Breast fat grafting: the evidence and its limits

When is breast fat grafting used?

The literature notes that there is a steady stream of requests from people who want their implants removed during revision surgery, or who want to enhance their breasts without implants from the start ^[1]. A 2021 review described a breast lift that combines fat grafting with augmentation using the patient's own tissue, in which part of the breast tissue is moved upward ^[1]. It stated that combining tissue repositioning with fat grafting in this way can add to the overall volume of the breasts or add volume to areas that lack it, such as the upper breast and the cleavage area ^[1].

In statistics from the International Society of Aesthetic Plastic Surgery, implant removal surgery has been the fastest-growing procedure since 2015, increasing by 46.3% over the past 5 years ^[4]. However, these figures come from a survey of plastic surgeons around the world, so they may differ from trends in Korea.

The controversy and the position of professional societies

In 2009, the fat grafting task force of the American Society of Plastic Surgeons stated that fat grafting may be considered for breast augmentation and for correcting defects caused by disease or previous surgery ^[2]. At the same time, it added the caveat that results depend on the technique and the surgeon's skill ^[2]. The author of a 2015 review considered that this statement settled the controversy surrounding breast fat grafting ^[2].

On the other hand, a 2016 review summarized that fat grafting for breast augmentation remains controversial because of concerns about its effectiveness and safety, particularly regarding breast cancer risk and screening ^[3]. Because assessments differ from one publication to another, it is better to consider the limits of the evidence as well rather than judging on the basis of one side's conclusion alone.

Why results differ from person to person

A 2016 review summarized, step by step, the techniques for harvesting, processing, and injecting fat, care after surgery, methods for improving fat survival, outcomes, complications, and breast cancer risk ^[3]. It concluded that because fat grafting for breast augmentation has not yet been standardized, results vary greatly depending on the surgeon's skill ^[3].

There are also limits to how much fat can be transferred. A review of breast and body contouring surgery for transgender women mentioned that when there is not enough fat to graft, priorities need to be set for which areas to use it on first ^[6]. The change you can expect varies from person to person depending on your body type, the amount of fat you have, and the condition of your breast tissue and skin.

Complications and concerns about breast cancer

According to a 2016 review, most of the complications reported were minor and did not place a heavy burden on the body, and long-term safety based on the data available so far was favorable ^[3]. There was no evidence that fat grafting increases the risk of breast cancer, but the review stated that long-term follow-up is needed ^[3].

Distinguishing changes in grafted fat from other lesions on screening images was also named as a concern ^[3]. A radiology review stressed that knowing what normal findings look like after cosmetic surgery is necessary to correctly identify complications such as seroma (a collection of fluid), hematoma (a collection of blood), infection, and fibrosis (hardening of tissue) ^[5]. If you have had fat grafting, it is a good idea to mention this at future breast screenings.

What to check during your consultation

Several publications stress that the results of breast fat grafting depend heavily on the technique and the surgeon's skill ^{[2, 3]}. It is a good idea to discuss the size and shape you hope for, the amount of fat to be harvested, and your screening plan, and to make your decision based on the judgment of the specialist who examines you in person.

• Whether the change you want is in overall volume or in specific areas
• How much fat can be harvested and from which areas
• The possibility of additional procedures if the volume decreases
• Your breast screening plan after surgery and what to mention when you have imaging tests