Your Questions

Q: Dr. Eppley, I am writing concerning liposuction and fat grafting into my breasts. (fat injection breast augmentation) I am curious as to if this surgery could be performed by mid April if I were to schedule immediately. I am 18 and my high school prom is April 30, so I was wanting this as soon as possible. Also, can liposuction incisions be made through previously existing laparoscopic scars? Thank you.

A: The first question about your potential procedure is whether you are a good candidate for breast augmentation by fat injections. The key question is whether you have enough fat to harvest to create enough of a breast size increase to justify the procedure. While the operation is understandably appealing, few women are actually good candidates for it…they either don’t have enough fat to harvest (it takes a lot more than most people think) or their breast size increase goals are not realistic with what fat grafting can achieve. (usually about a half cup size is the typical outcome) Thus it it important to understand that breast implants and fat grafting are not really interchangeable procedures in terms of their outcome.

There are a variety of secondary issues that are also relevant. If you have the procedure by mid-April you would be barely recovered to go to a prom by April 30th. Also more small incisions would be needed to harvest fat than just that from laparoscopic scars. That is because abdominal liposuction alone is unlikely to have enough fat in most people to do a worthwhile fat injection breast augmentation procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,  I am interested in breast augmentation by fat injections. I have no interest in implants whatsoever. I’ve attached a couple pictures for assessment. Do you think I would get a reasonable breast augmentation result (one to two cup sizes bigger) if the fat was taken by liposuction from just my abdomen and flanks. I just weighed myself this morning and my weight is around 170, but I’m typically 165. I’m approximately 5’7” tall.

A: Thank you for sending your pictures and your inquiry in fat injection breast augmentation. I think you have  a low amount of fat to harvest to do the procedure given what your breasts are initially like and what your goals are. They have several unfavorable characteristics including a very narrow breast base with large areolae, breast mounds that are very widely separated and a very wide chest width. It would take more fat than you have to inject your breasts to increase the size of your breast mounds to the level that you are seeking. With the amount of fat needed and the assured loss of 50% of what is injected, your breast augmentation result is not going to meet your goals. If you can accept more modest goals such as a 1/2 cup to maybe one cup size bigger, then you become a better candidate for fat injection breast augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I want to know the cost of fat transfer breast augmentation procedure. (fat injection breast augmentation) What is the time needed for prepping before surgery with the Brava bra? How long does the procedure take? Will there be any scarring?

A: Thank you for your inquiry. The first place to start in this type of breast augmentation is to determine whether you are a good candidate or not. There are many more variables in fat injection breast augmentation than in breast implant augmentation in determining a successful outcome. When using a breast implant, the final volume is assured regardless of the overlying breast soft tissues as the implant is firmer than they are and it provides a good push outward. Also whatever implant volume is placed will remain no matter the healing process and how the body responds to it. Picking a target volume is also assured although what implant creates the desired breast look is still as much art as it is science.

Fat injection breast augmentation is a completely different animal in  which achieving even a modest permanent breast size change depends on numerous factors. The key ones are how much fat you have to harvest, how much natural breast tissue you have, the tightness/looseness of the overlying breast mound, and what your breast size expectations are. There is also the unknown variables of how well the fat will survive, does one need multiple fat grafting sessions and is the use of the Brava device absolutely necessary. Lastly there is the expectation level of the patient and are they prepared to accept these unknown and costs that will substantially exceed what breast implant surgery costs.

To help you make this determination I will need to evaluate you. This can be done by sending pictures and height and weight numbers or come into the office for a more thorough one on one discussion.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I saw you back in July and was inquiring about Saddlebag removal. We also discussed Fat Grafting my breasts. Definitely, want to remove the saddle bags. I have a couple questions about the Grafting.

 I understand it’s not a guarantee that it will stick, but based on your experience:

1. Have you performed this several times?

2. Is there a risk of them being uneven?

3. Is there any discoloration?

4. What would be the major risks of performing this procedure?

5. What’s the recovery time?

A: Good to hear from you again. In answer to your questions about fat injection breast augmentation (FIBA):

1) Fat grafting to the breasts has become more common in the past five years and is a safe method of breast augmentation that is now formally acknowledged by the American Society of Plastic Surgeons in their position paper on the procedure published last year.

2) I do perform FIBA in properly selected patients. A properly selected patient fulfills the following criteria:

a) Absolutely opposed to the use of breast implants

b) Is accepting of a modest 1/2 cup to maybe full cup size breast increase with maximal fat take

c) Has reasonable donor fat areas from which to harvest (enough to make the procedure worthwhile)

d) Is accepting that fat grafting by injection has unpredictable volume retention (outcome can not be assured)

3) It has been my experience that about 50% or less of the fat injectate into the breasts persists. Volume retention is the main risk, not unevenness or lumps.

The real question in your case is whether the amount of fat harvested from your saddle bags alone is sufficient for a FIBA procedure. The answer is probably not. The only reason to do it in your case is because the fat is otherwise going to be thrown away and maybe 1/4 to 1/3 cup size increase may be better than where you are now. But if your goal is one to two cups sizes bigger, then implants are the only options to achieve that goal.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a natural breast augmentation that will last and hopefully not need to be redone repeatedly. Also, I can not support stem cell enriched augmentation if the source of such cells is from aborted babies. Is this the only source? What is being done such as in other countries?  I am also wondering about the possible risk of cancer cells growing from such a procedure. The only info I could find about that seemed to be related to women who had the procedure following a lumpectomy or mastectomy.

Do you recommend the fat transfer procedures? I am not comfortable with the silicone or saline options because of the risks.

I am very small busted and have breast fed many children and now have nearly nothing left.I was small to begin with and now that my last baby is weaned, it is quite different than lactating. Thank you for the information.

A: What you are seeking in natural breast augmentation is the holy grail…natural, permanent, and does not involve an implant. By today’s techniques, you are seeking something that does not yet exist. Natural breast augmentation today uses one’s own fat that is processed and then injected and may have some viable stem cells in it. Besides having to have enough to fat to harvest and use, one has to accept the unpredictability of how much fat will survive and whether it survive smoothly without irregularites. There is also the risk that the procedure may have to be repeated depending upon how much fat survives during the first procedure. What is not known about fat transfer is if it increases the risk of breast cancer although this is believed to not be a concern.

While fat injection breast augmentation is done today and is becoming more mainstream, it is still restricted to a very few women who have the right physical qualifications for it. It is far from a breast augmentation technique that is perfected. For a reliable breast augmentation result that produces an immediate and predictable result, implants a much more reliable technique despite the limitations of being a medical device.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, How can I be a part of the FDA-approved clinical study for stem cell enriched breast augmentation?

A: To the best of my knowledge, there is no current FDA study that is evaluating stem cell enriched breast augmentation. Some plastic surgeons use the term ‘stem cell enriched’ when breast augmentation is done by fat injections, but that is neither part of an FDA sanctioned study nor is it truly stem cell enriched. Since all harvested and processed fat contains stem cells, calling fat injections stem cell enriched is a very liberal use of that term. (more bluntly an exaggeration) True stem cell enrichment would mean that stem cells are isolated and then put back into fat injections in a very concentrated form with high numbers of active cells. That is a quite different process that simple fat harvest and concentration.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had fat injection breast augmentation done six months that had a lot of problems afterward. There was drainage from under the left breast for three weeks after the procedure. I was put on antibiotics to treat it but was told the rubbing of my bra on it was the cause. Then a month later my right breast developed a large painful lump that turned out to be an abscess which required more antibiotics and needle drainage. I am now left with one breast bigger than the other and one of them is lumpy. The doctor now wants to do the procedure again but this time using the Brava device. Will this make a difference and make it more likely that the fat grafts will take? My doctor is an ObGyn who specializes in cosmetic surgery but my first experience has now made me nervous.

A: Unlike breast implants, the use of fat injections for breast augmentation is not an assured outcome. As you know and have experienced, the take of injected fat is subject to a wide variety of factors not all of which is completely understood. The take of injected fat is highly dependent on the harvesting, method of preparation and the injection technique. While the injection of fat seems like, just like the liposuction of fat, successful results ultimately depend on surgeon experience and attention to technique details.

The concept of using the Brava device is a good initial approach for small breasts with a tight skin envelope. Whether that would have been advised for your first fat grafting surgery is now irrelevant but should probably be considered for any second stage. But it is important to remember that the Brava device is an adjunctive procedure to prepare the recipient breast bed, it is not the magical solution or a substitute for adhering to sound fat graft harvest, preparation and injection principles.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a fat injection breast augmentation done one month ago. I took a vacation one week after surgery and I was fine. Well exactly two weeks after my procedure I noticed my left breast was bigger, swollen, tender, painful, and very warm. I thought nothing of it and my doctor said it was normal. When I questioned why my right breast didn’t feel that way he said each breast healed differently. Well the next day after my symptoms got worse and I felt dizzy and weak. I woke up soaked and noticed a yellowish pinkish discharge leaking from my left breasts incision. I ran to the ER and was admitted for 6 days. I had an abcess and required surgery for drainage. I was given a lot of antibiotics and I’m now having to clean and change dressing twice daily. This has been a total nightmare! How long will it take for my infection to go away and for pus to stop leaking? When will my incision close if I have no stitches? I’m afraid my breasts will now look deformed and different in size but im terrified to get another procedure done for correction. What caused my infection? Why only my left breast? Could too much sun exposure, drinking, and pool have caused my infection?

A: Sorry to hear of your very unfortunate complication. While using your own fat for breast augmentation is a natural material, that does not exclude it from the risk of infection. (although that risk is probably lower than with implants) Because the injected fat has no blood supply and must acquire it after being transplanted, there is a period of time after surgery when infection can develop. That is usually between 10 and 21 days after surgery, the time when you are off antibiotics and bacteria have had time to multiply and grow.

Almost all infections that occur close to surgery, regardless of the procedure, occur because some bacteria go into the wound during surgery. Why it occurred in one breast and not the other will never be known but fortunately it was just one breast.

Once you have developed an infection around injected fat, there will be fat loss or less take in that breast. Probably what you have coming out of your wound now is mostly liquified fat rather than pus which is injected fat that is breaking down due to the infection.It will probably two to three weeks until this clears up and heals.

That breast should be allowed to heal for a year, get soft to the feel, and see what the final  amount of fat take will be. I suspect there will be some breast asymmetry due to different amounts of fat take per breast. Correction of that breast asymmetry, if it occurs, will be by additional fat injections. Just because you have had this complication does not expose you a subsequent or higher risk if you have the procedure done again.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in fat injection breast augmentation. I have a consultation coming up with you next week and was wondering if you use the Brava before fat transfer for breast expansion? I was wanting to get into surgery ASAP as I am going on vacation next month and want the surgery prior to the trip. If I have to wear the Brava, I won’t be able to get the surgery done before the trip and be healed enough to wear a bathing suit. Also, I would prefer conscious sedation to a general if you do that. 

A: If your goal is to have a completed fat injection breast augmentation within the next thirty days, that is not an achievable goal. Breast augmentation by fat injections, if you are a good candidate (and most people aren’t) requires 3 to 4 weeks of presurgical breast stimulation by the Brava device followed by a similar time period after surgery of use of the device. This is an optimal device, even though it is inconvenient, as it provides stimulation to the breast tissue and the injected fat so that its survival is optimized. Thus you can quickly see that is not going to work by your desired schedule. The only way that time period works to enjoy the benefits of breast augmentation by your vacation is the placement of breast implants. In either case, however, both are best done under general anesthesia. Successful breast augmentation, by any method, is not something to be done under local or sedation anesthesia without suffering a suboptimal result.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I will be turning 20 later this year and I was wanting a more thicker appearance at the top of my breasts. I’m fine with my chest area I really wanted to get a fat transfer I really don’t want the implants but if I would need to I could.Thank you.

A: Whether you are a good candidate for fat injection breast augmentation depends on the size and shape of your breasts  and what your breast augmentation goals are. You describe the goal of ‘thicker appearance at the top’ which I interpret as just wanting more upper pole breast fullness. Given your young age and this smaller type of augmentation, fat injection breast augmentation may be a reasonable option instead of implants for your needs. However, whether you have enough fat to harvest, how much fat graft volume is needed and whether this would require more than one injection session are issues to be evaluated before determining if fat injections can achieve your aesthetic breast goals. We know that a small breast implant can achieve that goal successfully and in an efficient manner, the question is whether fat can do the same.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in enhanced fat injections, but was told by a doctor that it was no longer allowed but see you are discussing it so you must be using it. I have a couple questions. I had a lumpectomy nine months ago with radiation. Can not get implants so I am looking at fat injections to fill the hole and add some volume as my beasts are quite small. Is this a procedure you would recommend for someone in very good health and 69 years old? Can injections be done on my other breast to increase volume?

A: The term ‘enhanced’ fat injections can have various meanings. Some use the term to simply refer to liposuction-harvested fat that is  concentrated and then injected. Other interpretations refer to actually adding a stimulant to concentrated fat such as PRP (platelet-rich plasma), stem cells or even insulin. I prefer to use this latter definition of enhanced fat injections as adding something to the concentrated fat.

Currently no one really knows if adding any agent to concentrated fat is helpful in creating better fat survival but it remains biologically appealing. The addition of stem cells to fat is the most intriguing and captures the greatest public interest. But the harvesting of stem cells, growing them in cell culture and putting them back into a patient is not presently permitted by the FDA unless it is part of a sponsored clinical study. (as no one knows what such concentrates of stem cells will really do) Fat, by its composition, already has a lot of stem cells so every fat injection is technically already ‘enhanced’ to some degree.

Since the addition of extra stem cells is not permitted, I prefer to add PRP to smaller volume fat injections. PRP is an extract of your own blood that contains platelets which are full of various growth factors. These have well known stimulant properties on wound healing, take a few minutes during the procedure to harvest and concentrate and are easily mixed in with fat.

Fat injections are an excellent treatment for lumpectomy defects particularly in tissues that have received radiation, regardless of the patient’s age. While fat can also be injected into breasts for general volume enhancement, the success of that breast augmentation approach depends on what your breast currently look like and what result you are expecting to achieve.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 20 year old female. I used to weight 105 lbs and gained a lot of weight after going on the Depo shot. I currently weight 145 lbs. My height is 5’0 so I believe it is a lot of fat for my size. I have fat on my arms and back and a lot on my belly area, also my legs are very thick. I would like to know an estimate on having the fat removed from those areas and having it place on my butt and breast. I am a B cup and would like a little more in that area but don’t want to go for implants at all. Maybe around a 36C. I have a little fat on my butt but I would like it to be round and firm with a little more extra fat. I wear a size 7 going on 8 pants, I can also fit a size 9 already. A lot of my fat is on my thighs. I’ve been interested in having this procedure done for a while but I’m not sure on the price and would like to know how much you would charge for the procedure. I have looked at your reviews online and I was very impressed. So if I do decide to get the procedure I would definitely like to go to you. Can you give me an estimate on the procedure for both breast and butt together and an estimate for butt only? Thank you very much for your time. I’m looking forward to hearing back from you.

A: Thank you for sharing your body description and your goals. With these in mind let me provide with some clarifications.

1)      While liposuction can effectively remove fat, it cannot do it equally well everywhere on the body. The thigh is a particularly challenging area because circumferential thigh liposuction can not be done. It can not effectively reduce large thighs. The outer thighs (saddle bags) and the knees can be treated but only some areas of the contours of the thigh can be changed.

2)      Transferring fat from liposuction to the buttocks is commonly done and is known as the Brazilian Butt Lift. Provided one has enough fat to harvest, the shape and and firmness of the buttocks can be improved.

3)      Fat grafting to the breasts, however, is not so simple for an augmentation effect. While fat can be injected directly into the buttocks without stimulation, it can not be done so in the breasts. The breasts must be pre-treated by an external suction device (Brava) for weeks before the procedure, have the injections, and then have the suction device used for several weeks after. Fat injections into the breasts are a lot like planting seeds to grow. The ‘garden’ must first be prepared and fertilized to receive them. Also it is highly that you would have enough (after processing and concentrating it) to inject both the buttocks and the breasts at the same time. You would have to pick either the breasts or the buttocks for fat injections, you can not do both.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Do you do fat injections for breast augmentations? I read your article and have already been in to be seen and I am planning to have surgery in June. Is this a possibility for me? I did not know about this before the time I had my breast augmentation consultation or I would have asked. 

A: Fat injections for breast augmentation (FIBA) at this time is a procedure that is in a state of development. The reliability of the procedure and whom is the best candidate for it will take time to know better. The fairest statement one can make about the FIBA procedure is that the result can not guaranteed (breast volume and shape), can cost more than traditional breast implants, and may likely take two or three injection sessions spaced 3 to 6 months apart to get the desired result. Then there are the very real risks of fat necrosis and lumps throughout the breast.

To the best we know at this time, FIBA may be a reasonable alternative for a woman whose breast size goal is modest (B cup, maybe small C) and is willing to assume multiple procedures and the associated risks. This is not to mention that one must have enough fat to harvest on one’s body for transfer.

Compared to the success of traditional breast implants, FIBA is not for the vast majority of women considering breast enlargement today. It may be a different story (or not) five or ten years from now.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I am interested in the Fat Injection Breast Augmentation surgery but have a few questions. What are the preop requirements and do you have to have multiple operations?

A: Breast augmentation with fat injections is in the early stage of technique development. While the appeal is enormous for some patients, it is a concept which has not been shown to be consistent in results just yet and the long-term outcome on breast health and cancer surveillance is unknown. Breast augmentation with implants remains a proven technique. Whether fat injections will one day be a comparative procedure remains to be seen.

What is known about fat injections for breast augmentation is that one has to select the patient for it very carefully. Several criteria are important. First, one has to have enough fat to transfer into the breast. If one is very thin or skinny, they will not be a candidate due to lack of adequate donor tissue. Secondly, one’s desired breast size increase must be modest. At best, only a 1/2 cup or maybe more can be gained in size. Desiring a bigger change than that is beyond what fat injections can yet achieve. Lastly, one must be prepared to accept the likely possibility that more than one fat transfer may be needed. Injecting too much fat in a single session will not work. It is better to incrementally increase the fat breast volume to ensure the best survival and decrease the risk of fat necrosis. Therefore, patients must be willing to accept, and have enough donor tissue, to do a second fat injection session in most cases.

Dr. Barry Eppley

Indianapolis Indiana