Breast augmentation without implants? Is that possible?

There are terms like “natural breast augmentation”, “breast augmentation without implants” and “minimally invasive breast augmentation” – names aimed at what is medically called fat transfer to the breast or lipofilling. But the growing interest in this cosmetic surgical procedure – and it is undoubtedly a surgical procedure – is not only driven by marketing and social media.

The recent rise of lipofilling
How can I get a breast augmentation without implants?
What are disadvantages of fat transfer?
When should I opt for lipofilling?
Implant or not, that is the question here

The recent rise of lipofilling

Fat transfer to the breast (lipofilling) by liposuction has not always had a good reputation. At the beginning of the application of the technique in the 80’s there were many voices advising against it. Even the major medical associations worldwide advised against lipofilling. However, with the advent of more refined and safer fat grafting techniques, fat grafting experienced increased popularity. Internationally, we noticed an increase in patients asking for fat grafting in breast augmentation only to avoid implants.

The increase can be attributed in part to fear of BII as well as patients’ desire for a more natural look by using their own fat. The trend of “smaller” breast augmentations also plays a role.  And fat grafting works well for modest augmentations.

It is a popular breast augmentation procedure for patients who have had breast implants removed and would like to restore some volume. Certain patients – especially those whose already thin breast tissue has been damaged by the implants or removal – may benefit from a little extra padding in certain areas. However, lipofilling, like any other breast augmentation, is an invasive surgery and not every patient is suitable for it. Successful fat grafting is a technique-dependent procedure. The way the fat graft is processed affects both the survival of the fat and the rate of complications.

What are considered the most pressing questions my patients ask me when it comes to breast augmentation with autologous fat transfer?

How can I get a breast augmentation without implants?

Lipofilling can indeed make your breasts bigger without implants by using a two-step technique. First we perform liposuction, in which areas of the body with excess fat are suctioned off – the abdomen, hips, flanks, etc. This body fat, after being purified, is then transferred to the breasts. Of course, this is an oversimplification of what aesthetic surgery has developed as an extensive and nuanced procedure. You must be very gentle with the fat, with minimal handling and manipulation during harvesting. The grafting process should also be approached with the same level of care. My experience and that of my colleagues has been to distribute the fat evenly throughout the breast tissue and inject tiny amounts at each pass. If we proceed in this way, it is more likely that the fat will get a blood vessel and remain permanently on the breast.

Injecting multiple small fat packages as opposed to one large injection not only gives the entire fat bundle the best chance of being perfused and surviving in the long term, but also promotes stability as smaller fat pads are more easily supported by the surrounding tissue. Depending on where the fat is placed, it can augment the entire breast or create a more customized effect by targeting selected areas for injection. The upper pole is often targeted because this is where the typical volume loss occurs – especially during breastfeeding, weight loss and after the removal of implants.

The disadvantages of fat transfer

The problem, however, is that because fat has no structure, it cannot give the round, projected shape that many patients desire in breast augmentation. If you want the appearance of a voluminous breast, breast augmentation with implant should be your choice. In addition, lipofilling is not able to make your breasts more than one cup size larger. A large percentage of my patients want to go two cup sizes larger with breast augmentation – and this cannot be achieved with a single fat graft. The patient who does best with a fat transfer to the breast already has a good shape and is only looking for an increase in breast volume.

In the end, this step might be smaller than expected, even if your surgeon did everything right. Fat behaves capriciously when it is separated from its point of origin and moved around the body, and not every bit survives. This may be due to the technique used to process the fat graft or other factors of the patient that are not exactly known. About half of the transferred fat does not survive and is absorbed by the body within the first few months after surgery. The fat that remains three months after surgery is likely to be preserved in the long term – provided there is no weight loss. The transferred fat reacts to weight loss and gain in the same way as in the liposuction area.

The biggest advantage of implants is that we know exactly what kind of volume increase we will get, down to the cubic centimeter. This is not the case with fat – and patients have to be able to live with this unpredictability. Besides, results with implants are much more permanent and if done correctly, you can achieve fantastic natural results.

When should I opt for lipofilling?

Aside from having realistic expectations, suitability for this type of fat harvesting is dependent on having both a generous harvest site (e.g., hips, abdomen, flanks) and a suitable recipient site (i.e., compliant breast tissue). In general, patients should not expect more than one cup size change.

Having sufficient fat pads is the most important prerequisite for successful breast augmentation with autologous fat. However, it is less obvious why one breast is more suitable for fat grafting than another. The best results can be achieved in breasts that are more fatty and have sagging tissue due to weight loss or breastfeeding. Dense breasts – with firmer, fibrous glandular tissue and less soft, pliable fat – are generally more difficult to augment. Above all, it has too little space. In any case, it is not advisable to inject fat into tight areas. Fat that is under tension can neither expand the tissue nor restore blood supply to survive.

Implant or not, that is the question here

Should I rather have a breast augmentation with implant or lipofilling now? I personally love fat grafting as an instrument. And for some women, it is the right choice. However, for the goals most patients seek, breast augmentation with implant remains the gold standard. It is crucial that your surgeon has an open and honest discussion with you, explaining in detail all the pros and cons of each option and any associated risks. Implants have risks, fat transfer has risks, it’s about what’s right for you.