Can You Do Fat Grafting With a Breast Lift or Explant?

You certainly can — but depending on your situation, you may not want to.

For fat grafting to take well, the transferred fat needs a front wall and a back wall — two layers of tissue to sandwich and support the graft while it establishes a blood supply.

For someone who's never had breast surgery before:

• The front wall is the skin
• The back wall is the pec fascia or deeper tissue

This setup gives the fat a good environment to survive.

Why does fat need walls at all? Because of what fat actually is. Grafted fat is a lot like scrambled eggs with a lacy network of blood vessels running through it. It has no firm structure of its own, so it depends on the front wall and back wall to hold it in place while it heals.

When you perform a breast lift (mastopexy), you're cutting through breast tissue, creating a raw surface area. Fat grafted too close to that raw surface won't take well — it doesn't have the stable, well-vascularized tissue bed it needs to survive.

The same applies to implant removal (explant) patients. After a capsulectomy, the area where the capsule used to be is another raw surface. Fat grafted too close to that zone won't get good take either.

This is the question I get all the time, so it's worth spelling out. If you have implants, your walls look a little different:

• The front wall is still your skin
• In the middle is your fat
• The back wall is your capsule, with the implant underneath it

So when we remove the capsule, you've done two things at once: you've lost your back wall, and you've created a raw surface area. Fat placed too close to that raw surface doesn't stay in place the way we want it to. There's no back wall keeping it where it belongs, so more of that fat is lost.

That's why a capsulectomy at the time of implant removal or revision limits how much fat we can graft in the same operation. (Whether your capsule needs to come out at all is its own conversation, and so is what a capsulectomy adds to recovery.)

If you have:

• Plenty of breast tissue — giving the fat enough healthy tissue to graft into, away from the raw surfaces
• A good donor site — enough fat to harvest from elsewhere on the body

...then there's no reason you can't do fat grafting at the same time as a mastopexy or implant removal.

If you:

• Don't have much breast tissue — limiting where the fat can be safely placed
• Don't have a great donor site — not enough fat available to harvest

...it's probably better to do the fat grafting as a second, separate procedure. This gives the tissue time to heal from the lift or explant, creating a better environment for the fat to take successfully.

If your tissue is quite thin and you've lost your back wall, you can't graft much at baseline, and even less with a capsulectomy. Now add a minimal donor site: you may only have one good round of fat grafting available to you.

If that's your situation, it can make a lot of sense to wait. Once the capsulectomy has healed, you have a new back wall, and that one round of fat gets you the most bang for your buck.

If you're planning fat grafting with a capsulectomy, ask your surgeon directly:

1. How much fat do you realistically think I have?
2. How much fat do you realistically think you can graft?

Honest answers to those two questions will tell you whether doing it all at once makes sense, or whether you're better off staging it. (And for what to expect once the fat is in, here's how much fat actually sticks.)

Combining fat grafting with a breast lift or explant is absolutely possible, but it depends on your anatomy. Patients with more breast tissue and good donor sites are the best candidates for doing both at once. If tissue is limited, staging the procedures gives you the best chance at a lasting result.

If a capsulectomy is part of your explant or revision, factor that in too: removing the capsule takes away your back wall and lowers how much fat can be grafted at the same time.