[Case Review] Sagging Breasts: Liposuction or Fat Grafting?

In this article, we explain with illustrations how to choose between breast liposuction and breast fat grafting when you have sagging breasts: from measuring breast volume before surgery, to the surgical method, to the principle by which breast liposuction improves sagging, to how fat grafting is done. We then show the amount of fat removed and grafted and the before-and-after photos of two actual cases.

This applies if you have sagging skin and want your breasts to become smaller. Breast liposuction may also be suitable when there is no suitable area on your body from which to obtain fat for grafting (donor site). Many people think liposuction is not suitable when the breasts sag, but at Venus Clinic we also consider sagging breasts as candidates for liposuction. When breast volume decreases, the weight pulling the breast downward becomes lighter, and when suction is done evenly, skin contraction is encouraged, so the sagging can improve at the same time.

This applies if you want the sagging to improve while your breasts become larger. It also applies if you have an area with fat to remove (donor site), such as the abdomen or thighs, and also want to improve the body contour of that area with liposuction. Fat is removed by liposuction and the removed fat is grafted into the breast, which lacks volume, so you can get both body contour improvement and added breast volume.

When planning breast liposuction or fat grafting, the volume of both breasts is measured first. When you lean forward and immerse the breast in a graduated container filled to the brim with water, water overflows by the volume of the breast. After you take the breast out, the amount of water needed to fill the container to the brim again is the volume of the breast. This is called the water displacement method. It is important to immerse both sides to the same depth, and the average of values measured two or more times is used. This lets us know the size difference between the two sides in numbers and plan the amount to remove from each breast more precisely [1].

Surgery is performed with small incisions only a few millimeters long, placed in inconspicuous spots such as the inframammary fold or the armpit crease, through which a thin microcannula is inserted. Long incision lines around the breast or around the areola are not needed. The breast is a fibrous area because of its glandular tissue, and a thin microcannula can pass through such fibrous tissue with little force [3]. Suction starts at the deep layer and gradually moves up to the more superficial layers. From each incision, suction is performed in several directions and at several depths in a fan-like pattern, overlapping the paths of neighboring incisions [2].

Breast ptosis is a state in which the skin cannot support a breast that has become heavy, so the breast hangs downward. When fat is reduced by breast liposuction, the breast becomes lighter, and as the skin contracts to fit the reduced volume, the whole breast is pulled upward. After breast liposuction, upward rotation of the breast shape and a higher position of the nipple and areola along with skin contraction have also been reported in the liposuction literature [4][5]. At Venus Clinic, we perform suction evenly not only on the breast but also on the accessory breast tissue, the armpit, and the lateral chest (bra-line) area, so that the border with the surrounding area blends naturally.

First, fat is harvested by syringe liposuction from an area with enough fat, such as the abdomen. The harvested fat is separated from blood and fluid so that only the fat to be grafted remains, and it is then placed into the breast with a thin cannula. If a large amount is placed in one spot at once, the central part has difficulty surviving, so it is placed in small amounts, divided among several layers. Part of the grafted fat is absorbed, and the proportion that remains differs between reports depending on the grafting method and the measurement method [6].

These are the cases of two patients who had surgery for sagging breasts. All after-surgery photos were taken about 1 week after surgery. This is a period when swelling remains, so they do not show the final result, and part of the grafted fat is absorbed over time.

The two cases were chosen because a similar amount of fat was involved. In the first case, about 550cc of fat was grafted into the breasts; in the second case, about 500cc of fat was suctioned from the breasts and the accessory breast tissue, armpits and nearby areas. Please compare how breasts change when a similar amount of fat is added (breast augmentation) or removed (breast reduction).

This is a case in which fat was removed by abdominal liposuction and, at the same time, grafted into the breasts. According to the surgical record, the pure fat volume suctioned from the abdomen was 550cc, and all of this fat was divided and grafted into both breasts. Please compare the change in the abdominal line and the change in breast volume together from the front, side, and back views.

Below is the fat harvested from the abdomen and grafted into the breasts in this case. The yellow fat, with blood and fluid filtered out, was placed in syringes and divided between both breasts.

This is a case of sagging breasts in which the size was reduced with breast liposuction, and fat in the accessory breast tissue and the lateral chest (bra-line) area was also removed. The breast, accessory breast tissue, armpit, and lateral chest area were treated together, and according to the surgical record, the pure fat volume was 500cc. Please compare the breast size, along with the height of the lower edge of the breast, with before surgery.

Below is the fat removed by breast liposuction (breast reduction) in this case. The upper yellow layer in the canister is the removed fat, and the lower red layer is the tumescent anesthetic solution infused during surgery.

When you have sagging breasts, there is no fixed right answer on whether to choose breast reduction with breast liposuction or breast augmentation with breast fat grafting. Please decide at a consultation by looking together at whether you want your breasts to become smaller or larger, whether there is an area from which fat can be removed, and how much sagging and skin elasticity you have.

References: Breast Fat Grafting and Syringe Liposuction Liposuction for Sagging Breasts After Childbirth (Breast Reduction)