Fat Grafting and Internal Lift Facts, Myths and Q&A with Dr. Lisa Cassileth

Authored By Lisa Cassileth MD, FACS


The breast implant business has been huge for plastic surgeons, with over 626,000 implants placed per year. Has this been healthy? Many patients have been wondering the same, as they seek implant removal to cure chronic fatigue, brain fog, and autoimmune issues; but, is that hysteria, or fact? After 20 years in the business of breast explanting, and interviewing and performing surgery on thousands of patients, my goal is to separate fact from fiction, and if we remove implants, to make the breast look just as good as it did with implants, if not better.

We receive many questions from people regarding breast explantation procedures, and have compiled answers from breast revision specialist, Dr. Lisa Cassileth. Read below for facts, myths, and tips regarding breast implant removal, fat transfer and breast lift below.

Am I a good candidate for breast fat transfer?

Almost all women are candidate for fat transfer to breasts. There needs to be a site to take the fat from, and almost everyone has a little bit of fat somewhere that they would be happy to have removed. There also needs to be some breast tissue to transfer the fat into. The more fat you have, and the bigger your breast is the more fat that can be transferred. My rule of thumb is that I can double the patient’s native breast size, so if you are a natural a we can make you a B with one session of fat grafting.

Does the fat “take” (survive), and will I need it redone?

The fat to the breasts does survive, and as our studies have a proven 82% and higher take of our transferred fat. The fat is permanent, and whatever percent you still hold on to after a few months will stay there forever. Like the original fat from whence it came, that fat will go up and down with your weight. Regardless of if the cell is big or small, it is permanently there!

Should I gain weight before having fat grafting surgery?

There is a common myth that gaining weight before this surgery will increase the take and breast size. This is completely false, which is pretty obvious if you think about it. The transferred fat is true to the native harvest site, so it goes up and down with your weight just like the original fat did. So if you gain weight prior to surgery, then transfer the fat, then lose the weight again, clearly your transferred fat will shrink in volume. If anything, go into surgery THIN. I have had fat transfer rates between 95-105% take with patients that simply LOSE a few pounds prior to surgery.”

What is the recovery like for fat grafting breast augmentation?

“The recovery for this procedure is rather minimal and can be compared to the recovery of liposuction. Breast pain minimal after this procedure however, patients may feel sore around the donor site. Like liposuction, patients wear a garment for a couple weeks after surgery, and they should also avoid high impact sports and push-ups so they do not traumatize the transferred fat.“

Are there risks associated with fat transfer to breasts?

“Fat transfer breast augmentation risks include fat necrosis (death of fat cells), oil cysts, and calcification from poor technique. We have a meticulous purification process and insertion technique that almost fully eliminates such risks.”

Is it better to perform fat grafting as a secondary surgery vs. all at once if I am removing my implants?

“I generally prefer to do fat-grafting during breast implant removal. It is completely safe, and allows some fullness that can help with sag and loose skin. If the patient’s goals are to achieve more than double their natural cup size however, we will need multiple sessions, so it is ideal to start during the initial layer of fat into the breasts to minimize additional surgeries.”

How long do I have to wait in between fat grafting sessions?

“Waiting 6 months between each fat grafting session is ideal to see how much of the fat from the previous session stayed. It also allows us to figure out he percentage fat take, which tends to be reliable from surgery to surgery. We check a 3D photo called a Vectra of the breasts, and that allows us to precisely measure changes in the breast volume and predict size and evaluate fat take.”

How do you prevent fat from turning hard and lumpy during fat grafting?

“I specialize in a meticulous process of processing and injecting to ensure the best results during my fat grafting procedures. Immediately after harvesting the fat, we purify the fat and then insert it into small volume 3cc syringes. The fat is carefully placed throughout the breast through small cannulas using 0.1 to 0.3cc strips. For 100cc of fat insertion, around 500 to 1000 individual “passes” are used in order to place the fat in even, spaced out aliquots like seeds in a field. This maximizes blood flow and nutrients for the new fat cells and minimizes fat necrosis. ”

Can fat grafting fix tuberous breasts?

“Fat grafting alone cannot fix a tuberous breast. Fat grafting can address the shape better than implants, however, because the implant shape can only be round, but fat can be grafted more like a “donut” type shape to add tissue where you are missing it most. For best results, debulking of the areola is still needed. If you are having a breast explant and your native breasts are tubular, it’s a perfect time to do a tuberous breast correction. During the explant, I have great access to the “back” side of the breast tissue, which is against the pectoralis major muscle. Using this posterior access, the extra tissue behind the areola is re-positioned. The areola then becomes smaller and the tissue is moved into typically thinner tissue under the breast to fill the deficient area with the patient’s own very own breast tissue. This also makes the nipples and areola higher and smaller, which is good for tuberous breast patient, who typically have larger and low appearing areola.”

I am thin, can I still get fat transfer to my breasts?

“Yes, even thin patients can be candidates, I can often find gift areas of fat on the arms and flanks. The ideal candidate should have at least 18% body fat. However, if patients are extremely thin with less than 10% body fat then this would make it much harder to find!”

I am planning to get fat transfer to the breasts. Do I need a breast lift?

“Typically, patients who opt for breast implant removal, I will recommend fat grafting, a pectoral muscle repair and either an internal or external breast lift. A good guess though is that if you look droopy BEFORE your implant removal, you will look even droopier after. So, if you need a lift now with implants in place, plan on having a lift when your implants are removed.”

Am I a good candidate for an internal breast lift?

“Patients are good candidates for an internal lift only with breast implant removal if the breast implant did not stretch out the skin and breast tissue too much. It typically brings the nipple upwards about 2cm, and helps the breast to look the same as it did before the removal instead of the typical sagging with removal only.”

What is internal breast lift vs. external breast lift?

“An internal lift uses the patient’s own breast tissue and internal suturing to hold up the breast to their restored position. There is no additional external scar. An external lift has an external scar, typically around the areola and possibly vertical between the bottom of the breast and the areola, and is made for lifting larger areas of the breast.”

What is a pectoral muscle repair?

“When the initial augmentation is performed under the muscle, the pectoral muscle is cut off the rib. One problem with implant removal is that the pectoral muscle moves too much with the implant gone, a condition called “pec flex” deformity or “windowshading”. The pectoral muscle is also weaker after augmentation, since some of the origin of the muscle is cut. This can be easily repaired during explanation, although for some reasons doctors rarely seem to perform this step. The lower edge of the cut pectoral muscle is sewn back on the rib, restoring the proper anatomical position of the muscle. This also prevents pec flex deformity, restores strength, and brings the breast together on top of the muscle, making the breast look fuller.”

I scar and keloid, what is my best option for a breast lift?

“If you keloid, the best technique is to make the smallest possible scar. An internal lift will most likely be recommended as an external breast lift is not the best option for any patient who keloids. If there is no choice, the proper keloid protocol is used to prevent scar post-operatively.”

My breast implants are big, what do you recommend to help with my breast’s appearance after breast implant removal?

“The breast implant size is less important than the ratio of fake to real and the natural elasticity of the breast. The patient most likely to need a lift is one with large implant, low amount of breast tissue, and a lot of sagging, non-elastic skin. For a nipple that is slightly too low, circumareolar mastopexy may be enough, where the scar is only around the areola. For more droopiness, vertical mastopexy may be necessary, where the scar extends down to the crease under the breast.”

Are you considering fat grafting breast augmentation and breast lift? To learn more about these procedures and your options contact our front desk concierge to schedule a consultation with breast specialist Dr. Lisa Cassileth at (310) 278-8200 or by requesting an appointment online.

Cassileth Plastic Surgery & Skin Care

Contact Cassileth Plastic Surgery to learn more about anything you see in our blog. Send a message online to arrange a consultation, or call (310) 278-8200.

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