What Is Explant with Fat Transfer -- and Can It Keep Your Shape?
What Is Explant with Fat Transfer -- and Can It Keep Your Shape?
Explant with fat transfer is a surgical procedure that removes your breast implants and uses your own body fat to restore natural volume in the same operation.
| Stage | What Happens |
|---|---|
| 1. Implant Removal | Implants (and often the surrounding scar capsule) are removed through existing incisions |
| 2. Fat Harvesting | Fat is liposuctioned from donor areas like the abdomen, flanks, or thighs |
| 3. Fat Transfer | Purified fat is injected into the breasts in small layers to restore shape |
Key facts to know up front:
- The procedure is done under general anesthesia and typically takes 3-5 hours
- Most women retain roughly 50-80% of the transferred fat long-term
- Results are considered permanent once the fat establishes a blood supply (around 6 months)
- It works best for women who want a natural, modest volume -- not a dramatic size increase
- You need enough donor fat for the transfer to be effective
I am Dr. Jonathan Kanevsky, a board-certified plastic and reconstructive surgeon trained at McGill University and USC, with experience in breast surgery and body contouring, including explant with fat transfer for women seeking a natural, implant-free result.
Understanding Breast Explant with Fat Transfer
When we talk about an explant with fat transfer, we are looking at a two-for-one transformation. In plastic surgery, this is known as autologous grafting -- meaning we use your own biological material to enhance another part of your body. The primary concern most of our patients in Beverly Hills and Los Angeles have when removing implants is the deflated balloon effect. By utilizing fat transfer, we can fill those empty spaces with living tissue that belongs to you.
Biocompatibility and the Natural Advantage
Because we are using your own adipose tissue, there is zero risk of an allergic reaction or rejection in the way the body might react to a synthetic implant. Furthermore, fat is more than just a filler. Adipose tissue is incredibly rich in regenerative properties. It contains a high concentration of mesenchymal stem cells -- the body repair crew. When we perform fat grafting, these cells help improve the quality of the overlying skin, which can be particularly beneficial for women whose skin has become thin or wrinkled from years of implant pressure.
Dual Contouring: The Silver Lining
Almost everyone has a problem area where they carry a little extra stubborn fat. Whether it is the abdomen, the love handles on the flanks, or the outer thighs, we can harvest fat from these sites using gentle liposuction. This means that while we are restoring volume to your breasts, we are also sculpting your waistline or legs. You lose it where you do not want it and keep it where you do.
The Procedure: From Removal to Restoration
The Importance of the Capsule
When an implant is placed in the body, a layer of scar tissue called a capsule naturally forms around it. In many cases, especially if there are concerns about Breast Implant Illness (BII) or capsular contracture, we recommend an en bloc capsulectomy. This involves removing the implant and the entire scar tissue capsule as one single unit, ensuring that any potential irritants or silicone debris are completely removed from your system.
Harvesting, Purification, and Injection
Once the implants are out, we use tumescent liposuction to harvest fat from the donor sites. We use low-pressure systems to keep these cells happy and healthy. After harvesting, the fat goes through a purification process using centrifugation or filtration to separate the pure, golden fat cells from excess fluids, oil, and blood.
We do not just dump the fat into the breast. To ensure the fat survives, it needs to be placed in very small amounts, known as micro-aliquots, throughout the breast tissue. By layering the fat in tiny droplets, we ensure that every cell has access to a blood supply. This process, called neovascularization, is how the fat takes and becomes a permanent part of your body.
Step-by-Step Process
- Anesthesia: You will be under general anesthesia throughout the 3 to 5 hour process.
- Incision Reuse: Whenever possible, we use your original augmentation incisions to remove the implants and capsules. This prevents unnecessary new scarring.
- Liposuction: We perform gentle harvesting from your pre-selected donor sites (abdomen, thighs, or flanks).
- Processing: The fat is purified via centrifugation to isolate the most viable cells.
- Grafting: Using specialized micro-cannulas, we inject the fat in a crosshatch pattern across multiple layers of the breast.
- Closure: Incisions are closed with dissolvable sutures.
Ideal Candidates
- Sufficient Donor Fat: You need to have enough spare fat to harvest.
- Stable Weight: Fat cells behave like any other fat in your body -- if you lose a lot of weight, the transferred fat will shrink.
- Realistic Expectations: Fat transfer is about restoration and shape, not massive size. While we can often achieve a 1 to 2 cup size increase over time, we cannot replicate the projection and extreme upper-pole fullness of a large silicone implant.
- Non-Smokers: We require patients to be nicotine-free for at least 4 to 6 weeks before and after surgery.
- Good Health: You should be in good overall health with no uncontrolled medical conditions like diabetes.
Recovery and Results: What to Expect
The Healing Timeline
- Days 1 to 3: You will need plenty of rest. You will likely have surgical drains in your breasts to prevent fluid buildup, which are typically removed within 3 to 5 days.
- Week 1: Most patients can return to light desk work. You will be wearing a supportive, non-underwire bra and a compression garment over your liposuction areas.
- Weeks 2 to 3: Bruising begins to fade. You can usually resume light walking, but no heavy lifting (nothing over 10 lbs).
- Month 1: You can often return to most normal activities, though we still advise against high-impact exercise.
- Months 3 to 6: The settling phase. This is when the initial swelling subsides and you see the true, final volume of the fat that has survived.
Immediate vs. Delayed Fat Transfer
| Feature | Immediate Fat Transfer | Delayed Fat Transfer (3+ Months Later) |
|---|---|---|
| Pros | One surgery, one recovery, immediate volume restoration. | Allows the breast skin to shrink wrap first for more precise shaping. |
| Cons | Harder to predict exact skin contraction. | Two separate surgeries and two recovery periods. |
| Best For | Most women wanting to avoid the deflated look immediately. | Women with significant sagging who may need a lift first. |
Long-Term Success and Mammogram Safety
Once the fat has survived the first six months, it is there to stay. It becomes a permanent part of your breast tissue. It is a myth that you cannot get mammograms after fat grafting. However, fat transfer can sometimes lead to small microcalcifications or oil cysts as some fat cells are reabsorbed. Experienced radiologists can easily distinguish these from cancerous lesions. Fat grafting does not increase the risk of breast cancer.
Comparing Restoration Options
- Explant Alone: The simplest option. If you have small implants and very good skin elasticity, your breasts may bounce back well on their own. However, for many, this leads to a deflated look.
- Explant with Breast Lift (Mastopexy): If you have significant sagging (ptosis), a lift is often necessary to reposition the nipple and remove excess skin. While a lift improves shape, it does not add volume.
- Explant with Fat Transfer: This is the scarless volume builder. It fills the empty space left by the implant without the need for the long anchor scars often associated with a traditional breast lift.
In many cases, we combine these techniques. An Aura Fill and Lift might involve a minor lift to tighten the skin combined with fat grafting to restore the cleavage area and upper fullness.
Frequently Asked Questions
How much fat survives the transfer process?
On average, about 50% to 70% of the fat we inject will survive long-term. Some studies have shown retention as high as 80% with optimized protocols. Because we expect some cell death, we often slightly overfill the area during surgery. The fat that is still there at the six-month mark is generally considered permanent.
Can I achieve the same cup size as my previous implants?
It depends on the size of your implants. If you are moving from a very large 600cc implant, it is unlikely that we can replace that entire volume with fat in a single session. Fat transfer is better for a subtle and sophisticated look. If you desire a significant increase, we can sometimes perform staged grafting -- doing a second round of fat transfer six months after the first.
Is the procedure performed under general anesthesia?
Yes. Because we are performing both an implant removal (and potentially a capsulectomy) and liposuction on multiple body areas, general anesthesia is required for your safety and comfort. The procedure is performed on an outpatient basis in our accredited surgical centers in Los Angeles or Beverly Hills, meaning you can go home the same day.
Conclusion
Choosing to remove your implants is a deeply personal decision, often marked by a desire to return to a more natural state of being. At Aura Aesthetica, we do not just see this as a clinical procedure; we see it as an opportunity for mind-body transformation. Our Surgery as Ceremony philosophy ensures that your journey -- from the first consultation to the final reveal -- is handled with intention, grace, and expertise.
If you are ready to explore how we can help you transition into your next chapter with confidence, we invite you to schedule your consultation for breast explant en bloc capsulectomy today. Let us help you keep your curves, naturally.