cancer screening.
• You need to use BRAVA to preexpand, but you have a contraindication to it. Contraindications to BRAVA are easy scarring and hyperpigmentation, allergy to silicone, and others.
• You don’t have enough fat to graft.  Suprisingly, this is not as common as one would think- I just did fat grafting for breast augmentation on my typical skinny Bay Area woman and was still able to get enough fat for her desired size.  Should you gain weight before doing the surgery?  I am not a fan.  I think you should be the healthiest, best you.  Deferring to my favorite expert on fat grafting, Dr. Khouri does not recommend you go chow down on Ben and Jerrys to fatten up.  Why?  He believes you want to harvest the fat which is diet resistant- that way the transferred fat will survive better after transfer, even if you lose weight in the future.
• You are in the process of weight changes. Whether up or down, when your body is in flux is not a good time to do breast surgery.  You want your weight to be stable.
• You are going to have kids soon. Again, this is just another general reason not to touch the breasts.  Pregnancy and breast feeding change the breasts in a multitude of ways.  Have your babies.  Enjoy your time.  Add volume and fix what they did later.  If your timeline is years down the road, then it is okay to consider surgery now.  I will discuss the pros and cons with you.
• It is a new procedure. It is not terribly new.  Fat grafting has been gaining traction over the last decade.  But when compared to breast implants which have been around for 40 years, fat grafting for breast augmentation is the new kid on the block.  I get why this makes fat grafting a more difficult choice.  We don’t have tons of data on what it will be like 20 years down the road.  But unlike implants, the fat is your own tissue.  It is transferred to another area which is similar, as the breasts are primarily made up of fat.  It is very low tech- you are just using some simple cannulas and techniques.  I wish I could give you reassurance and statistics which had been gathered over the past 40 years, but I can’t.  Using your own fat makes sense to me.  I don’t see any glaring issues with it, and I have met with and studied those who have been doing it for 5+ years.  I have seen some fantastic results and spoken with patients who had rave reviews.  But if its newness makes you uncomfortable, I understand.

So for most of my patients, there are few reasons not to consider fat grafting.