Breast Implants or autologous fat transfer? Your one-stop guide to Breast augmentation

For many women, the appearance of their breasts is very important to them. In fact, many women are interested in breast augmentation surgery to have bigger breasts. In Singapore, there are 2 main types of breast augmentation surgery: Breast implants and Autologous fat transfer.

Both procedures are effective at augmenting the breasts. However, their similarities end there, as the 2 procedures have distinct advantages and limitations.

Breast implants

Of the 2 procedures, breasts implant surgery usually comes to mind first when “breast augmentation” is mentioned. Like the name suggests, this procedure involves the insertion artificially made implants to add volume to the breasts. These implants usually have a medical-grade silicone shell with saline or silicone gel filling. They are also available in different sizes, and shapes such as round and teardrop. Some brands like Motiva also offer premium implants that flow naturally with a woman’s movements, mimicking those of natural breasts.

Breast implants can be inserted with 3 different approaches:

• Under the muscle: This is the most common and popular approach as the incision is well-concealed within the folds of the breasts. Also, this approach is least likely to damage muscles and milk glands.
• Above the muscle/Through the nipple: This approach is usually not recommended as it is likely to damage milk glands and other breast tissue. However, some patients have claimed that this approach causes less post-surgery discomfort
• Through the armpit: This is the most challenging approach for the surgeon as the incision point is the furthest from the breasts. However, the scars will be well-concealed in the armpit and may not be associated with the breast.

Nevertheless, most surgeons will only choose round implants for this due to the difficulty of this procedure.

Advantages and limitations of breast implants

Advantages:

• Breast implants typically produce well-predictable, consistent results as the implants are of standardised shapes and sizes. Although results cannot be completely guaranteed, they are more than consistent enough for all intents and purposes.
• Only one part of the body needs to be operated on when inserting implants, unlike fat transfer
• Pre-operation preparation is about 4 weeks, which can be much shorter than fat transfer.
• In most cases, implants can be easily removed should the you decide to do so.
• Large augmentations of more than 1 cup size is possible, provided that suitable implants are available

Limitations

• Breast implants can become damaged from wear and tear, and may need to be replaced with follow-up surgery in this case. However, this is rare and only happens after many years.
• In rare cases, the implants can rupture, which will require immediate surgery.
• Scars from breast implant surgery are usually more visible than fat transfer
• Implants may look/feel unnatural to some people, especially if the size/shape are poorly chosen.
• The implant may extrude itself and become visible as an unnatural budge on the skin surface

Autologous Fat Transfer to breasts

In this approach, fat harvested from other parts of the body is used to add volume to the breasts. The donor areas are usually areas with excess subcutaneous fat like the abdomen, buttocks and thighs. A liposuction machine and cannula are used to extract the fat tissue via a small incision. This fat is purified in a centrifuge and injected into the desired areas in the breast, usually in multiple positions.

Advantages and limitations of autologous fat transfer

Advantages:

• Results from fat grafting typically looks and feels very natural
• There are low risks of immune system related complications (like allergic reactions and rejection) as natural fat from your own body is used to add volume.
• Fat transfer leave much less visible scars
• Injected fat is incorporated naturally into existing breast tissue by the body, hence there is no risk of extrusion and ruptured “implants”
• Allows for minor adjustments in breast sizes, something that is usually not possible using breast implants
• Can be conveniently performed together with liposuction for better body contouring

Limitations

• Depending on the approach used, the pre-operation preparation time may be much longer than breast implants. In some approaches, the breast skin may need to be manually loosened and expanded using a specialised system (BRAVA) for up to 3 months.
• The enlargement is limited by the amount of excess fat you have. This typically limits the augmentation to 1 cup size, or even lesser if you are naturally lean.
• The results are usually less predictable/consistent as:
  o Usually only 60 to 80% of the transplanted fat cells survive
  o Transplanted fat does not have a well-defined shape, unlike standardised implants.
  o Long-term results can be affected by drastic lifestyle/diet changes, as the fat cells can shrink in size.
• Injected fat has a chance to calcify, potentially affecting future mammographs

Comparison of breast implants and autologous fat transfer side-by-side

	Breast Implants	Autologous Fat Transfer
Pre-Op Preparation time	Around 1 month	Up to 3 months, depending on the approach
Operation duration	1 to 2 hours	1 to 3 hours
Downtime	2 days of stay-home rest No strenuous activities for 4 weeks
Post-Op recovery/follow-up	Up to 3 months.   A compression garment is required for about 2 weeks	Up to 3 months.   A compression garment is required for about 2 weeks   Some diet/exercise therapy may be needed
Size/extent of augmentation	Large augmentations (more than 1 cup size) are possible.   Minor adjustments are usually not possible	Large augmentations are usually not possible.   However, minor adjustments are possible
Look and feel post-surgery	May look/feel unnatural depending on the type/size of implant used	More natural look/feel compared to implants
Scars	Inconspicuous, but usually more visible than fat transfer	Less visible than implants
Consistency	Very consistent as implants are of standardised sizes and shapes and surgery procedures	Survival rates of transplanted fat is inconsistent (typically between 60 to 80%)   Transplanted fat does not have a defined shape, giving less predictable results
Longevity	Effectively permanent, but implants can become damaged from wear and tear. May need replacement if damaged.	Surviving fat cells become part of the breast so there is less need for maintenance.
Risks of complications	Higher	Lower
Breastfeeding	Breastfeeding is usually not affected
Mammograms	Implants do not affect mammograms	Depending on the injection site, some of the fat may calcify, affecting future mammograms
Surgery sites	Breasts only	Breasts and donor area
Combinable with other plastic surgeries?	Usually performed alone	Usually combined with liposuction for better body contouring

Which procedure is more suitable for me?

The preferred type of breast augmentation surgery is largely dependent on individual preference, body contours and health conditions. Still, here are some general guidelines which you can follow:

Breast implants are more suitable if:

• Large augmentation (more than 1 cup size) and/or a more defined shape is desired
• You do not want to undergo liposuction
• You want more certainty in the results
• You are naturally lean and may not have enough fat for fat transfer

Autologous fat transfer is more suitable if:

• Smaller adjustments (less than 1 cup size) are desired
• You want your breasts to look/feel more natural
• You are considering liposuction on other parts of your body
• You want lower risks of complications
• You do not want visible scars

Conclusion

We understand that the decision to perform breast augmentation surgery is a very personal one, and you would definitely want the best of yourself. Hence, it is important to weigh the options carefully and decide which factors are the most important to you. We hope that this article was informative in helping you make your decision.

Ultimately, the most important thing is to consult a reputable and experienced plastic surgeon for your breast augmentation procedure. This will ensure that whichever option you choose, you are more likely to be satisfied with the results.