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Dr Tim Neavin
Surgery with Symmetry
Dr Tim Neavin

Fat Transfer

The fat transfer breast augmentation surgical method has gained popularity in the last several years.  And for good reason. A breast augmentation through fat transfer is a very safe surgery that can enlarge breasts without the use of breast implants.  While breast augmentation with saline or silicone implants are predictable and safe, some patients prefer to avoid the addition of any foreign materials into the body.  However, not all patients are good candidates for a breast fat transfer.  And the results of fat transfer are less predictable than using implants.  To learn more about the surgery, risk, it’s benefits, and ideal surgical candidates, keep reading.

Before and After Photos

Breast Augmentation via Fat Transfer

Liposuction is performed in areas of excess fat deposit such as the abdomen, waist, flanks, or arms, then injected into the breast to add volume. The result is improved body contour and larger breasts. This means, of course, that patients must have sufficient body fat to adequately fill the breasts to their desired size. How much fat does one need? Well, that depends on the desired increase in cup size. But as a general rule, one needs at least 100 cc of fat per breast to see a noticeable difference in size since not all of the fat transferred will survive. This principle is elaborated on below.

After the fat is collected from liposuction, it is filtered to eliminate some of the fluid that was injected to anesthetize and reduce bleeding in the area. Fat is then injected in multiple layers with a blunt cannula from a few access sites on the breast.

After surgery, the breasts are wrapped and a garment is placed to combat the swelling from liposuction.


Proper patient selection is critically important to ensure good outcomes. The plastic surgeon must consider not only the donor site potential (areas of liposuction), but also the recipient site (the breasts).

The donor site must be of sufficient fat to fill the breasts to a desired size. One way to assess desired size is to use breast implants in the office under sport bras. While this is not an exact correlation since not all of the fat transferred will survive, it helps determine what is achievable and what is not achievable. In some cases, it may be that more than one surgery may be required to enlarge the breasts to a desired size.

In patients who do not have adequate body fat, the option of breast augmentation with implants is discussed. Patients are reassured that saline and smooth silicone gel implants are safe and provide very predictable results. And, a third option is discussed: hybrid breast augmentation with both implant and fat. This is discussed further below.

The plastic surgeon must evaluate the recipient site (the breasts) to determine how much fat can be safely transferred. While it is tempting for patients to request to be injected with as much fat that can be removed, this isn’t always a good idea. Because each fat cell must receive blood and oxygen within the tissues it is injected, overcrowding a breast with too much fat can overwhelm the tissues leading to dead fat, nodule formation, or infection.

It is safe to say that women with small breasts such as an A cup or small B cup will not wake up from surgery with D cups or double D cups. To achieve such a large volume increase, more than one surgery may be required. This is an important point that must be understood to avoid disappointing outcomes. And this is one of the major limitations that exists with fat transfer that does not exist with implant based augmentation.


The main benefit from breast augmentation using fat is that one avoids the use of prosthetics and the associated risks attributed to implant based breast augmentation.  While implant based augmentation is very safe, there are risks of the implant moving leading to implant malposition, the tissue around the implant hardening called capsular contracture, breast implant infection leading to removal of the implant, hematoma from breast augmentation surgery, animation deformity from muscle contraction moving the implant, breast implant rupture, and bottoming out.

Another added benefit from fat transfer to the breast is that fat is removed from areas where they patient desires to be thinner, namely the abdomen, waist, love handles, back, and arms. 

Additional benefits from a fat transfer breast augmentation include:

  • Fat is softer and more natural feeling than breast implants.
  • One avoids larger scars.
  • There is no risk of implant visibility (rippling).


Many of the disadvantages of fat have been addressed above.  Here is a list of the most common problems associated with breast augmentation using fat:

  • One may not have enough fat
  • One may not be able to achieve the desired size increase which may be based on the amount of fat and the current size of the breast
  • Results aren’t as predictable as with implant based augmentation since not all of the fat willsurvive
  • It may take more than one surgery to achieve the desired size
  • It may be more challenging to correct for size mismatches between breasts since fat survival is unpredictable
  • Fat cyst or nodular formation (more on this below)
  • Possible interference with mammography (more on this below)
  • Added costs (generally speaking, the surgery takes longer than breast augmentation with implants and costs more money
  • Added morbidity and recovery due to the need for liposuction
  • Often less perkiness or breast roundness than implant based augmentation
  • Large increases in breast size may only be achieved through multiple surgeries of the use of pre-expansion (below)

Hybrid Fat Transfer

One of the latest trends in plastic surgery, particularly in Brazil, has been the use of fat transfer along with breast augmentation.  This is commonly referred to as hybrid breast augmentation or composite breast augmentation.  The idea of adding fat to an implant based augmentation is to volumize certain areas of the breast to enhance the results.  Commonly, more cleavage can be added or more upper breast fullness can be produced with the addition of fat transfer.

Hybrid breast augmentation is most commonly performed with breast lift (mastopexy) since the tissues in this subset of women have more laxity than those that already have perky breasts.  The advantage of fat addition is to create more fullness above the breast implant that often cannot be improved for long term with just lift and implant.

In women who already have breast implants and desire more cleavage, larger size, or more fullness above the implant, fat transfer may prove to be a superior surgery than removal and replacement of breast implants.


One of the major limitations to breast augmentation with fat is that there is only so much room in the breast to accept injected fat — and still provide an environment for the transferred cells to live and thrive.

The idea of pre-expansion using Brava® was pioneered by Dr. Khouri. The technique uses gentle negative pressure from the use of devices placed over the breast for a several weeks leading up to surgery to “prime” the tissue for fat transfer. While the idea isn’t necessarily new, the resurgence of breast augmentation with fat transfer has generated newfound interest in this methodology. To date, there is not a lot of literature on the topic, but recent studies show that pre-expansion breast augmentation with fat is safe and can prime the breast for larger volume transfers with (probably) improved fat cell survival.

Of course the main disadvantage with this procedure is the difficulty with being complaint with the use of the breast appliances. For this reason, and the added expense to using the Brava® system, this procedure has not gained much traction in the plastic surgery world.

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