Can Breast Fat Grafting Be Done With Implant Removal?

Q: Dr. Eppley, I am interested in removing my breast implants and doing fat grafting as a replacement. I’ve had two children and after their births, I lost a lot of volume and my areolas stretched quite a bit. Currently, I have 350 cc saline implants making me a full C-cup. I was hoping to get a donut lift with areola reduction and fat grafting. I don’t expect to be a full C-cup again but what type of volume replacement could I expect?

A: While breast implants can be ‘replaced’ with fat grafting, it is important to appreciate several concepts about breast fat grafting. The success of any fat grafting procedure is dependent on the amount of fat one has to harvest and how much of the injected fat survives. Each part of the fat grafting process has a depreciating value. This means for example if 1000cc of fat aspirate can be harvested, when it is reduced (concentrated for each injection) the amount of fat available for grafting will be 1/3 to 1/2 of the harvest. (1000cc = 500cc) When the fat is injected only a percent of it will survive. While that percent can be quite variable for each patient (0 to 100%), let us assume the average take is 50% of the injected fat. (250cc) When you do this math for each breast, the final volume replacement of a 350cc implant will be 125cc of fat volume. (and this assumes that you would have 1000cc of fat to harvest) So you are correct in assuming that you would not be a full C cup with fat replacement but more likely a small to medium B cup. Thus it is easy to see that replacing implants with fat grafting is not close to a 1:1 exchange and the trade-off for a natural replacement will be loss of 50% to 75% of what the implant volume provided. Of course it is also possible that you may have greater than a 1000cc fat aspirate obtainable and then the volume replacement will be somewhat better.