Dr. Wong Thoughts


posted April 12th, 2013 by waesthetics in Breast Augmentation

Breast enlargement has traditionally been done with breast implants. Advances in these devices means that today breast implants are safer, more predictable and able to deliver better results for patients. At the same time, breast enlargement with fat grafting has also matured as a technique and today offers a viable alternative for patients seeking to naturally enlarge their breasts. It is increasingly popular with patients who would like to enlarge their breast but were not keen to consider the use of breast implants.

As to what technique, implant vs. fat grafting, should be used or that are best suited the needs of an individual patient, it depends on the patient preference and aesthetic goals. While both techniques can enlarge the breast, the degree of enlargement and the ‘look’ achievable is slightly different and generally patients would instinctively know what they are looking for.

Figure 1: Breast implants will achieve a more significant degree of breast augmentation than is generally achievable with fat grafting. The breast looks firmer, more ‘perky’ and project to a greater degree. This is particularly so in thinner patients. For patients wanting a more natural look, smaller implants should be selected. If one prefers, larger implants will give a more stylized or operated ‘look’.

Breast implants as a medical devise has matured significantly over the past few years with the use of more cohesive gels that reduces the risk of the silicone leaking and the use of anatomical or tear-drop shaped implants. Patients now have an option of selecting either the classical round shaped implants or tear shaped implants. Generally round implants gives more fullness in the upper part of the breast (in the cleavage area), while a tear shaped implant gives more fullness in the lower part of the breast, for patients wanting to achieve a more natural looking breast. These new generation breast implants are safer and are able to not only give the breast greater volume but also a more beautiful shape and even lifting the droopy breast to a certain degree. Breast implants give a more perky and fuller ‘look’ to the breast (Figure 1). Breast implant are particularly suitable for patients looking to significantly enlarge their breast.

Figure 2: Fat grating gives a softer and more natural look to the breast. Fat grating if ideal for patients looking to modestly enlarge their breast and for patients wanting to fill out deflation of their breast after pregnancy or breast feeding.

Fat grafting to the breast on the other hand serves a different group of patients. These are generally patients are looking to enlarge their breast but are not comfortable with the prospect of having an implant in their breast or are not looking for the breast ‘implant’ look. Fat grating gives a softer and rounder ‘look’ to the breast. They are particularly suitable for patients looking to modestly enlarge their breast (Figure 2). The art of fat grafting is also conceptually different from breast implant surgery. Fat grating is in essence a transplantation procedure. Fat is taken from one part of the body (usually the abdomen or hips) and transplanted into the breast. It is a highly operator dependent procedure and depending on the technique used the fat graft survival do differ. Because the fat graft rely on the surrounding tissues to provide the needed nourishment for it to survive, it also means that depending on the availability of the breast tissues, the amount of fat grafts that can be predictably implanted each time differs. For patients with larger breast, more can be grafted. Conversely for patients with smaller breast, less can be grafted. What this means is that patients with smaller breast may need 2 or even 3 sessions (or surgery) to achieve the enlargement that they desire. To temporarily enlarge the breast (to allow for more ‘space’ to graft the fat), a suction devise called the BRAVA device may also be used. The use of BRAVA gives a better result with fat grafting.

As to the question of weather one should choose breast implant vs. breast fat grafting, it is an important decision that the patient should make only after careful consideration and detailed discussions with the plastic surgeon. There are pros and cons, advantages and limitations of each procedure. Ultimately, either technique would significantly enhance the aesthetics of the breast and it’s a matter of personal choice, preference and even taste.