#23: Everything To Know About Fat Transfer To The Breasts!

On this episode of The Natural Plastic Surgeon…

Dr. Barrett: Believe it or not, a lot of people don't even know that this procedure can be done. All right? Yes, you can take fat from various parts of your body and make your breasts bigger.

You are listening to The Natural Plastic Surgeon Podcast. I'm Dr. Daniel Barrett, Board-Certified Plastic and Reconstructive Surgeon located right here in Beverly Hills. I specialize in cosmetic surgery of the face, nose, breast and body. This podcast is dedicated to those deciding if plastic surgery is right for them and revealing all the latest beauty secrets. Let’s get started.

00:35 FAT TRANSFER TO THE BREASTS

Dr. Barrett: The Natural Plastic Surgeon, you guys. We are going to talk about fat transfer to the breasts. So buckle your safety belt, you guys. Hang on to your armrest. We're gonna go fast. We're gonna make this chock full of information. We're gonna make this the best use of your next 15 to 20 minutes to go over all the information about fat transfer to breasts. And through a lot of the common questions that we're getting right now from our patients and from our listeners and viewers, okay? So let's start. What is fat transfer to the breast?

01:05 WHAT IS FAT TRANSFER?

Well, it’s exactly that. We're taking fat from various parts of your body. And no, you can't use someone else's fat. We're taking fat from where, areas we don't want it and placing it where you do want it. Typically, this is the breast for a lot of my patients. Because I do a lot of breast surgery. Believe it or not, a lot of people don't even know that this procedure can be done. All right, yes, you can take fat from various parts of your body and make your breasts bigger. Okay?

So there's a lot of news lately about implants and implant-associated illness and capsular contracture and, you know, a lot of that is overblown. Implants are still a great option. But if implants aren't right for you, and your goals are realistic, fat transfer can be the way to go. So bottom line is fat transfer to the breast is taking fat from where you don't want it and placing it where you do want it. Okay.

01:50 HOW IS IT PERFORMED?

How is fat transfer to the breast performed? It's done very carefully. It's basically two operations in one. So we have to do the harvest. We have to find the fat on your body. If you have a 2% body fat percentage, this operation is not right for you. Okay, this is, this is something where you have to take some fat from somewhere, whether it’s the abdomen, the love handles, the inner thighs, even the arms, the neck, anywhere you have fat, we need about 200 to 400 to 500 cc's. Depending on how much volume you need for the breast to look reasonable, to get a reasonable result. Otherwise, it's not worth your time to go through this procedure. Okay?

02:38 SAFE LIPOSUCTION TECHNIQUE

What I like to do, and I talk about this on other episodes, is my safe liposuction technique. You cannot use energy-assisted liposuction with a laser or, sometimes you can use ultrasound but you definitely don't want to use a laser. You don't want to burn the fat cells. You want to harvest the fat, do your liposuction. So that's step number one. That is the operation, that is the first part of this operation. Okay, like I said, two operations and one.

The second part is taking the fat and transferring it to the breast. So we take the fat and we process it very quickly on the back table and then delicately transfer it to the breast. So the breast is like, it's like a garden. Okay? So it's a big sponge. And we want to take each droplet of fat and carefully place it in its own little home. You don't want to take all of the fat and put it in one spot. It's not gonna survive. Just as if you’re planting a garden...I talk about gardens a lot because, I think, I garden and it makes sense to me.

You don't want to take all your seeds and put it in one spot. You want to take each of your little seeds, maybe two or three together, and put it in its own little place. So they have a equal chance to grow and thrive. And they have the nutrients that they need.

This is true for your fat cells too. They need to have space. They need to not be under pressure. They need not to be traumatized by your harvesting technique. They need to have good blood supply. So we don't want to compress the breast right after the operation. And it needs to be evenly distributed because you, the fat cells are like a big glob. This is an implant I’m holding in my hand...but it's like a big glob. And this is a very delicate structure, it needs oxygen, it needs nutrients to survive.

04:08 FAT VIABILITY DEPENDS ON TECHNIQUE

So we want to optimize that with our transfer technique. So the other key concept is I use very small cannulas to transfer the fat. So that we can place lots of tiny droplets. We don't want big oil cysts or, or big accumulations of fat. We want tiny little droplets so you can't see any contour irregularity with the fat that you're transferring. Good quality fat, very meticulous placement is gonna give you a very nice result.

04:36 REPEATED TRANSFER OPERATIONS

Sometimes this has to be done more than one time. I get a lot of patients they get two, maybe three separate fat transfer operations. The main reason why is the breast can only expand a certain amount. People that are great candidates who, so this is our third question, who would be a good candidate for fat transfer to breast?

04:55 GOOD CANDIDATES FOR TRANSFER

Well, let's start by saying who's not a good candidate. We already answered one of those. If you don't have any body fat, we don't have any spare parts. And no, you can't use someone else's fat, because your body is gonna recognize that person's fat as a foreign body and it's going to reject that fat. It’ll look good at first, but then your body is gonna clear it out. It’s, like, no, no, no, no you don't get to come here.

05:15 THE BREAST IS LIKE A SPONGE

All right, the next thing is our sponge. Think about your breast as a sponge when it comes to fat grafting. So people that have had previous breastfeeding, previous weight gain and then weight loss, are typically home-run candidates for breast augmentation. Okay, these are people that have a sponge that was big at one time and then it shrunk down and now we need to refill that backup. They have, they have the latticework, they have the connective tissue and they need, they have the extra skin. So when you do the fat transfer, it's not tense, right?

So if you're completely flat-chested, your fat transfer results are gonna be pretty minimal, okay? Because there's no place for the fat to go. All right. Doesn't mean it can't be done, but depends on your expectations right? So if you're expecting more than a cup size improvement, it's not going to happen with fat. Right. So that leads us to our next question, what results can people typically expect?

06:10 EXPECTED RESULTS

I tell everybody that are considering a fat transfer...it's very unpredictable. Okay? Expect a half cup size improvement. What's the best I've ever achieved with a single fat transfer? One cup size improvement. But the stars were aligned for that patient. Don't expect that to happen for you, you're going to be disappointed. Because if, if we do your procedure and you don't get that full cup size improvement, you only get a half-cup size improvement, you're going to be underwhelmed.

Okay, an implant. This is a 350 cc implant I have in my hand. This implant will be 350 cc’s 10 years from now. Fat has a mind of its own, okay? Sometimes it likes to stay and take and thrive. And sometimes we lose a significant more, significant, significantly higher percentage of the fat that we transfer.

So fat is great on one hand, because it's natural. It's your own body's product. You get the benefit of liposuction. But it has a mind of its own once we graft it, right? An implant is very stable, very reliable. I'm able to get two, three cup size improvements, if we want, with an implant. And, but the downside of an implant is they get, it has implant-associated complications. It can rupture. You can get capsular contracture. If you have autoimmune problems, and may not be the best idea for you.

So, that's what I tell people when, when it comes to what should you typically expect with fat transfer.

Do I see this procedure on a rise? Are you performing more fat transfers to the breast? And why do you think it's trending?

07:35 FAT TRANSFER IS TRENDING RIGHT NOW

Well, I think it's trending because it's recently been reported as a, a safe thing to do. And I'm gonna, I'm gonna dive into that, let's see here...I'm gonna dive into that in the 12th and 13th question. But it, it's on the rise because, first of all, more surgeons are doing it. It's becoming a more popular thing. It was virtually unknown 10 years ago. And now more and more people are doing it. If you know how to do it right, you can get good, reasonable and natural-looking results.

I think a lot of people are, have, fearful of implants and I, and I think that's a great thing to be fearful of. If you don't go to the correct doctor with an implant, you could have a horrible breast result with a breast augmentation. I certainly do a lot of implants and I make it look very natural, here in my office. So I, I want to dissuade people thinking that all implants are gonna look unnatural. If done in the right hands, implants are a great option.

But I think a lot of people are not, they, they don't, they don't want to put something foreign in their body. And, and, and that's totally fine. I totally respect that. There is an alternative. I think a lot of the cancer reconstructive surgeons have started using it and that really, kind of, broke into the mainstream. And now people are doing it for cosmetic reasons. The gains are not, again, they're not huge. You’re not gonna get a dramatic difference. Doesn't work for that 21-year-old that's completely flat-chested and wants a C-cup breast. It's just not gonna work for there.

But I think for a lot of women, especially moms, who’ve done breastfeeding and they want some restorative volume in the breast, it's a great option. I'm performing a lot of this because I think my technique is superior. In that, it takes a lot of dedication and meticulous attention to detail to do this, right.

You got to do it right, you got to, you got to maximize your fat cell viability. Implants are implants. They're gonna be the same size however you put ‘em in. But it takes a special hand. It takes a special amount of dedication and determination to get a good fat grafting result. There's some extra skill and diligence involved with fat transfer that a lot of surgeons don't have the patience for. So I think that's why we get good results here. And I think that's why I'm doing more of these procedures is because I believe in natural things as much as possible. I do still believe in implants. I think they're great, making them natural-looking, but they're nothing, there is nothing that beats the natural look and feel of your own body's fat when it comes to augmentation.

09:55 RISKS AND COMPLICATIONS

Okay, what are the risks or complications? There's always a downside to everything. Implants have their risks and complications. Fat has its own risks and complications. The biggest risks and complications happen from that first part of the procedure, the liposuction part. So, your biggest risk is contour irregularity from the liposuction, okay? That happens a majority amount of time, where you get dimpling or rivets in the skin.

It doesn't happen as much with me. I do occasionally get issues that we, we have to deal with. It's rare. From over resection or not doing your liposuction properly. That's why I use the safe liposuction technique, breaking up the fat very carefully before I remove it. Small cannulas. Taking your time.

So beyond contour irregularities with the liposuction, you can actually have infection. So with liposuction alone, you can get an infection. And when you're transferring fat, it is now devascularized fat. It is something that you're putting into a breast that could potentially get infection, infected because there's no blood supply there. Have I had infection?

10:55 INFECTION AFTER LIPOSUCTION

Yes, I have. And the infection...I had to deal with, in office. We had to do, start antibiotics on the patient. And we had to do a drainage procedure. Now that's one out of several hundred that I've done. So it's not very common. But if it does happen we deal with it. It wasn't life-threatening. There is a, a chance for scarring with any operation. However, our scars are minimal with this type of procedure.

What else can I tell you? The, the other risks are not getting the result that you anticipate. Either too big or too small. Typically we’re, we end up being smaller than we anticipated. So that's always a risk that not all the fat actually takes...that we transfer.

What else? Bleeding. Can have a little bit of bleeding from the operation. It's rare to have a hematoma. I've never had one but that's, that's a known risk for blood collection after liposuction or even fat transfer to the breast. Nipple sensitivity, as far as I know, I have never lost nipple sensitivity. That is a possible risk anytime you're doing any kind of surgery around the areola or the nipple; could have a potential loss there.

What else? You could have a disruption of breastfeeding ability. However, there's no evidence that actually shows that there could be loss of breast, breastfeeding ability. There's no studies on that. So I always mention that because anytime you do surgery on the breast, you could affect the function of, of the breast, breastfeeding, sensitivity, so forth. Okay.

If you don't do fat transfer properly, you can develop cysts, you can develop oil cysts, where the fat accumulates and it, it's something that needs to be drained off. It'd be hard nodules and painful. Okay, again, this is, this goes back to proper fat, I've never had this happen, but this proper fat injection technique. Taking tiny little droplets, lots of little straight cannula, a precise placement of the fat to avoid the, that collection of fat and fat cysts, oil cysts.

12:45 SCARS AFTER SURGERY  

Okay? Next question. Where are the scars? Scars are super minimal. And when it comes to breast augmentation, there is no other operation that has as minimal scarring as fat transfer to the breast. It's a tiny little pinhole either in the border of the areola, on the bottom, or in the inframammary crease. Typically you only need one and you never really ever see it. If you look closely enough with a magnifying glass, yes, you can see it. But there's no other breast augmentation operation where you can minimize the scarring as much as you can with fat transfer. It is a tiny little hole for a tiny little cannula. Okay?

Now you can see the scars with liposuction, but those, again, are really small. Those are typically the size of a pencil eraser. The tip of your pinky finger are typically what you would notice with a liposuction access site. And those tend to heal very well. We tend to put them in discrete locations, depending on the location. If it's in the abdomen, it's inside the belly button. If it's on the flanks, we do it right at the bikini line. If it's in the inner thigh, we do it right in the groin crease. And if it's on the arms, we do it right at the elbow. And, of course, the neck, we do it right underneath the chin that nobody really sees.

13:50 BREASTFEEDING ABILITY

Question 8 is: what is the impact on breastfeeding ability? This is one that I've just did a research article search on. There is no current evidence about the effects of fat transfer on breastfeeding ability. I do think breastfeeding is extremely important. I've, have I had patients that have been able to breastfeed after having this operation? Yes, I've had that. I don't have any data on that. We can't really say yes or no, whether or not this affects breastfeeding ability.

In theory, we're using a blunt cannula to transfer the fat. We're not really interfering too much with the, the duct, the glandular pyramid, right? The breast is like a glandular pyramid, it goes from the breast all the way up to the nipple. We’re not really interfering with that duct network, with the fat transfer, to really interfere with it, theoretically. And in practice, nobody's really reported significant decreased ability to do breastfeeding. But again, we don't have really good studies on that. So I don't have an answer for you.

Again, if breastfeeding is the most important thing to you in the world, don't do breast surgery at all. Okay, wait till you're done breastfeeding. Wait till you're done having children if that's the most important thing to you in the world, okay?

14:55 FAT TRANSFER AND BREAST SHAPE

Can you enhance your breast shape if you are unhappy with your original shape of your breasts? Or is it better for someone who recently lost weight and they're trying to regain volume?

So this, this is a really good question. Breast, so it, when, we have less control over their breast with fat transfer than we do with implants. With implants, we can create more cleavage. We can create, we can drop inframammary folds. We can change the shape a limited amount with an implant and make them bigger with fat transfer. What you see with your breasts, just expect a bigger version. That's all we can do. It's a liquid, basically, that we're putting in there and it's, and it's, and it fluctuates based off of what's denser and what's got more pressure. So we really can't ash...affect the shape of the breast very much. We can definitely make it fuller, a fuller version of your breasts, and which is what most people are going for anyway.

15:45 WHERE DOES THE FAT COME FROM?

Where does the fat come from? Well, we talked about that. I, I typically get most of the fat from the abdomen, the flanks, love handles. That's typically all we need for most people. That's about an hour and a half to do that. If we have to add inner thighs, it’s about 30 minutes. I just saw a patient today where we signed her up for abdomen, flanks, inner thighs and arms. Okay? So those are all common areas to get fat from. I don't like to take from areas like the buttocks, because I really think we want to keep that volume there. And you can always add neck liposuction as well. Typically we get about a 50 cc's from there. It's not a whole lot of fat, okay? But where people smuggle their fat is in the abdomen, the love handles on the side and inner thighs. That's my secret weapon. Now, sometimes we when we stage it, I'll just do abdomen, flanks. Take as much fat from there. Then the next one we’ll do inner thighs, okay? Because the inner thighs is, I think, most people's secret stash for fat, especially most women, okay?

16:45 WEIGHT LOSS AFTER TRANSFER

All right, we're halfway through you guys. I hope you're still listening. If you get a fat transfer to the breasts, what happens if you lose weight or exercise a lot? Is there a chance that you could lose that volume?

Absolutely. The fat regains, retains its memory from the place you took it from. So if you are likely to gain weight, or lose weight, in your love handles more than other areas, and we take the fat from that area, your breasts will retain that memory. Okay?

So if, that's an important thing to bring up during your consultation with your doctor, where do you gain and lose weight the most. Is it your breasts? Is it your thighs? is your abdomen or your flanks? We want to be aware of that when we're doing our fat transfer. I personally am a big believer in not gaining weight before this operation. Because if you gain weight befor this operation, that fat, that extra fat that we take, is going to go right away when you lose the weight. So my recommendation for almost all of my operations is: be at your goal weight, and then you don't have to worry about it. And then don't gain weight afterwards.

17:40 WEIGHT GAIN

A lot of people ask, if I just take, if I do liposuction in one area, am I gonna gain weight in other areas? Well, the way I like to, to make an analogy is you have a central warehouse, and you have different parts of your body that have warehouses, okay? So your ware, so your, your fat stores in your, in your inner thighs, for example. Let's say it's, you know, the warehouse is in Oklahoma. And you're sending fat out to all the warehouses and all of a sudden, you've taken all that fat from the inner thighs, those warehouses are no longer there. So the fat is going to go elsewhere if you're gaining weight. So my recommendation is: stay at a stable weight, if you're thinking about doing this procedure. And afterwards it’s just healthier. But a recent article just came out, saying that fat does regrow after about 10 years. So yes, this fat isn't going to come back within those first 10 years in your inner thighs. But beyond that 10 years, it might start to redistribute there. It doesn't really lead to unevenness unless you gain a lot of weight after your procedure, which is just not good for you anyway. Okay?

18:40 EXERCISE

Exercise. I recommend exercise every single day. And, for all my patients. But the bill, the, exercising actually improves your fat grafting survival. So I do encourage my patients to exercise. And then appropriately after two weeks of the fat transfer, to start exercising again, to increase blood supply and angiogenesis to those new fat cells. We want to make them very happy, very well fed and lots of nutrients and blood supply. Okay?

19:10 FAT GRAFTING AND MAMMOGRAPHY

Does fat grafting interfere with mammograms or breast cancer screenings? This is a good topic, you guys. Back in 1987, I pulled up these papers. The American Society of Plastic and Reconstructive Surgeons--this a society that I belong to--said that, predicted, and they put out a position paper, and this is so stupid, ‘cause they had no evidence. They said fat grafting would compromise breast cancer detection and should therefore be prohibited. All In theory, no evidence, no facts, none whatsoever.

So since then, there's been review articles, after articles, after studies not demonstrating this. Okay, so you have lots of operations that interfere and show calcifications, all of which a talented radiologist--a radiologist is someone who could look at a mammogram and really understand what's going on with calcifications, notice on a mammogram. And they have bigger problems with breast augmentation. They have bigger problems with mastectomy. They have bigger problems with breast reductions, versus fat grafting. Okay, so this whole theory didn't, didn't pan out. There was no evidence for this.

So since then, the, the societies have actually, kind of, reversed their, reversed their position on breast fat transfer. And in the past couple years, they've actually said, there's no evidence to say that it's not safe.

So when you go online, you're actually gonna see a lot of old school surgeons, saying that fat transfer is not safe. And I refuse to do it. Because there's not enough information out there about it. Well, there's a lot of information that's not out there about implants as well. And I think when it comes to fat, they're really, we've been doing it now for the past, you know, incognito, past 20-25 years. And people are really happy.

And there isn't been an evidence, there's no evidence, not a shred of evidence, that it shows It interferes with, with cancer, the, the screening. And there's no evidence which leads to my other question, does fat grafting increase my risk for breast cancer?

21:05 RISKS OF BREAST CANCER

Absolutely no evidence that it increases your risk for breast cancer. They've done the studies, they have a few very iso, esoteric studies where they’ve done, where they’ve shown that there's a theoretical possible increase. But nothing's ever panned out of the women have gotten breast augmentation, breast augmentation with fat and the actual more realistic animal studies showing increased risk of breast cancer. Okay? So in my opinion, it is extremely safe and I wouldn't have it wouldn't hesitate to get it done myself if I wanted it, or for a family member who is considered getting breast augmentation using fat. In fact, it might, in my opinion, it’s probably safer than using implants. Okay?

21:50 RECOVERY TIME

How long is recovery time?

Well, it depends. You know what the breast, it doesn't really hurt very much. What hurts or, kind of, is a little bit sore is the liposuction afterwards, That's where your, that's where your main recovery is gonna be. It's from the liposuction that we would do for your procedure. The fat transfer to breasts, not a big deal, okay? Your breasts will be fine. We're not actually messing with the muscles as, when we do with an implant, I go partially underneath the muscle, have to release that, and that’s sore. Because anytime you mess with muscle or fascia, you get a lot, a lot more tenderness. Because that's what your nerves are. The glandular tissue in your breast and the fatty tissue in your breast, there's not a whole lot of sensation there. So yes, they get swollen, but your pain is not really that bad.

Recovery time, I'd say give yourself about two weeks. Three days of, like, solid downtime, and then two weeks of, like, relative downtime. I have lots of patients who go back to work after five days, and they're totally fine. Depending on the amount of liposuction.

Now we're doing total body liposuction, you're going to be out for a good full two weeks. So it depends on your situation. So anywhere from three days to two. to two weeks is a recovery time. I have all my patients up and walking right after operation, drinking lots of fluids and exercising starting at two weeks.

23:00 HOW LONG DO RESULTS LAST?

How long will results, will results last? Do you have to get touch-ups after the first procedure, similar to someone who might need touch-ups after filler?

Well, fat lasts an incredibly long time. We lose fat as we get older. So yes, you, your, your fat cells that we transfer there, majority of them and as, are going to be there until the day you die, but some of them are going to die off, just as if you were, when you're normally aging. How many fat old people have you seen out there? Not very many. Either they're so fat that they die because of cardiac disease, or they just lose fat over time, and they're skinny.

So the same thing happens with anything that we fat transfer. So of everything that we do, it's probably the longest-lasting thing. Because even if we use an implant, has to be replaced every 10 years in my opinion, or how you run the risk of it rupturing. So, fat is a great long-term option for improvement.

23:50 FAT TRANSFER AFTER BREAST AUGMENTATION

Can people have this done in addition to a breast augmentation or if they already have a breast augmentation to add a more natural, fuller look and feel?

Absolutely. It gives us lots of...it's, it’s like an extra tool in our toolbox. So I get a lot of women who've had breast reconstruction, no breast tissue, have an implant, very visible implant, we can do fat grafting to, kind of, buffer around the implant. To make it smoother. And to hide any contour irregularities that happened with that.

I get some women who want, who’ve had augmentation and they want to increase just a little upper pole fulness, or cleavage line or decolletage wrinkles, we do that too. So it gives us an extra added ability to fine-tune someone's breast augmentation result. If you get fat transfer and you're still not happy with your size, you can definitely get an implant and, guess what, you probably don't need as big of an implant to give you the look that you want. So you never burn any bridges with fat transfer. Okay, you still have options on the table.

24:55 PRICE OF FAT TRANSFER

Okay, so a couple more questions here. Is the price of a fat transfer comparable in price to getting implants if all variables are equal?

No. Fat transfer is a little more expensive because it takes more time to harvest the fat. Where an implant comes off the shelf, Yes, you have to pay for the implants. But in terms of your costs, it's typically more expensive to harvest that fat. Just, it's, it's just not readily available. And then we have to do the fat transfer itself.

A breast augmentation with silicone implants, it's in a box, comes off the shelf, completely sterile, ready to rock and roll, but it's much less operating time which translates to less cost. It's not a huge difference. But you can check out my website for more on that cost information NaturalBreastAugmentation.com, okay?

25:40 WHAT ARE NEXT STEPS FOR SOMEONE WHO IS CONSIDERING FAT TRANSFER?

What are the next steps that someone should take who are considering getting a fat transfer to breast?

This is our last question, you guys. Reach out to us. Leave your comments, questions, feedback on our, on our feedback page. On our YouTube, if you're on our YouTube. Check out our website: NaturalBreastAugmentation.com. Check out my main website: DrDanielBarrett.com. Feel free to reach out to us info@BarrettPlasticSurgery or give us a call 310-598-2648 to take the next step and see if you're a good candidate.

We do virtual consultations. We have a whole virtual consultation page on the Dr. Daniel Barrett website where you can send in your photos and see if you'd be a good candidate. So that's it you guys if you're considering it, reach out to us. We'd love to hear from you. And thank you again for tuning in.

Thank you for tuning into our podcast. If you liked today's podcast, don't forget to share, rate, review and subscribe. Also, find out if plastic surgery is right for you by using our virtual consultation at DrDanielBarrett.com/virtual-consultation. See you soon.

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