Most people will have adequate fat stores in certain areas of their body to enhance their breasts, even if they are slender.

A good candidate for breast fat transfer is someone who would like a natural looking soft breast, a subtle breast augmentation without large scars and does not like the idea of having breast implants. As well, people seeking liposuction can use the removed fat to augment their breasts or buttocks at the same time, without much further recovery time.

A small number of patients will be too thin to achieve reasonable results. If you feel you could be in this category, you are welcome to email some details of your weight and photographs for assessment of your suitability prior to booking a consultation to [email protected]

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Patients with body disproportion (ie slender top half and bottom heavy) achieve additional benefits as body shape rebalancing occurs with removal of fat from the liposuctioned areas into the breast.

Also people who have had problems with breast implants such as hardening or  capsular contracture or simply do not wish to have multiple exchanges of implants during their lifetime.

Patients with breast asymmetry may not want to have breast implants, especially if one breast is an adequate size. It is rare to be able to achieve a good correction of breast asymmetry with an implant on the smaller side only. A breast implant always sits higher than the non implanted side, therefore the majority of patients who have breast asymmetry corrected with implants end up having one in both breasts.

Patients who are in their teens with a constricted or tuberous breast who have severe asymmetry in clothing and swimwear may benefit from early release and correction with breast fat grafting without committing to a big decision such as breast implants at such a young age.

Tuberous breasts typically present with not only constriction of the breast (especially the lower pole) and a high tight inframammary fold, and usually some breast asymmetry. Fat transfer helps maintain release of the tight fold and lower pole constriction and assist with maintaining this correction much better than an open release alone with reduced rates of double bubble deformity. This is where tight tissues springs back to their original position following release and indent the implant across its surface creating the appearance of two folds.  Tissue lack in the lower pole of the breast and cleavage area and precise asymmetry correction is helped with a fat transfer even if breast implants are used.

Read more here about tuberous and constricted breasts.

Usually if people are able to grab a handful above the underwear line in the love handle area and two handfuls below the belly button in the stomach area area a rough guide.

Elite athletes typically have minimal fat stores and are constantly replacing fat with muscle and tend to not have great success with fat transfer.

-Small scars less than 1cm, usually hidden in body creases (typically two tiny ones per liposuction site, two in the inframammary breast crease and one in the armpit)

-Feels completely natural

-Ability to reshape breasts that are constricted or tuberous (a congenital breast condition) with a scarless release

-Ability to match asymmetry much more precisely than with implants if only one breast requires surgery

-Fast recovery (no specific exercise or movement restrictions; recovery is limited only by pain which varies from individual to individual)

-Bonus of liposuction which removes fat from unwanted areas

-No need for removal or exchange of devices down the track (an implant is not a lifetime device).

Although a fat graft may not give the same volume as an implant in one session, and is more costly as it is more time consuming, it has the advantage of not requiring removal and replacement in the future which is eventually required  for breast implants which have an average lifespan of 10 years.

Dr Simone Matousek still performs many breast augmentations with implants alone. Current breast implants have improved and are much softer and available in many shapes and sizes. These are still the best option for very slender people who simply do not have adequate fat stores. People wanting a very large size with one operation or those requiring a significant degree of breast lift may also be more suitable for implants.

Ultimately it is up to the patient to weigh up the pros and cons of breast fat grafting vs breast implants. Many patients may be suitable for either and it is up to them to work out why one may work better for them. Dr Simone can advise and present you with the options and show you before and afters which are similar to your body type to help you decide.

The advantage of seeing a surgeon who has extensive experience in both fat grafting and breast implants is that you can be given an outline of what is involved with either procedure and a recommendation as to which is the best choice for you. 

Although some very thin patients may not have enough fat for a breast augmentation with fat transfer alone, they may have just enough to be injected into regions where their breast implants are visible. This can often occur in the cleavage area or upper part of the implant if there has been weight loss after surgery.  It is also useful for implants that have been placed for breast reconstruction after mastectomy where there is little tissue coverage.

This can be done at the same time as breast augmentation with implants or subsequent to this.

Dr Simone Matousek specialises in revision breast augmentation surgery with a combination of fat grafting and breast implants. With each exchange of breast implants, there is a need to remove the capsule and in the presence of scarring and thinning of the tissues, fat can be beneficial in masking the visibility of implants and dealing with small asymmetries. Dr Simone also recommends a special type of polyurethane-coated silicon implant in this situation which has a significantly lower rate of capsular contracture, movement and rotation in the published literature. You can read more about these implants here and why they are an excellent choice for breast augmentation revision.

Breast implants can totally be exchanged for a fat transfer. For those with larger implants this will require more than one session of fat transfer to achieve a result close to their original volume.

In most cases it is best to perform a breast implant removal first and then return to do the first fat graft a minimum of three months later. This allows for fluid to resolve from the breast.

If there are copious fat stores a small fat graft can be performed at the time of removal. However, the best results are when fat graft is able to be placed in all areas of the breast. Immediately following a removal this can be limited and the graft is confined to only the tissues in front of the implant which can be very thin in some.

Many breast implant patients are slender and have limited fat stores. It is therefore better to do the fat transfer after the removal of implants has settled and the graft bed is more ideal.

Whether a fat graft is performed at the time of removal is discussed with patients at the time of consultation and decided on an individual basis.

In patients where implants have provided a degree of lift, fat graft will not provide the same as it is not as firm as a breast implant. Patients need to consider they may require a fat graft and a breast lift or mastopexy if this is the case.

It is possible to perform a small fat transfer during mastopexy or breast lift.

However, to try and do a large volume fat transfer and breast lift is not recommended. During a mastopexy, tissues are maximally tightened and lifted to achieve the greatest possible degree of lift. Tight tissues do not provide a good fat graft bed as the looser the tissues, the better the fat survival.

The mastopexy or the fat graft can be done first and depends on the patient. Many patients will be happy with the tissue rearrangement and lift provided by a mastopexy alone and not need a subsequent fat graft so in most cases the breast lift is done first.

Fat graft is soft and does not have the lifting capacity of a breast implant.

In patients with significant ptosis, a fat transfer is usually inadequate to give enough lift unless they are completely unconcerned with nipple position.

Early on when Dr Simone was one of the first surgeons in Australia performing fat grafting many patients were misinformed that it was dangerous, did not work or that there was no insurance cover to perform the surgery. This was despite it being standard practice in Europe and the United States. Breast cancer surgeons have since adopted the technique which has been demonstrated to be perfectly safe following lumpectomy, with long term studies showing no increased cancer risk. Here is a  publication on the safety of fat grafting showing no increased risk of breast cancer in a peer-reviewed journal, Plastic and reconstructive surgery. Lipofilling does not increase breast cancer recurrence risk

There is still much misinformation about fat grafting, particularly in Australia where the technique is still not as widely practised as it is elsewhere in the world. Much of this comes from people who have little or no experience with the technique.

In fact the only evidence for a cancer associated with breast augmentation is a very rare cancer (BIA-ALCL) related to breast augmentation with breast implants. 

Although there is no evidence that breast fat transfer increases the risk of breast cancer breast screening is done to ensure a clear picture of the breast is gained prior to surgery. 

A pre-operative screening MRI is required for all patients and mammogram or ultrasound (depending on age). This is read by a radiologist who is very experienced in reading breast MRIs. This allows there to be a comparison in the event of any changes to the breast following fat transfer. 

Scientific studies have shown it is easy to identify any concerning lumps in the breast compared to grafted fat. In fact, more abnormal areas are found after breast reduction surgery or breast lifting  (common standard plastic surgery procedures) compared with fat grafting. Here is a link to an article in a scientific peer-reviewed journal demonstrating this Mammographic changes after fat transfer to the breast compared with changes after breast reduction: a blinded study.

Fat grafting was rejected by plastic surgeon in the 1980s and earlier as the techniques used then meant the fat ended up lumpy and died. Refinements in how the fat is harvested and handled have led to improved take results and much lower rates of fat necrosis (or death of the fat). Injection technique and amount is also paramount in achieving good complication free results. In order to ensure your fat transfer surgeon has adequate experience, ask how many years they have been performing large v0lume fat transfer and where they learned the technique. Dr Simone is one of the most experienced fat transfer surgeons in Australia and has spent several years perfecting her technique.

Machine that select out stem cells from fat is an exciting area of current research. Fat itself is a rich source of  stem cells, and by centrifuging it, the amount of stem cells does increase in the injected fat. However, currently there insufficient evidence of the safety and efficacy of  fat augmented with large numbers of stem cells by the use of such devices. These are undergoing trials and may be used in the future, this technology is new and has little published data. All the published clinical trials and safety data regarding fat grafting have been done on patients with centrifuged fat, not with stem cell augmented fat. The current method of fat grafting achieves very good results, without needing to do this. No other experienced fat grafting pioneers in the world have demonstrated increased take rates with such devices or adopted them in their practices. 

There is no evidence that platelet rich plasma improves take rates in large volume fat grafting of the breast or buttock. 

Many patients are happy with the modest augmentation achieved with a single fat transfer.

People wanting a large breast augmentation or for breast reconstruction after mastectomy (especially those who have had radiotherapy) will need more than one session.

Constricted or tuberous breasts usually require more than one session as the tissue are abnormally tight and difficult to release and expand adequately with one session.

Some procedures are better staged (ie a breast lift or mastopexy and breast implant removal) followed by a fat transfer.

It is usually recommended to wait a minimum of  three months between fat transfer sessions.

If the same liposuction harvest site is to be used, it is more ideal to wait six months so it is fully settled.

Current studies suggest with newer techniques of handling the fat, it will last provided a stable weight is maintained and there are no major hormonal changes.

Large changes in weight will affect the results as the breast fat graft once taken behaves like living fat in the rest of the body.  Therefore if weight is gained post-surgery the fat grafted breasts will enlarge; if it is lost, the breast size will reduce.

If patients are planning to lose weight, this should be done prior to surgery.

There is no point gaining weight before surgery as in most people who maintain a relatively stable weight throughout their life, it is likely to gravitate back to the original weight post-surgery, and then volume will be lost from the breasts.

About 70% of the fat lasts according to current statistics of major fat grafters around the world.

There are individual variations in take that are unpredictable and due to factors that are currently unknown. Sometimes fat graft take can be better than this at other times worse.

The BRAVA Breast Enhancement and Shaping System was invented by Dr Roger Khouri whom Dr Simone Matousek has visited and learned this revolutionary technique through his operative surgery courses and direct visits to him.

The BRAVA can temporarily increase breasts by one to two cup sizes. This is not maintained once the machine is no longer worn. However, it creates a bigger space for the transferred fat to be placed and also improves the blood supply to the transplanted fat.

This means wearing BRAVA reduces the number of fat grafting sessions needed (a tight non-expanded breast is limited in how much fat can be injected into it) and enhances survival of the transferred fat. 

The BRAVA is not essential for everyone. Dr Simone will assess you at your consultation and recommend if the device will be of benefit for you.

Equally good results can be achieved with multiple smaller sessions without the BRAVA device.

It is recommended for those wanting a larger augmentation, those with a tight breast or those who have had a mastectomy.

Patients with loose breast skin (eg after multiple pregnancies or massive weight loss) or after a removal of breast implants where the skin has already been expanded should not need to wear it.

It needs to be worn for a minimum of 8 weeks before surgery  for 8-10 hours per day (the total time depends on how many hours a day the person is able to wear it). Leading up to the surgery it should be worn almost continuously for the final week.

The BRAVA device when worn for the full time pre-operatively and correctly, excellent pre-operative breast expansion can be obtained.

The BRAVA device can be challenging to wear for some and can be problematic if a patient is allergic to the silicon gel on the device and lead to skin problems. There is no point ordering one and wearing it for only part of the time recommended as adequate breast expansion will not be achieved. Some breasts such as severely constricted breasts may not expand well until a primary fat graft is performed.

There is a video link below on how to wear the device.

Making sure you are a stable weight prior to surgery is extremely important. You should be at your ideal weight or slightly less. This way, if there is slight weight gain post surgery, the graft will take better and end up growing.

Exercise habits should be stable and there should be no major plans to drastically increase this following surgery as this risks fat graft loss.

Unless you are permanently planning to remain at this increased weight for good, this is not really a good solution to inadequate fat stores. Most patients who are naturally slender will gravitate back to their lighter weight and risk losing the fat graft when this happens.

Fat transfer techniques have significantly improved over the past decade due to more careful harvesting, handling and injection techniques for the fat.

It is centrifuged after removal, which means unnecessary fluid is removed, concentrating the fat to the most effective portion to inject. It is then injected through very fine cannulas into the breast and spread and layered in a very precise manner in micro-droplets to ensure all the fat cells have a good blood supply to survive.

Older techniques did not use these refinements, therefore in the past, the fat did not survive as well.

At the moment, studies show up to  75%  and sometimes even more of grafted fat survives (so overcorrection is required). This has been confirmed with follow-up MRI studies of patients which demonstrate grafted fat.

Dr Simone uses specialised equipment to harvest and inject the fat (microcannulas) and has a custom made centrifuge with the ideal G force to not damage the fat graft.

She is an expert at scarless breast reshaping and release of the breast in combination with micro fat grafting.

For people with problematic skin that may not tighten up well after liposuction, the VASER ultrasonic skin tightening device can be used following fat harvest in these cases.

Patients are up and walking the day of surgery. Most fat gratings can be performed as day surgery.

Dr Simone Matousek works in conjunction with an anaesthetist who is focused on ensuring your post-operative pain is well controlled and minimal.  Local anaesthetics are injected in liposuctioned areas, and also in the breast which provides good pain control. General anaesthetic is the safest and most pain-free way of undergoing this type of surgery. 

There will only be very light dressings on the breasts where the cannula entry points for injection have been placed. This are waterproof and showering is permitted. You are placed into your compression garment straight after surgery and wake up in it. It can be removed for showering and short periods.

Bruising varies from patient to patient but should resolve in most by 2-3 weeks.

Some patients have returned to work the next day. Although this is not the norm, and at least a few days is required for most, there are no specific restrictions to movement. Movement is restricted due to pain, mainly in the liposuction sites which is largely variable from patient to patient. Taking regular post-operative pain relief is important in controlling this.

A compression garment needs to be worn on the liposuction sites for six weeks following surgery. These are skin tight and can be worn under clothes without being very visible. minimise bruising and swelling. This is essential to control swelling and bruising and ensure that the liposuction result is the best that it can be.

A healthy diet maintaining a stable or slightly increased weight is recommended in the post-operative phase.

Any extreme exercise regimens or diets should be established and stable before surgery.

One of the overriding advantages of breast fat transfer are due to the tiny incisions and rapid healing time which means there are no major restrictions to exercise after the surgery. Exercise is mainly limited due to pain, which is highly variable and usually dependent on the liposuction sites and volume as breast pain is minimal.

Fat grafting can be beneficial in other areas of the body, particularly the face. If you have used facial fillers in the past, fat is an alternative option. As it is your own tissue, in a lot of ways it is superior to synthetic fillers. Fat is good for replacing the volume loss that occurs with ageing or weight loss and this can be done at the same time as a larger volume fat graft without adding much operative time. As a stand alone procedure, it can be more expensive than filler which can be done in the rooms at a lesser cost and in many situations, can be almost as good. Ask Dr Simone at the time of your consultation if fat transfer to the face can benefit you.

Brazilian butt lift (BBL) or buttock fat augmentation is becoming increasingly popular.

Almost any soft tissue and even some bony defects can be corrected with fat transfer. Congenital asymmetries of the chest wall in males, post-traumatic defects and burns scarring are just some examples of situations where fat grafting can be of benefit. Fat transfer has been shown to remodel and reduce scarring and improve skin radiotherapy changes.

Dr Simone regularly has requests from interstate patients for consultations and surgery due to her extensive experience with fat grafting. Skype consults are an option as a preliminary way of assessing if you are suitable for the procedure. Click here for more information on how to arrange a consultation and surgery if you live outside Sydney. 

Dr Simone’s practice is in central Sydney and about 20 minutes from the domestic airport. It is easily accessible by public transport. There are plenty of accommodation options around.

You must stay overnight in the hospital the first night after your surgery if you are unaccompanied.  You may be a day surgery patient if you are collected from the hospital by a friend or relative and they remain with you for the first night.

Some patients who are a short plane flight away (ie less than 2 hours) have been able to fly home the next day following a fat graft. Staying one night minimum is recommended for shorter flights. Longer flights should probably remain a few days.

There are only a few sutures and very small wounds to manage after a fat graft. Most local general practitioners can assist with this. Dr Simone Matousek liases with your local doctor to ensure the correct aftercare. Skype, telephone or email follow up is available as needed.