Dr Michał Chartytonowicz Chirurg Plastyk

Which breast augmentation method is better? Autologous fat transfer or breast implants?

Medical practitioners have been trying to find the best method of breast enlargement since the time women started to dream about fuller breasts. The best method is one that will meet the patient's expectations regarding size, shape and natural feel.

Currently we have two main breast augmentation methods that offer very good results. Which one is better? The better method is the one which, suited to the patient's requirements and used by an experienced plastic surgeon, will enable the achievement of the desired outcome. Each method has both advantages and disadvantages. They have one thing in common - they are both safe and tested.

And this post will be about the above advantages and disadvantages

Breast implants were first used more than 55 years ago. Since that time they have undergone an evolution which gradually eliminated their drawbacks. Currently we are using 5th generation implants. Breast prostheses have been thoroughly tested in multicentre studies, which allows to regards them as a safe breast enlargement method. Obviously, they are not ideal: capsular contracture, implant rotation, BIA ALCL (breast implant-associated anaplastic large cell lymphoma) are among their most serious drawbacks. During consultations I always spend a lot of time discussing them. The patient's safety both during and after the procedure is the top priority.

            Although known for more than 100 years, lipofilling (own fat transfer) has been used in its current form by plastic surgeons from the mid-1990s. Progress in harvesting techniques and in processing but first of all in grafting made fat transfer a widely applied method. A dozen or so years of intensive research confirmed the oncologic safety of the method.

The use of breast implants enables a stable effect immediately after the procedure. The patient "wakes up with new breasts".  When a graft is used, the final outcome will be visible a bit later.  A correctly performed lipofilling allows the survival of approximately 50-70% of the fatty tissue.  A larger volume of retained graft is achieved by using an adequate surgical method and the Brava system (a special bra creating a slight vacuum pressure causing better blood supply to the breast and consequently enhancing the survival of the fat graft).

The patient's decision is most often motivated by the number of procedures required to achieve the desired result. Breast augmentation using implants is obtained during a single procedure, while the same increase in breast size will be achieved by repeating a lipotransfer two or three times (depending on the expected size), which increases the cost.  It should be remembered however that when deciding to have breast implants inserted the patient accepts the risk of a re-do surgery in the future. Although very small, the risk still exists. A well-taken fat graft becomes an integral breast tissue, so there is no risk.

If the patient wishes to have very large breasts, implants will be a better option. The huge range of their sizes and shapes allows to meet the patient's expectations. To achieve the same  result using lipofilling would require too many procedures. A fatty tissue graft will give very natural-looking breasts but will not allow to achieve large volumes.

In plastic surgery, surgical technique is key.  Breast augmentation using implants is not a simple procedure. When selecting implants, the patient's expectations need to be reconciled with her anatomy. The final result is also determined by precise preoperative planning.

Lipofilling is equally demanding for the plastic surgeon. Harvesting the fat for the graft is nothing else than liposuction, or the procedure during which the surgeon shapes a given area of the patient's body. The next stages involve adequate preparation of the tissue for transfer and, what is most important, a proper placement technique. It must take into account not only the volume of the fat transfer but also the injection location. The above enables the achievement of the right proportions and shape of the new breasts. It should be remembered that excessive volume of the fat graft placed during a single procedure does not increase the volume of retained graft, causing only a higher resorption of the graft.


So, which method is better?

Both techniques are safe, both have been tested, both allow to achieve very good outcomes. The most important thing is to select the surgical method that is best suited to the patient. A very good aesthetic result will be achieved only when an understanding of the patient's expectations is combined with a thorough knowledge of the advantages and disadvantages of the method.