Fat grafting after implant removal takes fat by liposuction from elsewhere on your body and places it into the breast to restore some of the volume the implant was providing. It is not a like-for-like replacement, and the difference matters.
What it can realistically achieve
| Fat grafting | An implant | |
|---|---|---|
| Volume added | Modest, and limited by what the tissue will accept | Chosen; larger increases possible |
| Feel | Your own tissue | A device |
| Predictability | Some of the graft is reabsorbed; the final volume is not exact | Predictable |
| Sessions needed | Often more than one | One |
| Requires a donor site | Yes — abdomen, flanks or thighs | No |
| Device-related revision | None | Possible over a lifetime |
The honest limitation is the first row. Patients hoping fat grafting will replace a moderate or large implant are usually disappointed. Patients wanting to soften the transition after removal, restore some upper fullness and avoid another device are usually satisfied.
Reabsorption, plainly
Not all transferred fat survives. A proportion is reabsorbed over the first months, and the amount varies between patients and between areas. That is why more than one session is often needed, and why no surgeon can promise you a specific final volume.
It is also why the result is judged at six months rather than at six weeks.
Where the fat comes from
Abdomen, flanks or thighs, taken by liposuction. That has a side benefit for patients who also have contour concerns in those areas — and a limitation for very lean patients, who may not have a usable donor site.
The donor site has its own recovery: a compression garment for six weeks, bruising, and the firm lumpy stage between two and six weeks. Liposuction recovery.
Doing it at the same time as removal, or later
Grafting into a breast that has just had an implant removed is grafting into tissue that is swollen and changing, and the pocket left behind does not hold graft well. Where a meaningful volume is wanted, staging — removal first, grafting once the breast has settled over three to six months — usually gives a better and more predictable result.
Where only a small amount of softening is needed, doing it at the same operation can be reasonable. Dr Kumar will tell you which applies to you.
Does it affect breast screening?
Grafted fat can produce calcifications and areas of fat necrosis that show on mammography. These are generally distinguishable from cancer by an experienced radiologist, but you must tell the radiographer you have had fat grafting so the images are interpreted correctly. Continue routine screening as recommended for your age.
Medicare
The removal has its own item — 45548 or 45551 where at least half the capsule is excised and no prosthesis is inserted, the latter intended for capsular contracture, a mass in the capsule or evidence of BIA-ALCL.
Fat grafting performed for shape attracts no rebate. Where a lift is also performed and you meet item 45558, that item applies on its own criteria. What implant revision costs.
Common questions
How much volume can be added? Modest per session, and limited by your tissue and donor site. Dr Kumar will give you a realistic figure at consultation.
How many sessions? Often more than one where meaningful volume is wanted.
Does the fat last? What survives the first months generally stays, and behaves like your other fat — it changes with weight.
Can it replace a lift? No. Fat adds volume; it does not remove skin or reposition a nipple. Implant removal with a lift.
What about auto-augmentation instead? That uses your own breast tissue rather than transferred fat. Auto-augmentation.
Next step
Bring a GP referral — it is required to see Dr Kumar — and your implant cards. He will tell you honestly what fat grafting can achieve for your tissue. Call 1300 267 726. More about explant surgery and breast lift with fat grafting.
The initial consultation with Dr Kumar is $400, with a Medicare rebate of approximately $88 where you have a GP referral. Surgical fees are quoted individually after your consultation, in a written itemised quote.
All surgery carries risks, and individual results will vary. Read more about the risks of surgery here. A GP referral is required to see Dr Kumar.
Dr Rohit Kumar (MED0001630444) Registered medical practitioner, specialist plastic surgeon (specialist registration in surgery – plastic surgery).
