Breast Implants vs. Fat Transfer: Which is right for me?

Speaker 1 (00:02): You're listening to Behind the Double Doors, bringing you behind the scenes to learn about cosmetic surgery procedures and the latest non-surgical aesthetic treatments with Houston board certified plastic and reconstructive surgeon Dr. Bob Basu.

Dr. Bob Basu (00:18): Today we're talking about how breast enlargement can be accomplished without the use of breast implants by using one's own fat. This is called breast augmentation with fat transfer or breast auto-augmentation. So most patients think if they want their breasts enlarged they have to opt for implants and that is not the case. We have other alternatives where we can volumize the breasts without implants using their own tissue. And what fat transfer breast augmentation is is we essentially perform liposuctioning of somewhere else in the body and we put that excess fat to good use. We actually process that fat and isolate the adipocytes or the fat cells, concentrate them, and carefully inject small aliquots of fat throughout the breast tissue to volumize the breasts.

Dr. Bob Basu (01:06): So we're essentially using a patient's own fat to perform the augmentation without a foreign body implant. We can harvest fat from any body part. My preferred areas of the tummy, either the waist or the posterior flanks, the love handles. We can go to the bra line, we can go to the upper medial thighs. There's a lot of different areas. As long as these areas have not been previously liposuctioned and there's no scar tissue within the fat, the fats are very robust to survive the transfer process.

Dr. Bob Basu (01:35): Breast augmentation with fat transfer is a great option for some patients, but it's not exactly the same as breast augmentation with implants, and what are the differences? In breast augmentation with fat transfer we're not using a foreign body implant, so you don't have to worry about scar tissue formation with implants or implant rupture or an implant replacement down the road, which are positives.

Dr. Bob Basu (01:58): But patients also have to realize that an augmentation with implant typically takes me about 45 minutes to perform as a surgery. Breast augmentation with fat transfer can take two, maybe even two and a half, three hours to perform, and there are some limitations. This is really important. There are some limitations on how full I can make each breast with one session of fat transfer.

Dr. Bob Basu (02:20): And so based on studies and also my personal experience doing this procedure on a regular basis, you can only volumize each breast up to about 200 to maybe 250 cc's of volume in each breast, and that's probably the upper limit. And what that means to the patient is that that typically is a, I would say, approximately half cup size on a smaller breast, that could be one cup size.

Dr. Bob Basu (02:44): So who's a great candidate for breast augmentation with fat transfer? It's someone that's seeking a more conservative augmentation and someone who doesn't want to use implants. Now for those patients that don't want to use implants and they want a fuller augmentation, let's say they're an A cup and they'd like to be a full C or D, those patients need to understand that they may need a second surgery to add more volume, because you can only add up to about 200 cc's to 250 cc's of volume from each session. So there are some limitations with fat transfer breast augmentation.

Dr. Bob Basu (03:17): So the survival rates of fat when we do fat transfer to the breast vary, and it varies by surgical technique, it varies by the patient's healing potential, and it varies by the quality of the patient's fat. So there's a lot of variables involved. And I tell patients that if you're meeting with a surgeon, a board certified plastic surgeon, and they tell you that 100% of the fat that they transfer sticks around, that's not possible, 100% of the fat that we transfer will not survive the journey. The truth varies between 50% to up to 80% of the fat that we transfer survives, and there's a lot of variants in there because of the variables that I told you about, right? A patient's healing potential varies, the quality of the patient's fat varies, and the technique that's utilized varies.

Dr. Bob Basu (04:01): One of the things that has optimized my fat graft survival rates. In other words, when we transfer the fat, how much of that fat survives. One of the things that's optimized my fat graft survival rates is I like to use an FDA approved device called REVOLVE. It is made by Allergan and REVOLVE, basically without getting too technical, REVOLVE is a FDA approved advanced adipose harvesting system that helps to ultra purify the fat that we liposuction so that what I'm injecting into the breast is not liquefied fat, it's not damaged fat, it's not oil, it's purified adipocytes. And in my experience, when I use REVOLVE the device to filter the fat, my survival rates and outcomes have significantly improved. And quite frankly, I've not looked back. I use REVOLVE on my breast augmentation with fat transfer all the time and I'm very pleased with the outcomes.

Dr. Bob Basu (04:52): So once fat has taken, meaning it's survived and your body has created blood supply to feed the fat cells that have been transferred, that fat is there for life. It's permanent. Now of course, those fat cells remember they're fat cells and they remember that they may have come from the tummy, they may have come from your flanks, they may have come from the thighs. So I tell patients that if you gain a significant amount of weight, well, those fat cells might get bigger. Or if you lose a significant amount of weight, those fat cells may get smaller, right?

Dr. Bob Basu (05:24): So ultimately when we've done fat transfer and the cells have survived and they're there for long term, meaning permanent, they behave like fat cells anywhere else in the body. They're dynamic. They can get bigger, they can get smaller. So if you need more than one fat transfer session, I typically like to wait approximately six months before we do the second session. This gives enough time for any residual swelling to resolve and we've given it enough time to see your end result from the first session.

Dr. Bob Basu (05:53): It is similar, but it's different. We are not making any major incisions with this because the cannulas or the devices that we use to inject fat are typically three to four millimeters in diameter. So oftentimes I'm hiding a little tiny opening underneath the breast, or maybe hiding it at the transition, at the edge of the areola pigment. They're barely noticeable. I don't want to say it's scarless because that's not really true, we are making a tiny little incision, but it's not like a one inch or an inch and a half incision that you may see in breast augmentation.

Dr. Bob Basu (06:25): So I don't have patients complaining of pain in their breasts, what they may be concerned about is the soreness from the area where we've harvested fat. In other words, the areas where we've done liposuctioning. Patients really need to remember that in a breast augmentation with implants, we're only operating on the breast. There's no incisions, there's no surgery being done on any other body part, whereas when we do breast augmentation with fat transfer, we're actually doing surgery on another body part, we're doing liposuctioning. And with liposuctioning, you get soreness in that area, and it's very, very important to wear compression garments in that area for a good four to six weeks at a minimum. So the complaints of pain really don't come from the breasts, it's from the soreness from the liposuctioning.

Dr. Bob Basu (07:09): The good news is for breast augmentation with fat transfer, patients typically have some soreness for about three to five days. Most women are very comfortable to go back to a desk job in three to five days after surgery, but they do need to wear their compression garments while they're back at work. Compression is very important in the areas where we've done liposuctioning. I generally recommend no heavy lifting or strenuous activity for about three to four weeks. No running, no gym, no weight training, no yoga, pilates, and you'll want to be very careful with intimate activity for a good four weeks.

Dr. Bob Basu (07:39): So breast augmentation with implants typically is a surgery that takes one hour or less, and so that really helps to contain the costs. Of course, there's the cost of implants, but when we talk about breast augmentation with fat transfer, we're not only operating on the breasts, but we also have to liposuction at least one or more areas to harvest enough fat and so that adds significant time to the surgery. Patients are often thinking that the cost of breast augmentation with fat transfer is exactly the same as breast augmentation with implants and that is simply not the case. If breast augmentation takes me less than an hour to perform the operative time for breast augmentation with fat transfer can be two, sometimes even three hours, depending on how much liposuction we need and the patient opts for. So this obviously commensurately increases the costs. The cost increase will depend on the number of areas that are being liposuctioned.

Dr. Bob Basu (08:28): So the first step is to engage our patient consultants and start the dialogue, learn about your options, the costs, and the recovery, and then schedule a consultation with us. We have to determine first if you're a good candidate for breast augmentation with fat transfer. Do you have enough fat to make it worthwhile and can we achieve your goals? It's important for you to bring us your wish pic so we understand where you're trying to go so that we can tell you okay, this will require just one session or in order to achieve your goals as demonstrated by your wish pics, we may need to do a second or maybe even a third surgery to get you there. So it's important to have that discussion well before surgery.

Dr. Bob Basu (09:07): I'm thinking about one particular patient a couple of years ago, she actually had augmentation with a different surgeon. She experienced scar tissue or capsular contracture, and for whatever reason, the surgeon just removed her implants. She presented to me for two reasons. One, she did want her breasts to be a little bit fuller. She was looking for a very conservative argumentation, maybe like a half to three quarters of a cup size at most, but she also presented to me because when the other surgeon took out her implants, it left an empty space on one of her breasts and the breast caved in and she had a scar contracture there. In other words, she had a fold crease and a divot, an indentation on one side that was very unsightly.

Dr. Bob Basu (09:49): So she presented to me looking for options to make the deformity better and the deformity occurred because the other surgeon removed the implant, and she was also looking for an option to enlarge her breasts by a small amount, but she was petrified of implants. I think she had a really bad experience at the other practice, and I did discuss with her the option of breast augmentation with implants. We reviewed the safety profile of the smooth gummy bear implants, but she just had a really bad experience and was looking for alternatives.

Dr. Bob Basu (10:21): So we then talked to her about breast augmentation with fat transfer. She had never heard about it, and so we educated her about how we harvest fat, how we process fat using an FDA approved adipose harvesting system called REVOLVE, and how we inject fat. We talked about the recovery, and she was very, very excited. And she was hopeful that not only we could achieve her cosmetic goals, but we could also improve the deformity that's left behind from her previous surgery.

Dr. Bob Basu (10:50): We did breast augmentation with fat transfer. I liposuctioned her tummy as well as her thighs, and immediately after surgery, I don't know if she was more excited about her breasts or her liposuction results, but we'll take that as a double win. That's good. But she did very, very well. I actually saw her back ... I think she was about 18 months out, so almost a year and a half after surgery, and I was blown away by how great she looks. We achieved her goals with volume. I added about enough volume where she would get about a 200, 250 cc enlargement on each side, which is exactly what she wanted.

Dr. Bob Basu (11:22): So number one, she was very, very happy with her volume augmentation. It was a conservative augmentation, she got about a cup size or a little less than that of an enlargement. But more importantly, when we looked at her before/after pictures, the scar contracture deformity on the one side, meaning the divot ... She had a significant indentation, I wish I could show you the photos, was completely rectified and corrected. It was smoothed out as if it was never there, and I needed to make no new incisions on the breast. And she was very, very happy.

Dr. Bob Basu (11:52): And I think as a surgeon what that teaches me is that breast augmentation with fat transfer can be a very reliable way to augment the breast safely with good long term results, number one. But number two, there's a powerful healing potential with fat and any board certified plastic surgeon that does fat transfer, whether it be on the breast, on the buttock, or on the face. I do a lot of fat transfer with my face lifts, the skin overlying the areas where we inject fat looks better. There's some healing properties with fat cells that we fully don't understand, but there's some theories out there that our fat cells have growth factors perhaps they're adult stem cells. There's some healing property of fat that heals adjacent tissue.

Dr. Bob Basu (12:36): And in this patient's case, remember, she had a significant scar deformity, a divot, an indentation, and by volumizing with fat, the fat not only filled in the volume deficit, but it healed the overlying scar in the skin to give her a fantastic result. And that's one of the results that I specifically remember that we made a huge impact on the patient's confidence and overall her satisfaction and her quality of life.

Speaker 1 (13:01): Basu Aesthetics and Plastic Surgery is located in northwest Houston in the Towne Lake area of Cypress. If you'd like to be a guest or ask a question for Dr. Basu to answer on the podcast, go to BasuPlasticSurgery.com/podcast. On Instagram, follow Dr. Basu and the team @BasuPlasticSurgery. That's B-A-S-U Plastic Surgery. Behind the Double Doors is a production of The Axis, TheAxis.io.