A Plastic Surgeon Breaks Down the Differences Between Fat Grafting and Implants

The world of breast augmentations can be a hard one to sift through if you don’t know the facts, and New York plastic surgeon William Lao, MD is breaking down what we need to know about fat grafting and implants. “When it comes to breast augmentations, these are the two types I perform frequently in my practice,” he says. “An augmentation with fat grafting uses liposuction to take fat from other parts of your body and inject it into your breasts, and an augmentation with breast implants uses the implant to bump up your breast size and make it appear fuller.” While he urges patients to talk through their best route with a board-certified plastic surgeon, he says it doesn’t hurt to know the differences between these two augmentation options before you head to the office.

Pros and Cons

“Both types of breast augmentations have pros and cons,” says Dr. Lao. “The pros of implants are that they offer very nice structural support, so they’re great for people who have volume loss from things like breastfeeding. A breast implant can also lift the breast and give you whatever size you desire, as there are many to choose from.” Although Dr. Lao praises breast implants for their ability to fill and lift, he offers a disadvantage, too: “it requires surgically placing a foreign body into the breast area. A foreign body may be a cause for secondary surgeries down the line.”

Fat grafting, on the other hand, has an entirely different slew of advantages and disadvantages. “The advantage of fat grafting is that you can kill two birds with one stone by taking fat away from places where you don’t want it—like your belly or love handles—and you can use that fat to make your breasts appear larger,” he says. “It also is great for patients who want a small part of their breast augmented, like an upper pull or a small area that needs correcting.”

But, Dr. Lao says the downside is that your results are more unpredictable, meaning a lot of the fat you inject to the area will be reabsorbed by your body. “For example, if we inject 400 CC of fat into one breast, you will probably be left with 100 to 200 CCs. It also doesn’t offer the same kind of structural support that an implant does. If you have a sagging breast, fat grafting will just give you a bigger saggy breast. It is also important to note that you must have fat on your body to pull from in order to undergo fat grafting. If you are very thin, this may not be the best option for you. It is important to speak to a board-certified plastic surgeon to talk about your expectations and which surgery is right for you.”

Recovery Time

“For breast augmentation with an implant, the pain afterwards is just going to be around the breast,” says Dr. Lao. “Most pain is within the first two to three days and it is very controllable with pain medicine. After those first two three days, you should feel very good. However, the patient should wait at least a month before getting back into a normal exercise routine like running or swimming.”

When it comes to fat grafting, he explains that the recovery depends on how many areas are receiving liposuction to obtain the fat. “If you take fat from five different areas, you’ll have pain in five different areas. If you receive liposuction in just two areas, you’ll only have pain in those two areas.”

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“Between 70 and 80 percent of the augmentations I perform are with implants because not many of my patients have a lot of fat, so a breast augmentation with fat grafting isn’t in the cards for them,” Dr. Lao continues. “My most common request is to go from a size A to a size C cup, because C makes your breast look like it has a nice shape and size, but it’s not too big. However, on the other hand, D or double D sizes can look a little bit big and unnatural.”

Round Two

One common reason to perform a second-time breast implant surgery is if the patient wants a size change, but Dr. Lao says this can be totally avoidable by good communication before surgery. “We use a 3D system to help our patients decide which size they want, and we also give them the real implant to touch and feel beforehand.”

Another reason for a second-time surgery with implants is something called capsule contracture, “a special phenomenon meaning any time you implant a foreign body into your system, your body can naturally form a capsule around it.” According to Dr. Lao, “This capsule can harden and thicken, and then it makes the breast feel hard. This is the most common reason for second-time breast surgery after an implant. Probably around 10 percent of patients experience this, but it varies between implant companies.”

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