The Do’s and Don’ts of Fat Transfer Breast Augmentation Autologous fat grafting is currently one of the most talked about topics in modern Plastic Surgery. Not only do advanced fat grafting techniques render highly consistent results, but the option to use one’s own fat for shaping the ‘dream breast’ is very appealing to many patients. The procedure, known as breast lipoaugmentation because it uses fat for augmentation, also allows the surgeon some flexibility when giving the breasts their final shape since with silicone gel implants only, the possibility to mold the breast is somewhat limited.

Even the most diligent and perfectionized of fat grafting techniques has some limitations, the most important being what size of breast can be achieved in the time available. The maximum possible augmentation within one session at Hospital Quirón is limited to approximately 250cc per breast, which is a little more than one cup size. In one case however, we successfully transferred more than 400cc per breast in one session, although this was limited to various special circumstances.

The main reason for this limitation in volume is due to the limited recipient tissue bed. For safety reasons injection of fat into the actual breast gland is to be avoided. Fat can safely be transferred into the breast muscle, under the skin (subcutaneous) and into the so-called subglandular space. If done correctly, fat transfer into these anatomic locations yields excellent results, but of course space is limited. One most never inject so much fat that the pressure exerted by the augmented tissues may jeopardize survival of the fat. In other anatomic locations, such as the buttocks, these limitations do not exist. As a large muscle mass, the buttocks allows safe placement of very extensive fat grafts (1000cc or more into one buttock is not unusual).

So what happens if patients require a increase of more than one cup size? Any surgeon with a lot of experience in fat transfer breast augmentation will have his own protocol (“a lot of experience” refers to a minimum of 100 fat transfer cases a year). This is a much discussed topic since every surgeon here has their own opinion, but only several have the necessary experience and caseload which give that opinion sufficient weight.fat-transfer-breast-augmentation

Is vacuum expansion of the breast necessary before treatment?

Generally, vacuum expansion is not necessary before treatment. Pre-surgery vacuum expansion can be helpful for patients with limited fat resources and most importantly tight skin. Bearing in mind that transplanted fat does not tolerate pressure it may be beneficial to expand tissues before transplantation of the fat. The most popular way to do this is the so-called BRAVA external expansion bra, which has to be worn a few weeks before and after surgery. Expansion can also optimize fat intake by several per cent. We feel that it is beneficial in some fat transfer cases, but this is rather the exception. Mostly, expansion is unnecessary.

Does Fat transfer breast augmentation interfere with breast cancer detection?

No, definitely not. A 2009 comprehensive literature review found that there was no compelling evidence to show that fat grafts interfere with breast cancer detection. Women can take added steps to ensure their safety, such as a mammogram or MRI before the procedure to assist radiologists. Fat grafting to the breast is an accepted, safe procedure cleared by the American Society of Breast Surgery.

Will fat transfer breast augmentation lead to a superior aesthetic result?

In our experience, yes. Surgeons have greater control over the shape of the breast because they can target specific areas. Therefore fat transfer breast augmentation will have a better long-term result in the cleavage area; it is also an excellent way to conceal any possible gap between the breasts. Only in fat transfer cases do limitations regarding the possible amount of augmentation apply.

Can I have an increase of more than one cup size with fat transfer only breast augmentation?

Yes, absolutely but this will usually involve a second session and many of our patients opt for this. More specifically, this means that we augment each breast with the maximum safe amount in the first operation and about three months later we conduct a second session. This enables safe transfer of up to 500cc of fat with excellent recipient rates. Most patients desiring breast augmentation are happy to do this. However there has been an ongoing controversy regarding how much fat actually survives after lipoaugmentation, as well as fears about whether the procedure might make cancer detection more difficult.


  • Breast lipoaugmentation avoids the risks associated with alternative procedures like tissue grafts and implants.


  • Breast lipoaugmentation is limited to upgrading the breast by one cup size and so cannot provide the larger sizes associated with implants.
  • Between 20 to 25% of the transplanted fat is likely to die. This is because fat, as a living tissue, requires oxygen from the blood in order to survive. Research is ongoing to determine what combination of techniques might be best to prevent cell mortality; very promising work with bodily stem cells has been conducted recently.

According to, the unique advantages and drawbacks of breast lipoaugmentation make it especially well-suited to use in conjunction with breast implants. Instead of considering whether lipoaugmentation or implants might be appropriate, the article suggests that the best results may often arise from the two techniques working in tandem. Cirumed Clinic headed by Dr. Alexander Aslani, is a European leader in large volume fat transfer surgery, both for aesthetic as well as reconstructive procedures.. Our surgeons are specialized in using BodyJet Water Jetstream technology for fat grafting especially of the buttocks and breasts.

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If you require further detailed information on the Brazilian butt lift and BodyJet EVO waterjet liposculpture at the Department of Plastic Aesthetic and Reconstructive Surgery at Hospital Quirón Malaga, Hospital Quirón Marbella or Cirumed Clinic Marbella, please contact us.