Fat Grafting to the Breast in Beverly Hills

Fat grafting to the breast, also called fat transfer, moves your own fat from an area where you have some to spare into the breast. The fat is collected with liposuction and placed to add a modest amount of volume or to smooth a contour.

In Dr. Kelly Killeen's practice, most breast fat grafting solves a specific problem: restoring shape after implant removal, refining a reconstruction, filling a dent after a lumpectomy, or fine-tuning another breast operation. She also offers fat-only breast augmentation, selectively, to women whose goals match what fat can do. Fat adds volume, but it cannot reshape the breast the way an implant can, so whether fat belongs in your plan depends on your anatomy and your goals.

What it is

Moving your own fat, collected with liposuction, into the breast to add modest volume or smooth a contour

How much bigger

About a half to one cup size per round for most women; some gain less and some more

Where the fat comes from

An area where you have fat to spare, chosen together at your consultation

Facility

For operating-room procedures, the Quad A (AAAASF) accredited surgery center in Dr. Killeen's Beverly Hills office or Cedars-Sinai, with board-certified anesthesiologists

Recovery

A compression garment over the donor area for about a month; the result is judged at about six months

Insurance

Usually covered as part of reconstruction after a mastectomy; cosmetic fat grafting is usually self-pay

Often combined with

A breast lift, implant removal, revision or reconstruction, at the same operation or later

Dr. Killeen's practice is located in the heart of Beverly Hills, with fat grafting patients traveling in from across the greater Los Angeles area, including West Hollywood, Santa Monica, Brentwood, Bel Air, Pacific Palisades, Hollywood, Pasadena, Calabasas and Sherman Oaks, as well as from other states.

Every fat grafting procedure in the operating room is performed at an accredited facility, either the Quad A (AAAASF) accredited surgery center in Dr. Killeen's Beverly Hills office or Cedars-Sinai, with board-certified anesthesiologists. Patients who stay overnight after surgery at the center recover at a partner recovery facility.

1. 1

   Collecting the Fat

   The area the fat comes from is numbed with a dilute numbing fluid (tumescent solution), and the fat is removed with liposuction. Liposuction is limited in one day because too much at once raises the risk of complications, which can cap how much fat is available in a single round.
2. 2

   Preparing It

   Not everything liposuction removes is usable. Fluid, blood and broken fat cells are separated out, and only a fraction of what is removed becomes fat that can be grafted. Dr. Killeen uses tight grafting, removing as much of the fluid as possible so that mostly fat goes back in.
3. 3

   Placing It

   The fat goes in by hand through a thin, blunt-tipped tube, in very small amounts woven through the breast in many passes and at different depths, so each bit sits close to a blood supply. She places only as much as your tissue can support, because fat crowded into too small a space is more likely to be lost.
4. 4

   Taking Hold

   Grafted fat is a living graft, much like a skin graft. Over the first few days each bit has to pick up a new blood supply in its new home. The fat that does becomes a lasting part of your breast, and the fat that does not is gradually absorbed or, less often, leaves a lump.

Dr. Killeen recommends anesthesia based on how much fat is needed, what else is done at the same operation and your health history. A very small touch-up, such as filling a tethered scar, can sometimes be done in the office instead. Fat grafting can be done on its own, during another breast operation such as a lift or implant removal, or as a separate surgery later.

Fat grafting is planned around your goals and your anatomy. Depending on your situation, the goals include:

Physical Benefits

• Your Own Tissue: Fat from your own body, with no implant placed
• No Implant to Maintain: No implant to monitor or replace later
• Your Shape, a Little Larger: Volume added to the breast shape you already have
• Smoother Contours: Hollows filled, implant edges softened or a smaller side evened out

Emotional Benefits

• A Change That Looks Like You: A modest increase rather than a dramatic one
• An Option Without an Implant: For women who would rather not have one
• A Plan Made for You: Fat is added only when it fits your anatomy and your goals
• Honest Expectations: A clear discussion of what fat can and cannot do

Fat and implants give different results, so the choice starts with the look you want. Most of a breast's shape comes from its firmer breast tissue. Fat is soft: it makes the breast you have larger, while an implant can change its shape.

If fullness in the upper breast is your main goal, the option Dr. Killeen points to is Preservé, a tissue-preserving augmentation that places a smaller implant higher on the chest, for women having their first augmentation. For a specific size or a rounder shape, see breast augmentation.

• Enough fat to spare: Taking fat from an area without much extra can leave lumps or dents where it was removed.
• Enough breast tissue to receive it: Putting in more fat than the breast can support raises the risk of complications.
• A stable, healthy weight you plan to keep: Dr. Killeen does not ask patients to gain weight first. Weight gained before surgery enlarges the fat cells you already have rather than adding new ones, so the extra volume shrinks when your weight returns to normal.
• Good general health: Any medical conditions should be well controlled, with regular check-ups with your doctor.
• Realistic expectations: A good candidate understands what fat can and cannot do.

If you take a weight-loss medication, tell Dr. Killeen. Some plastic surgeons have reported less fat survival in patients taking them, so she will talk with you about timing. Tell her too if you smoke, vape or use any nicotine product. The fat must be your own: fat from another person would be rejected, much like a transplant. An autoimmune condition does not rule out fat grafting on its own, though less of the fat may survive, and tissue that has had radiation never holds fat as well as untreated tissue.

Some of the fat placed is always lost, because each bit has to find a new blood supply and not all of it does. The rest stays as your own living tissue.

Dr. Killeen will give you a realistic estimate for your own breasts at your consultation, based on how she grafts and what she has measured in her own patients.

1. First Days

   The breasts are quite swollen and often bruised, and they can look blotchy and red. They may feel heavy and full. This is normal and it settles. Follow your post-operative instructions closely while the fat establishes its new blood supply. Call the office if you have a fever, and call 911 for shortness of breath or chest pain.
2. First Weeks

   The area the fat was taken from is sore, more so for some people than others. You wear a compression garment over it for about a month. Remember that the size you see now is mostly swelling.
3. One to Three Months

   As the swelling goes down, check your breasts and tell the office about any firm spot early. Small lumps are easier to treat when they are caught early.
4. About Six Months

   The result is judged once the swelling has settled and the fat that did not survive has been absorbed, or closer to a year after a larger graft.

When you can return to work, drive and exercise depends on how much liposuction was done and whether fat grafting was combined with other surgery, and Dr. Killeen gives you your own timeline, including how to sleep and which bra to wear. If your timing is flexible, a cooler, less busy time of year makes the month in a compression garment easier.

Fat grafting can leave small calcifications or lumps that show up on breast imaging. Based on the studies Dr. Killeen follows, there is no evidence that they hide breast cancer, and as far as current studies show, fat grafting does not make imaging harder to read.

• Calcifications from fat grafting usually look different from the kind linked to early breast cancer, and radiologists can usually tell them apart.
• Occasionally a finding needs a closer look, so some women have a biopsy to be sure.
• Changes on imaging are more common than lumps you can feel, and they can stay long term.
• Keep up your regular breast screening, and tell your imaging team that you have had fat grafting to the breast.
• After a mastectomy, the rebuilt side no longer has screening mammograms (keep screening any remaining breast), but calcifications can still show up on other kinds of imaging, so mention your fat grafting there too.

In the best case, your body quietly absorbs the fat that did not survive. If it cannot, the leftover fat can be walled off into a small lump, called fat necrosis. The lump may be solid, or it may be a fluid-filled pocket called an oil cyst.

A breast can be rebuilt with fat alone after a mastectomy, but it takes more time and more operations than most women expect.

• Grafting does not start during the mastectomy. The remaining skin depends on a delicate blood supply, so you heal for a couple of months first.
• Each round can add only as much fat as the thin tissue can support, so it takes several rounds, usually at least three to four months apart. The tissue thickens as you go, so later rounds can hold more.
• Mastectomy skin tends to tighten as it heals, which can work against the slow build-up of fat.
• A breast made only of fat is soft, and it tends not to have the rounded shape that breast tissue gives.
• Many rounds raise the chance of oil cysts, firm lumps and calcifications, and findings that need a closer look can be stressful after breast cancer.

More often, fat is used to finish an implant reconstruction, and flap reconstruction is another way to use your own tissue. See breast reconstruction for the options.

Fat grafting is well studied and its risks are well understood. They are different from an implant's risks, not absent. Risks include:

• Firm lumps from fat that did not survive (fat necrosis), or fluid-filled oil cysts
• Small calcifications that show up on imaging and occasionally lead to a biopsy
• Less fat surviving than hoped, or more on one side than the other, which can mean another round
• Lumpy or uneven areas, or a fluid collection (seroma), where the fat was taken
• Redness and swelling that can look like an infection; infection itself is rare
• Asymmetry, since no two breasts match exactly before or after surgery
• General risks of any operation, including bleeding, infection and injury to nearby tissue
• Problems that appear later than with most operations, often one to three months after surgery