Breast implant exchange with  fat transfer instead of implants is an excellent option in patients with enough fat stores. It can provide an alternative to needing repeated breast implant exchange surgeries. Sydney plastic surgeon Dr Simone Matousek has a special interest in large volume breast fat transfer which she has been doing for over 10 years.

Here Dr Simone outlines who may be a suitable candidate to permanently remove their breast implants and replace with fat.

Breast implant exchange with fat transfer is best in:

Those who do not want to commit to further breast implant removal and replacement surgeries during their lifetime

Even if a fat graft does not give you as great a volume as an implant, there is not the need to undergo surgery again.

-Those who may have gained breast volume since their original breast augmentation

Patients that have had implants in for many years may have gained breast volume through weight gain. By the time they come for removal, they feel the implants are now providing unnecessary extra volume

-Those who do not like the look of their breast implants

Some patients feel their implants do not look or feel natural or find them unsuitable for their body frame

-Those due for an implant exchange and who were considering liposuction of a site

The fat from liposuction can be used to naturally augment the breasts.

-Those against breast implants due to the small risk of breast implant associated cancer and other complications

There is increasing concern that breast implants can be associated with breast implant illness or a rare implant associated cancer (BIA-ALCL). Information about this is available in other website sections. While the risks are not great enough to consider removing breast implants without any signs or evidence of this very rare cancer, for some it is not acceptable for a device to carry any risk however slight of cancer.

Breast implant exchange with fat transfer who is not a suitable candidate:

-Those expecting the same look as an implant (ie prominent cleavage, high sitting breasts)

Fat transfer is not a firm device therefore volume in the upper part of the breast tends to descend over time (like a natural breast)

-Those wanting one surgery only

Especially in those wanting to achieve a similar volume to their breast implants, most patients will require at least two surgeries. Of course implant exchanges are likely to be required at some point down the trackk

-Those without adequate body fat stores

Many very slender patients with implants and almost no native breast tissue simply do not have enough volume to replace their implant volume with fat. Slender patients run a greater risk of liposuction defects

Those wanting prominent cleavage

Those with significant volume loss in the upper part of the breast who want a cleavage that sits high; only an implant can achieve this.

Breast implant exchange with fat transfer- how it is done

Usually it is advisable to do a breast implant removal, allow everything to settle and then follow this with a fat graft if needed a minimum of 3 months later.

Why is a breast implant removal usually needed prior to any fat transfer?

Fat transfer is most efficient when done after a removal of breast implants has been performed and fully settled.

Occasionally a small amount of fat can be grafted and harvested at the same time as the removal. However, this is only possible in people with a large amount of fat and tissue in front of the implant. Grafting cannot be performed into the space that is left after an implant, the fat simply will not take in this environment. Once the cavity where the implant was has stuck back down, fat can be grafted to all the layers.

As fat transfer is a lengthier process (and therefore more expensive) than an implant exchange, it is best to make each transfer session as efficient as possible. Grafting during the time of removal means less fat will take for a similar liposuction time. Waiting for 3 months will mean more fat can be grafted with better fat graft take.

Who is suitable for a breast fat transfer at the same time as implant removal:

-Those who think they may be happy with a very small fat graft (ie breast implants too big and significant breast volume gain since the procedure) and may avoid a second procedure

-Those with a lot of excess fat who want multiple liposuction sites addressed (and therefore have enough fat for subsequent procedures if needed).

-Those with good skin quality who do not need a breast lift

-Those with a good volume of tissue in front of the implants

Who is not suitable for a breast fat transfer at the same time as removal:

-Those with limited fat stores with enough for only one fat transfer

-Those with thin tissue cover over the breast implants

-Those requiring a breast lift with external scar

Is a capsulectomy required at the time of breast implant removal?

If there is no rupture or complication, it is best to avoid doing an aggressive capsulectomy.

The capsulectomy is most people is scar tissue which is not dangerous. A normal capsule in an uncomplicated does not contain “nasties” that need removal. Removing your own scar tissue simply thins the skin further in patients who often need all the tissue they can preserve for the best result.

All tissue is potentially an area for fat graft take. Aggressive capsulectomies take surrounding tissue as well and leave less tissue to fat graft to.

Is a breast lift performed at the same time as an implant removal?

If the original implant was placed through the nipple-areolar complex, sometimes a lift can be limited to this area. Other patients with loose skin may benefit from a full breast lift with a vertical scar at the same time as removal.

Dr Simone performs a special  internal lift in many cases through the inframammary or breast crease incision to better reposition the tissue if it has dropped prior to the second stage breast fat transfer.  This type of lift is only suitable in some, but avoids the need for further external scars.

Recovery following an implant exchange with fat transfer

The first operation which is the removal requires breast drains for around a week. These ensure all the excess fluid is drained out of the space to ensure the tissues stick back down. Otherwise, the fluid can remain as a seroma or collection that needs drainage. A seroma is not a suitable environment for fat grafting.

Patients can generally get back to normal activities within 3 weeks of an implant removal.

The fat transfer procedure itself is done as a day stay and has less movement restrictions due to the small incisions associated with fat harvest and injection.These small incisions are healed within a week and patients can go back to gym activities as soon as their pain is controlled.

After a breast implant exchange with implants, movement restrictions are greater and require several weeks of upper body exercise restriction.

Exchange of breast implants with fat grafting in breast reconstruction

Breast implants in the setting of breast cancer reconstruction and radiotherapy have a higher risk of capsular contracture, distortion and poor cosmetic outcome. Implant removal and replacement in this setting (mastectomy) usually requires at least three fat grafting operations to gain a reasonable breast volume.

For more information about breast fat grafting read the first blog on fat transfer with implants click here.

For more information about breast augmentation with implants click here .