Implants vs. Fat Grafting: Two Strategies for Breast Augmentation

Implants are practically synonymous with breast augmentation surgery, but San Francisco Bay Area plastic surgeon Dr. Eric Culbertson works to educate his patients seeking a volume boost that there is also another option: fat grafting.

“Augmentation” is a word for increasing something, whether by a little or a lot. Both implants and fat grafting are effective augmentation strategies, but each offers its own unique properties. Breast implants may be ideal for one woman, while grafting is the more appropriate choice for another. The decision depends on the degree of augmentation desired, the starting size and shape of the breasts, and other factors.

Implants

Breast implants come in a range of sizes, shapes, textures, and types, but they are all shells filled with a substance designed to add volume and mimic breast tissue. Over the years, fillers have progressed from a sterile saline solution to silicone gel to a form-stable silicone gel that is better at staying in place in the event of a rupture.

Implants can either be inserted full, as with the silicone-filled shells, or inserted empty and then filled with saline once in place. The shells are fitted into pockets made specifically to accommodate them in the breast itself, with the implant sitting above, below, or partially above and partially below the chest muscle.

Incisions through which the implants are inserted may be located directly in the breast tissue, such as on the areola or in the crease below the breast, or they may be made some distance away, such as in the underarm area. The breast-based incisions give the plastic surgeon the ability to work with significant precision, and are generally adequately concealed at the border of the areola or within the lower fold of the breast. An underarm incision keeps scarring away from the breast, but the distance from the pocket makes precision more challenging.

Fat Transfer

For anyone who has ever wished they could control where on their body fat collects, fat transfer represents an ideal body-contouring strategy. By using specialized tools similar to the instruments employed during liposuction surgery, a plastic surgeon can remove fat from one area and, after treating it, inject it elsewhere to add volume.

Fat transfer can be used for breast augmentation, making use of a woman’s own fat taken from an ample donor area elsewhere on her body. The realities of this procedure mean it is intended for patients with fat cells to spare.

Because these fat injections are made up of living cells, some women prefer it to implants for two reasons: It does not need to mimic living tissue, as it is living tissue, and the body does not treat the injected cells as foreign bodies, as it may do with implants. Capsular contracture, for example, is a condition that causes scar tissue to form around a breast implant, creating a hardened wall that can squeeze the implant itself out of its natural shape. This is not a concern with fat transfer.

Even small amounts of fat can make a visually noticeable difference on the breasts. Fat transfer can be used to create more significant curves, but can also be used for refining a look. It may even be combined with breast implants to create the most natural-looking breast possible for a patient, especially in cases of breast reconstruction.

There is no universal “right” way to perform a breast augmentation. Each patient is a unique case, which is why a qualified plastic surgeon will wait to recommend a specific course of action until after a consultation with the woman seeking augmentation.

To learn more about fat transfer, breast augmentation, and other plastic surgery options for the breasts and body, contact Dr. Eric Culbertson at The Jacobs Center for Cosmetic Surgery in Healdsburg by calling (707) 473-0220 or San Francisco at (415) 433-0303. Send a message online via the practice’s Contact page.