When considering cosmetic breast augmentation, women typically consider implants as their main option. However, there are several other procedures to change how your breasts look that may have fewer risks and complications compared to breast implants. These alternatives include breast lifts and fat transfers.
Breast lifts, clinically called a “mastopexy,” raise and reshape the breasts. Surgeons remove extra skin and tighten surrounding tissue. In addition to reshaping the breasts, a lift can reposition the nipple and reduce the size of the areola if it has become enlarged over time. Many women choose to get breast lifts to improve the stretching or sagging of their breasts that could have been caused by pregnancy, weight fluctuations, and simple gravity. A breast lift alone cannot make breasts larger, but breasts will look fuller and more perky after the procedure. 1
There are four types of breast lift techniques, which depend on breast and areola size and shape, degree of sagging, amount of skin that must be removed, and the elasticity of skin. For women who have smaller breasts or minor sagging, a crescent or donut technique can be used to create small incisions around the areola. For women who have larger breasts and more severe sagging, surgeons will need to create multiple incisions, either around the areola and vertically down the middle of the breast (a lollipop technique) or including a horizontal incision along the breast crease (an anchor technique). 2
Swelling and bruising will last for about two weeks, and numbness may last up to six weeks. Final results of breast lifts will appear over the months following the procedure as the breasts settle into their new shape and position. Results of a breast lift procedure are long-lasting, especially with a healthy lifestyle. Women with smaller breasts will likely have results that last longer than women with larger breasts. It is also important to note that the cosmetic appearance of the breasts can change due to pregnancy, breast feeding, and significant weight changes that occur after surgery. Therefore, women should consider whether they are planning a pregnancy in the near future before having a breast lift. 3
Risks of Breast Lifts
When considering a breast lift, it is important to consider the risks of the procedures in addition to the benefits. For breast lift procedures, the most common risks include changes in nipple or breast sensation, asymmetrical breast shape, and partial or total loss of the areola.1 Less common risks that some patients experience are bleeding or hematoma formation, infection, poor incision healing, fat necrosis (fatty tissue around skin may die), and fluid accumulation. Although patients will have scars from a breast lift procedure, many notice that some scarring is hidden in natural contours of the breasts and that scars improve over time, typically within one year.3 As with any cosmetic procedure, some patients may be unhappy with the final result. Your chances of getting the results you want will be better if you choose a board certified plastic surgeon with a lot of experience doing breast lifts without breast implants.
Some plastic surgeons recommend getting both a breast lift and implants to get the best cosmetic result. However, that means patients will face the risks of the lift and the additional risks of the implants. While the breast lift procedure alone is safer than getting implants, there is still a lack of safety data and research on breast lifts to know how often complications occur in the solo procedure. The skill and experience of the plastic surgeon makes a big difference.
Fat transfers may be a good option for women who want to have more natural looking, fuller breasts without implants. Fat transfers use liposuction to remove fat from other parts of the body and insert it into the breasts. Fat for liposuction is typically taken from areas such as the back, thighs, abdomen, and buttocks. 4 Next, the fat cells are processed into a liquid so they can be injected into the breast area. 5 The surgeon will slowly inject the fat liquid to multiple areas of the breast until the desired breast size is achieved. Since the procedure uses body fat from the patient, thin women may not be good candidates for this procedure. Because the injected fat does not contain its own blood supply, only a small amount of fat can be injected at a time. Patients should not expect to gain more than one cup size.
Patients typically notice improvement right after the procedure, but the final results will appear one year after surgery when swelling has gone down. Multiple follow-up fat transfer procedures may be necessary to maintain the shape of the breasts. In many cases, fat that has been injected into the breasts may be reabsorbed by the body over time, move to other parts of the body, or die, causing breasts to lose volume.5 Therefore, surgeons may recommend follow-up sessions to repeat the procedure, which may be expensive and is an important factor to consider.
Risks of Fat Transfers
High patient and surgeon satisfaction as well as low complication rates have been reported for fat transfer procedures, but outcomes vary greatly based on the surgeon as the procedure is not yet standardized. 6, 7 The most common complications from fat transfers include development of cysts (lumps) or fat necrosis, which is when the transferred fat dies and is reabsorbed by the body. 8 Fat necrosis is more common when a large amount of fat is injected. This usually does not need to be treated, as the body takes care of the dead cells on its own.
Other less common complications can include infection and calcification of the fat.8 Like fat necrosis, these complications are more common when a large amount of fat is injected. Because the injected fat does not have its own blood supply, too much injected fat may lead to microcalcifications, which is when the fat hardens. These calcifications are usually harmless, but they may look like breast cancer on a mammogram, resulting in stressful and expensive breast biopsies.
Despite risks, lifts and fat transfers appear to be safer than breast implants. Breast implants are not lifetime devices, and women should expect additional surgery to replace them every 10-15 years if not more often. Health insurance often does not pay for removal or complications for augmentation patients and never pays for replacement of cosmetic implants. The high cost of these additional surgeries, as well as the common complications from implants, make lifts and transfers a safer option for many patients.
While breast lifts and fat transfers provide alternatives to breast implants for cosmetic breast enhancement, patients must consider the risks of both procedures before choosing to undergo surgery. More long-term research is needed to confirm the safety and effectiveness of both procedures.
When deciding whether or not to undergo cosmetic breast augmentation, it is important to weigh the risks and benefits of each procedure with a highly skilled, experienced surgeon who is board certified in plastic surgery, so you can make a decision that is right for you.
- Mayo Clinic. Breast lift. MayoClinic.com. https://www.mayoclinic.org/tests-procedures/breast-lift/about/pac-20393218. July 21, 2018. ▲
- American Society of Plastic Surgeons. Breast Lift Animation. PlasticSurgery.org. https://www.plasticsurgery.org/cosmetic-procedures/breast-lift/animation. Accessed August 6, 2019. ▲
- American Society of Plastic Surgeons. Breast Lift. PlasticSurgery.org. https://www.plasticsurgery.org/cosmetic-procedures/breast-lift. Accessed August 6, 2019. ▲
- American Society of Plastic Surgeons. Liposuction. PlasticSurgery.org. https://www.plasticsurgery.org/cosmetic-procedures/liposuction. Accessed August 6, 2019. ▲
- BreastCancer.org. Fat Grafting. BreastCancer.org. https://www.breastcancer.org/treatment/surgery/reconstruction/types/autologous/fat-grafting. Updated March 7, 2019. ▲
- Krastev TK, Alshaikh GAH, Hommes J, Piatkowski A, van der Hulst RRWJ. Efficacy of autologous fat transfer for the correction of contour deformities in the breast: A systematic review and meta-analysis. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2018; 71(10): 1392-1409. https://www.sciencedirect.com/science/article/pii/S174868151830175X. ▲
- Al Sufyani MA, Al Hargan A, Al Shammari N, Al Sufyani M. Autologous Fat Transfer for Breast Augmentation: A Review. Dermatologic Surgery. 2016; 42(11): 1235-1242. https://journals.lww.com/dermatologicsurgery/Abstract/2016/11000/Autologous_Fat_Transfer_for_Breast_Augmentation__.1.aspx. ▲
- American Society of Plastic Surgeons. Fat Transfer Breast Augmentation. PlasticSurgery.org. https://www.plasticsurgery.org/cosmetic-procedures/fat-transfer-breast-augmentation. Accessed August 6, 2019. ▲