Breast Fat Grafting ② Absorption and Additional Grafting After Breast Fat Grafting — How Much Remains, and When Is It Refilled

This is the second of two articles. In the previous article (Breast Fat Grafting ① Using Your Own Fat Instead of Implants), I explained who it may suit and how much can be placed in each breast. This time, I will explain in order how much of the grafted fat remains, when additional grafting is done, how leftover fat is stored, and what checkups it is good to have before and after surgery.

Part of the fat placed in the breast does not settle and is absorbed by the body. The literature also summarizes that some absorption always occurs after fat grafting, and that the absorption rates reported varied widely depending on differences in how the fat was collected, processed, and stored.[1]

The volume retention of breast fat grafting was reported in a systematic review as 62.4% on average (44.7–82.6%).[2] However, this figure can differ depending on the method of measurement. There is a summary noting that even when fat is grafted in the same way, retention is reported differently if the tool used to measure volume differs, such as MRI versus three-dimensional imaging.[3] So rather than taking any single number as "the amount that will remain in my breasts," it is more accurate to understand that there is a large difference from person to person.

General fat grafting literature explains that absorption proceeds, and that after 9 months the grafted fat settles stably and further absorption is hardly expected.[4] However, this is an explanation of fat grafting in general, not a figure for the breast alone, so it cannot be assumed to apply to the breast in exactly the same way. Please just remember that the volume right after surgery is not the final appearance.

Sometimes the procedure is divided into stages to fill in what is absorbed. The literature includes reports recommending repeated procedures on the same area at intervals of 3 to 6 months.[5] However, some sources state that there is no firm evidence on the minimum interval between procedures,[6] so it is appropriate to decide the interval based on each person's condition.

At our Venus Clinic, additional grafting is done within 3 months after the first grafting. Whether additional grafting is needed, and if so how much more to place, is decided at a consultation by looking at the condition of the breast at that time.

In a study comparing fat grafting with implants, nearly half (44.5%) of those who received fat grafting underwent a second procedure.[7] Rather than assuming from the start that it will be finished in one procedure, it is better to begin with the plan that it can be filled once more if needed.

Of the fat collected by liposuction, the fat left over after grafting into the breasts is stored frozen for up to 3 months. If additional grafting is needed within that period, the stored fat is used, so liposuction does not have to be done again.

Fat that is not used after 3 months is disposed of through a medical waste disposal company, following the procedures set by law.

If you are planning breast fat grafting, we recommend having a breast checkup (ultrasound and mammography) before surgery. Having a record of the condition of your breasts before surgery gives you a point of comparison if anything changes afterward.

If part of the grafted fat does not settle, it can appear as lumps, oil cysts, or calcifications. In a study that used ultrasound to classify 256 people who developed lumps after breast fat grafting, the order was cystic 31%, complex 25%, solid 19%, and calcification 23%.[8] Calcification is a finding that many people worry about; microcalcifications arising from fat necrosis are known to look different in size and shape from malignant ones to an experienced radiologist.[9]

So when you have breast checkups later, please be sure to tell the medical staff that you have had fat grafting in your breasts. It helps them when interpreting the images. If you feel a lump, please do not simply watch it; have it examined and checked.

The grafted breast is in the period when the fat is settling, so do not press it firmly or massage it. The area where the fat was collected, on the other hand, is managed by wearing a compression garment. The basic principle is to leave the filled area soft and to apply pressure to the area where fat was taken out. The specific wearing period and daily activities vary from person to person according to the post-operative instructions.

Even with the same amount placed, how much remains differs from person to person, and even with additional grafting, we cannot promise that the size and shape you want will be created exactly. Additional grafting may also be partly absorbed.

If your weight changes significantly after surgery, the volume of the grafted fat may change along with it. Because every surgery carries the possibility of side effects, please decide after a thorough consultation.

Because the breast is a sensitive area, this article does not include actual patients' before-and-after surgery photos. The image below is a virtual before-and-after example drawn to illustrate changes that may appear after breast fat grafting (after additional grafting is completed), and it may differ from actual surgical results.

This is an example of volume added by fat grafting to a small breast. The left side is before grafting and the right side is an image assuming the state after additional grafting is completed, showing the volume of the breast increased slightly and naturally. In practice, it varies depending on the condition of the breast, the amount grafted, and the degree of absorption.

Because part of the grafted fat is absorbed and how much remains differs from person to person, it is good to begin with the plan that additional grafting can be used to fill in as needed. At our Venus Clinic, additional grafting is done within 3 months using the fat set aside, and we recommend having a breast checkup before surgery. We will look together at the condition of your breasts and the look you want, and decide a reasonable direction at the consultation.

References: Breast Fat Grafting ① Using Your Own Fat Breast Fat Grafting and Syringe Liposuction