Breast Lift with Fat Grafting (Mastopexy with Fat Transfer)

After major weight loss the breast changes in two directions at once. Volume is lost, most noticeably from the upper part of the breast, while the skin envelope stays stretched. The result is a breast that is both emptier and lower, and a lift on its own does not put back what has gone.

• What weight loss does to the breast
• Lift, fat or implant
• Are you a candidate
• The operation
• How much volume survives
• Recovery
• Scars, sensation and screening
• Risks
• Cost and Medicare
• Common questions

What major weight loss does to the breast

Breast tissue is largely fat. When a large amount of weight comes off, the breast loses volume along with everywhere else, and it loses it disproportionately from the upper pole, the part that gives a breast its fullness in a bra or a fitted top. At the same time the skin, which has been stretched for years, does not contract. The nipple descends, the areola widens, and the remaining tissue settles into the lower part of the envelope.

Women describe the result as deflation rather than sagging, and the distinction matters surgically. A breast that has simply dropped can be lifted. A breast that has emptied and dropped needs both the lift and something to replace the lost volume, or the lifted breast still looks flat at the top.

Lift alone, lift with fat grafting, or lift with an implant

Option	When it suits
Mastopexy alone	Enough breast tissue remains to make a good shape once the skin is tightened and the nipple repositioned. No foreign material, shortest operation. See breast lift (mastopexy).
Mastopexy with fat grafting	The breast is deflated as well as loose, and there is fat available elsewhere, typically the abdomen, flanks or thighs. Upper pole fullness is restored with your own tissue. No implant, no implant-related revision surgery later, and the donor area is reduced at the same time. Volume gain is moderate rather than large.
Mastopexy with an implant	A larger or more defined increase in volume is wanted than fat grafting can reliably provide, or there is very little donor fat. Brings implant-related considerations, including the likelihood of further surgery over a lifetime. See breast augmentation.

After major weight loss the middle option is frequently the best fit, because the patient has loose skin and unwanted fat in the same body and an implant is not what she is asking for. It is not automatically the right answer, and Dr Kumar will say so where it is not.

Are you a candidate?

Very lean patients are often not suitable, simply because there is not enough fat to harvest. A personal history of breast cancer, a strong family history, or a previously abnormal mammogram does not rule the procedure out but does change the assessment and the imaging that is arranged beforehand.

What the operation involves

The operation has three parts, done in one anaesthetic.

Harvest

Fat is taken by liposuction from an agreed donor area, most often the abdomen, flanks or outer thighs. The donor area is contoured as part of the procedure, which is frequently a benefit rather than an incidental step for a patient after weight loss.

Processing

The harvested fat is processed to separate viable fat cells from fluid, blood and oil. Gentle handling at low pressure matters here: the proportion of the graft that survives depends heavily on how the fat is harvested and prepared.

Lift and graft

The mastopexy is then performed, reshaping the breast tissue and moving the nipple and areola to a position that matches the new breast mound. A vertical pattern is used where the lift required is moderate; an inverted-T pattern where more skin has to be removed, which is common after significant weight loss. Fat is injected in fine passes into the subcutaneous layer and behind the gland onto the pectoral fascia, building fullness where the upper pole has emptied. Fat is not injected as a single bolus, because a large deposit in one place is what produces oil cysts and fat necrosis.

How much volume survives

This is the part most worth understanding before you commit. Transferred fat needs a blood supply to survive, and not all of it establishes one. A proportion is reabsorbed over the first three to six months. Published survival rates for fat grafting to the breast vary widely between studies and between patients, and no surgeon can tell you in advance exactly what your result will be. What is reliable is the direction: the volume you see at six months is close to the volume you keep, and a second, smaller grafting session is sometimes planned from the outset where a larger increase is wanted.

The practical implication is that fat grafting is a refinement of shape rather than a way to add a large amount of size. If you are after a substantial increase in volume, an implant is the honest answer and will be put to you as such.

Recovery, week by week

When	What to expect
Day of surgery	Day case or one night. Where the breast surgery is combined with an abdominoplasty or body lift, expect a minimum of three nights in hospital. A post-surgical bra is fitted before you leave, and compression is applied to the liposuction donor area.
Days 2 to 7	The donor site is usually more uncomfortable than the breast. Bruising peaks. Walking from day one, no lifting.
Week 2	Most patients return to desk work. Support bra worn day and night, and pressure on the breast is avoided so the graft is not disturbed.
Weeks 4 to 6	Lower body and cardiovascular exercise resume. Upper body training and running are held until around six weeks.
3 to 6 months	Graft take settles and the volume you can see is close to the volume that will remain. Swelling in the donor area resolves over this period.
6 to 12 months	Scars soften and fade. Dr Kumar reviews his surgical patients for twelve months after surgery, and questions about refinement are usually better answered late in that year than early.

Scars, sensation, breastfeeding and breast screening

Scars run around the areola, vertically down to the crease and, with an inverted-T pattern, along the crease itself. They are permanent. They remain firm and pink for several months, soften over the first year and continue to remodel beyond it. Dressings and scar care are supplied and managed by Dr Kumar’s team to a set protocol.

Sensation in the nipple is commonly altered for a period after a mastopexy and can be permanently changed. Breastfeeding may be possible afterwards but cannot be relied upon, and that should be weighed if you are planning a pregnancy.

Fat grafting to the breast can produce areas of fat necrosis, oil cysts and calcification that are visible on mammography. These have a recognisable appearance to a radiologist, but you should tell the imaging service that you have had fat grafting so that the images are read with that in mind. Fat grafting does not remove the need for routine breast screening, and Dr Kumar will discuss appropriate imaging before and after surgery based on your age and history.

Risks and complications

All surgery carries risk. The complications relevant to a breast lift with fat grafting are:

Smoking, unstable weight and poor nutrition all increase these risks. Nutritional deficiencies after bariatric surgery, particularly protein, iron and vitamin B12, affect wound healing, which is why Dr Kumar’s team will offer to refer you to his Accredited Practising Dietitian before surgery.

Please read more about the risks of surgery here before making a decision.

Cost and Medicare

Dr Kumar’s initial consultation fee is $400, with a Medicare rebate of approximately $84 available with a referral from your GP. Surgical fees are quoted individually after consultation. The practice does not publish package prices for breast or body surgery.

The two parts of this operation are treated differently by Medicare. The mastopexy may attract a rebate under item 45558, which requires that at least two thirds of the breast tissue, including the nipple, lies below the inframammary fold, with the nipple at the most dependent part of the breast, and that photographic evidence including anterior and both lateral views, with a marker at the level of the fold, is documented in your notes. That item is claimable once per lifetime other than in defined reconstructive circumstances.

The fat grafting component is not rebatable in this setting. The autologous fat grafting items, 45534 and 45535, are restricted to defects arising from breast cancer treatment or its prevention, preparation of irradiated or thin skin flaps, breast reconstruction, and correction of developmental disorders of the breast. Fat grafting to restore volume lost through weight loss does not fall within those indications.

Eligibility is assessed at consultation. See our guide to Medicare rebates and plastic surgery and costs and payment for payment plans and what a quote includes.

Results

Surgical photographs are restricted to viewers aged 18 and over. The outcomes shown in any photograph are relevant only to the patient pictured, and individual results will vary. You can view the before and after gallery, and the breast surgery section sets out the full range of breast procedures.

Where Dr Kumar operates

Consultations are held at Westmead, Penrith and Orange, so you can be seen at whichever is closest to you.

Surgery is a separate question. Breast and body contouring after weight loss is performed at Westmead Private Hospital, a fully accredited facility operated by Ramsay Health Care, where the inpatient ward and the nursing team are set up for it. Somerset Specialist Centre in Penrith, operated by Cura Day Hospitals Group, is used for day-case procedures.

Dr Kumar’s nurses also work on the wards at Westmead Private Hospital. The nurses who prepare you for surgery are the same ones who look after you at every post-operative review, and they measure and supply your compression garments and manage wound and scar care throughout.

Common questions