In the past few years, fat grafting has evolved as a new method for breast enhancement. Recently, this technique has been widely practiced and is gaining momentum. Nonetheless, it has its own limitations in terms of the availability of sufficient donor fat stores and the amount of fat that can be safely injected in one session. Not to mention the concern of possible interference with future mammographic studies which remains until this date an unsettled matter. Despite this, at least for now, current literature favorably suggests that it may not interfere with mammographic studies and should not mask underlying pathologies in expert hands.
Also, according to the current practice trends, you can only go one cup size bigger, possibly two, in the right patient. Therefore, a woman with an “A” or a small “B” cup size who desires to go into a full “D” cup, may have to accept enhancement through breast implant surgery rather than fat transfer.
A common scenario where a patient presents with large droopy breasts desiring surgery to go smaller in her breast size. One valid option is to undergo fat augmentation to the breast combined with a breast lift surgery in one setting. However, this may not be a good idea if the patient has breast implants already. In this group patients who desire to go bigger, it makes more sense to go larger with the size of their implants.
In my opinion, patients who had prior augmentation surgery using breast implants, may have to accept staging their procedures. The initial surgery includes the removal of the device (implants) along with breast lift surgery. In the second stage, possibly three months later, liposuction procedure combined with fat grafting to the breast can be carried out. This will allow time for the implant pocket to seal off and for the breast tissue vascularity to improve increasing the chance of fat survival.