Category Archives: BREAST SURGERY

Fat injections for breast enlargement

Fat Injections to Breasts


I have previously written about fat injections for breast enlargement but new information keeps on coming up and cosmetic plastic surgery patients continue to show interest in this plastic surgery procedure. here are photos from an article in the Aesthetic Surgery Journal of March 2014 by Drs. Spear and


Breast augmentation with fat injections  Breast augmentation with fat injections

Breast Enlargement with implants

The traditional methods of breast enlargement by either placement of saline or silicone breast implants under the chest muscles have been performed by board certified plastic surgeons since the late 1960 s.  Breast augmentation surgery has withstood the test of time. The surgery will produce consistent results and has a 98% satisfaction rate amongst patients.

Multiple variations of breast sizes and shapes are possible now that moderate profile implants, moderate -plus sized implants, and high profile implants are available from multiple breast implant manufacturers. These implants satisfy the needs of patients who typically are looking for at least a 2 cup size increase in their breasts.

Breast implants are foreign objects for the body and will form capsules of scar tissue around them which can become problematic at time. The implants can also break or rupture and in general need upkeep.

100% of patients will get a substantial improvement in breast size that is long lasting. Breast surgery with implants takes one hour.

Breast Enlargement wit Fat injections

In order not to have the problems that implants can sometimes cause, fat injection to the breasts has been advanced as an alternative surgery by some plastic surgeons.

Fat is removed by liposuction from one area of the body and injected into the breasts to enlarge them. Breasts are made up of a combination of breast glandular tissues and fat. Breast enlargement with fat injections adds to the fatty tissue already there.

Advantages of breast augmentation with fat injections

  1. Natural tissue and feel of breasts

Disadvantages of breast augmentation with fat injections

  1. Un-predictable loss of  breast volume- some of the fat always dies after a fat transfer. How much will die is unpredictable despite multiple techniques for handling and injection of the fat. Typically the latest study shows that only 30% – 40% of the fat injected remains within 6 months.
  2. Risk of development of breast cancer – The fat that is injected will have stem cells which when in the vicinity of breast tissue could cause breast cancer. This has been shown to occur in animal models. Even the latest plastic surgery article about breast enlargement with fat injections mentions that patients should be counselled about the risk of developing breast cancer!
  3. Small volume of breast enlargement possible.  In general breast augmentation achieved with fat injections only gives one cup enlargement of the breast. Typically about 250 cc fat is injected.  Within a few months after surgery only 30- 40 % of the fat remained. How much of that actually stays long term is unknown.
  4. Longer operative time. Typically surgery took 3 hours for fat injections.
  5. 10% of patients have substantial improvement in breast size, and 50% have a moderate improvement in breast size.


Breast enlargement with fat gives minimal improvement in breast size ,has un-predictable results, of unknown duration, requiring three times longer surgery, and increases the risk of breast cancer.

No thanks- I’ll stick to implants for now.




Breast enlargement surgery revisions

Breast augmentation revisions


Breast enlargement surgery revisions are a tricky topic since its is a mixture of  a number of factors which are all prickly to consider for plastic surgeons and patients. This patient came to me complaining of differences in breast size after surgery elsewhere. The previous  plastic surgeon had placed two implants of markedly different sizes in her. I assume he had his reasons. She was unhappy with the difference in size and in the revision surgery I performed, I placed two implants of the same size for a great result.  However, breast revision surgery can be a tricky surgery due to previous scarring and changes in blood supply and the results can sometimes be worse! A careful analysis of the risk benefits of the cosmetic breast surgery must be performed. Even here the difference may not be noticeable to the untrained eye!


Before breast revision surgery

after breast surgery






Causes for breast augmentation revisions include

  • Technical error by plastic surgeon
  • Poor tissues  and tissue healing of patient
  • Lack of patient following directions post op
  • Complications of surgery
  • Perception of a bad result by patient
  • Perception of a bad result by plastic surgeon
  • perception of results by everybody else
  • Bad luck

Technical errors

Problems arising from technical errors by the surgeon at surgery include

  • rupture of breast implants
  • mal-position of breast implants
  • Inadequate hemostasis leading to bleeding

Poor Tissues

These problems arise from poor genetics on part of  patients.

  • Loose skin /poor elasticity
  • Thin skin / lack of strength
  • Reactive skin / skin which does not heal properly

Poor follow up

Specifically poor follow up of the plastic surgeon’s directions. After breast augmentation massage is essential. Lack of massage can lead to capsular contracture and breast hardening needing a revision surgery.

Complications of Breast surgery

  • Bleeding
  • Infection
  • Nerve damage
  • Implant deflation
  • Scarring
  • These are all known reasons for complications of surgery amongst many others

Perceptions of surgery result

Perceptions of defects ion the surgery results and the reason to change the surgical result with another procedure differ amongst

  • Plastic surgeons- for whom minor defects in the surgical result are acceptable based on the patient’s anatomy and the naturalness of the result
  • Patients – who may have expectations that are not real. Often patients forget that their two breasts are not exactly the same and never will be
  • Friends and family of patients may say something regarding the surgery result which even the patient and plastic surgeon were unaware of .

Bad luck

Sometimes the reason is just bad luck and no known cause can be found and there is no one or anything to blame!

In summary- beware of revisions and listen to your plastic surgeon. Sometimes the risk is just not worth it.



Mommy makeover-Breast-Abdomen plastic surgery

Mommy makeover

Mommy surgery before

                                                                                    Mommy surgery after

Cosmetic Plastic surgery of breast and abdomen after childbirth or massive weight loss is often called a Mommy makeover. Recently a patient asked me if in fact it was not a ‘Mummy makeover” since patients are often bandaged up like mummies after this cosmetic surgery duo!


Changes  to body after pregnancy or weight loss

Several distinct but common changes occur to the body after pregnancy or weight gain and loss.

  • Fat Deposits – occur in the flanks, love handles, back and abdomen
  • Loose skin – as a result of stretching of the skin leads to loss of elasticity of skin and its hanging down
  • Breasts become smaller and may also become droopy due to loss of volume and elasticity- in women and men!
  • Arm skin becomes droopy but fat accumulation in the arms may increase
  • Facial  and neck skin may droop giving an older look


Surgery of the abdomen and breasts

Mommy makeovers typically include

Other procedures may include

Mommy makeovers will take between 3.5 to 4.5 hours depending on the type of surgery that needs to be performed. Though some surgeons like to continue to operate on other body areas at the same time, I find that 8 hour cosmetic surgeries are just too much for me. They are also way too much for the patient! I prefer to divide up the surgeries into more reasonable segments, sometimes just by a few days, to allow easier healing for patients.

Recovery from Mommy makeover

After a mommy makeover the recovery will depend on the number and type of procedures performed as well as all the usual reasons for differences in individual healing. Although patients are up and walking the same day as surgery, typically it will take about 10-14 days before patients are back at work. I have had patients return as soon as 3 days after surgery and as long as 14 days.

Here is a link to a patient returning to the office after only 12  hours following mommy surgery;

Full healing though will take about 4 months though their healing is gradual and progressive.

Mommy makeover surgery gives women a new look . A new look for their bodies and a new look on life.

Breast Augmentation Implants

Confusion about breast augmentation implants enlarged


The other day a patient came for consultation for breast augmentation. I have written extensively about these procedures in the past. Here are a few of those posts;

A great deal of confusion has arisen over the past 20 years with respect to breast implant sizes and types.

1. Saline vs Silicone

Initially there were just two types of implants;   Saline and Silicone. The shapes were the same; what we now call moderate profile implants.  Patients choose between volume they wanted and the type of material.

Then came new types of textures.

2. Smooth vs textured

Patients ( or rather their plastic surgeons) could now choose between smooth silicone implants and textured implants. The idea behind textured implants was to decrease the rate of capsular contracture or scar formation around the implants. There was no difference in shape of implants with textures…initially.


            siltex gel family plus ultra

3. Round vs Teardrop

Textured implants were noted not to move! So the breast implant manufacturers came forth with tear drop or “anatomic implants” which supposedly gave a more natural form to the implants. However it was noted that all implants in the body will have some tear drop shape due to gravity anyway. Also these anatomic implants sometimes flipped giving a very “un-anatomic” shape to breasts.

tear drop breast implants







4. Low, Moderate, Moderate plus, high profile implants

More recently there has been an explosion in breast implant shape options. The are now different profiles, or base diameters, for every volume of a breast implant. The same volume can now look very different indeed.

Breast implant profile






Here is an example of just a how different an implant of the same volume can look.


Given the huge choices that now exist in breast implant shapes, types, textures and volumes, things are now complicated. It is no longer enough to say i want a “350 cc implant”  . Let your board certified plastic surgeon choose the right implant for your body. That should be based on your



size of hips

chest wall

amount of breast tissue

quality of the skin of your chest

experience of the surgeon

your preference for materials based on risks and upkeep, size of scars, just to mention a few of the variables.

Breast augmentation surgery with implants; Its complicated.




Breast Sizes across the World

 Breast size differences across the world


Breast size in women varies due to genetic and racial variability.  There are differences in any group, but useful generalities can be made. I have written about this subject indirectly in previous posts:


World map of breast size

Here is a recent map I came across produced by Target Map. I cannot vouch for the accuracy of the data, but in my professional experience, the findings hold true.

Regions with the largest breast size are in red, regions with the smallest in green.


breast size chart


Women in the Far East and the Indian subcontinent tend to have smaller breasts and stature, while central European women tend to have larger bodies and breasts by nature.  Nevertheless, some of the differences are interesting.

Breast implant companies that manufacture saline and silicone breast implants have produced data that shows that the average breast implant size in the US increases the farther south one goes. There is also an increase in average breast implant size as one goes west. Obviously, women in southern and southwestern parts of the US have more occasion to have their breasts in view due to warmer weather than women in Maine, for example, which may contribute to the use of larger breast implant sizes.

What we do not know is the extent to which men in different regions prefer different breast sizes.

Here is a similar map of penile size across the world. We all know men exaggerate in this regard, so take these results with a grain of salt!

penile size



Dark green shows largest penile size and dark red the smallest.


Morad Tavallali, M.D., FACS

Breast Lift, Augmentation or Both?

Breast lift alone or with breast enlargement? What to do.

As a cosmetic plastic surgeon, breast surgery is a large part of my practice. Breast augmentation with implants is common among my younger patients, breast lifts are common among those a little older and breast reductions are common in those a little older still!


I have written in the past about breast lifts and augmentations:

Breast lift photo


Yesterday, though, I saw two women in succession who needed both a breast lift and a breast enlargement with silicone or saline implants. That made me think about the decision process a plastic surgeon makes to recommend the right cosmetic plastic surgery for patients with small, droopy breasts.


Breast enlargement

Breast augmentation is performed by placing a saline or silicone implant under or over the muscles of the chest. The surgery is performed through small incisions in the areola or under the breast. Implants are foreign materials, and the body will form scar tissue around them to wall them off. Also, they can rupture and need replacement. But they do make your breasts larger!

Breast lift

A “mastopexy,” or breast lift, is a surgery in which the plastic surgeon will shape your breast tissue into a more pleasing shape (round rather than flat) and a higher position on your chest (closer to your neck rather than your belly). This is the plastic surgery for droopy breasts, which are defined as breasts on which the nipple is below a point 21 cm from the neck base with a majority of breast tissue below the nipple/areola.

I perform my breast lift surgery with a “lollipop” incision: an incision around the areola and then downward. Other plastic surgeons may use an “anchor incision”: the lollipop but with a horizontal cut along the width of the breasts.

The nipple/areola is elevated to its “normal” point 21 cm from the  neck base, the breast tissue secure on the chest.


Breast lift and Breast Augmentation

Some women need to have both a mastopexy and a breast augmentation performed at the same time.

A breast enlargement is needed because the breast tissue is too small for their frame, either from genetics, weight loss or, commonly, breast feeding. Breast feeding can lead to the involution of breast tissue (a decrease in breast glands).


A breast lift is needed because the breast became or always was droopy due to:

  • genetics
  • weight loss
  • pregnancy


Breast lifts and breast augmentations can be performed at the same time. The surgery is more difficult than either surgery alone, and some plastic surgeons report a higher complication rate when doing the two procedures together, yet I know of no one who does them in two separate appointments!

The weight of breast implants needs extra attention in cases of lift and augmentation because the skin of droopy breasts tends to be thinner; a reinforcement with dermal tissue may be necessary. On the other hand, the risk of capsular contracture (scar tissue around the breast implant) is much less, in my experience.

The danger of not having a breast lift when you need one

There is really no danger.

Just accept that if you have a breast enlargement performed with droopy breasts, you will have large droopy breasts—or, to use a euphemism, “mature breasts.”

Morad Tavallali, M.D., FACS