Breast enlargement or reshaping: It's not all about the implants.

Convention dictates that breast enlargement surgery must be associated with breast implants, but are all the facts known and are there alternatives?

Silicone implants do have scares and controversies, which should be explained to all patients prior to deciding on their final procedure. These can include, hardened scar tissue causing pain and uneven skin, the risk of rupturing the implant, the risk of implant rippling, misshape displacement and breast pain. 

A Breast uplift or Mastopexy involves extensive scars, even if Breformtm mesh (surgical breast support) is used. The breast usually does drop slightly within a few months so reducing complete patient satisfaction unless the ‘internal bra’ Breformtm is used. In such cases Silicone implants are commonly offered to patients.

Despite the risks, well over 70% of women are happy with the results after silicone implants over a 10 year period. What about the others though?

With thought and maturity of experience, the best results from breast implants are those that gently enlarge the breast but result in a more natural shape, without being round or deformed.  

Over the past 20 years fat grafting of the Breast has come into fashion and offers filling of loose tissue and a tightening rejuvenation of skin. Around 200mls, just under half a pint, of harvested fat needs to be available in the individual for each breast and the operation may need to be repeated in the event of poor graft take. Sometimes the results can be amazing over the long term with very little in the way of illness. However, volume loss may occur but silicone implants can still be used at a later stage to improve the result, if needed. The benefits of liposuction from the unwanted areas and transfer to breast have dual purpose; to both improve the contour of the donor site and to create a fuller natural breast shape.

To succeed the fat must be carefully harvested and we use the proven Aquavage system provided by Eurosurgical. Tumescent fat is carefully aspirated under low suction pressure into a sealed container, transferred into syringes and methodically injected into the tissues surrounding the breast.

Small needle holes are used and there is very little in the way of residual scar or downtime. The fat graft needs 2 weeks to bed down and revascularise so smoking is prohibited and a comfortable soft bra is continuously used for 6 weeks to maximise fat survival. In addition straight after surgery cooling hilotherapy, or equivalent, is used. This is day surgery at its best and results can be amazing but without the inherent risks of silicone gel implants. Why take the risk, think Fat before Fact when it comes down to safety.  


Written by Professor James Frame, Consultant Plastic and Aesthetic Surgeon

Date: 19/07/2016