Awake Autologous Fat Transfer for Breast Augmentation: A Safe and Effective Technique with High Patient Satisfaction
Although deployed in plastic surgery practices, awake autologous fat transfer to the breast for aesthetic augmentation has not been comprehensively described in the literature. Furthermore, there is lack of research on the clinical and patient-centered outcomes of this technique. The aim of this study is to review the outcomes of a single surgeon practice, therefore providing evidence that awake fat transfer breast augmentation is a safe and effective technique with high satisfaction.
Methods/Technique:
Consecutive cases of single surgeon (senior author) performing awake autologous fat transfer for breast augmentation over the course of 10 years (2014-2024) were reviewed. All procedures were performed in an appropriately accredited office-based operating room. Patients provided written informed consent for surgery and peri-operative photographs. Indicated pre-operative workup and medical clearance were performed.
Patients were allowed to have a light meal up to 2 hours before the procedure. Active pregnancy was excluded with a urine test. A combination of oral analgesics, antibiotic, and anxiolytic (if requested by the patient) was administered 15 minutes before the procedure. Patients were evaluated standing upright for sites of fat procurement. Liposuction access sites were marked and injected with 0.5% lidocaine with 1:200,000 epinephrine. Tumescent fluid was introduced at a low rate to both the fat harvest sites and breasts. Liposuction was initiated 20 minutes after tumescent administration. Traditional, power-assisted, and water-assisted liposuction were employed, all using 3 and 4 mm cannulas. Fat was appropriately processed according to the liposuction technique utilized. Fat grafting was performed with 10 mL syringes and a long Coleman cannula, enhancing the entire breast but in most cases focusing on the upper pole.
Following the procedure, patients were placed in a compression garment for 4-8 weeks and instructed to begin wearing a sports bra at 1 week post-op, for 2 months. Patients were seen for routine follow-up, with 6 months being the shortest follow-up time in this series. At the 6 month appointment, all patients were surveyed on whether they would make the same choice to have the procedure given their current result and on satisfaction with overall outcome.
Results/Complications:
This series includes 28 cis-gender female patients, 7 of whom had the procedure performed twice – for a total of 35 procedures. Mean age was 35 (ranging from 22 to 55). Mean BMI was 23.8 (ranging from 17.7 to 35.5). 1 patient (3.6%) had prior implant augmentation and requested the implant to be removed. 33 cases (94%) were bilateral. Most cases (86%) were performed as an isolated procedure; 5 cases involved other concomitant cosmetic procedures. Mean operating time for fat grafting was about 2.5 hours (149 minutes).
Water-assisted and suction-assisted liposuction were most frequently used (37% and 34% of cases, respectively). Power-assisted was used in 9 cases (26%). The trunk was the most common fat donor site (77% of cases), followed by thighs (54%) and arms (11%).
Mean fat volume (calculated as solid fat without the liquid component) injected into each breast was 79.6 cc (ranging from 12.5-212.5 cc). At the 6 month follow-up, 21 (75%) reported a sustained increase in cup size. Most commonly, this was a B to C cup (10 patients); followed by A to B cup (4), and AA to A cup (3). 2 patients reported an increase from AA to B cup. Of the 7 patients whose cup size did not change, 2 were already C cups and 5 were B.
A minor complication occurred in 2 cases (6%). Notably, there was only 1 case of clinically appreciable fat necrosis with palpable firmness. There was no further sequelae and the patient declined treatment. The other complication was a panic attack during the procedure, but the procedure was able to be completed as planned. Additionally, one patient with a significant prior lumpectomy contour deformity was only partially improved with fat grafting.
All patients reported satisfaction with the procedure at the 6 month follow-up, responding affirmatively when surveyed whether they would have made the same decision to have the procedure. Patient-reported satisfaction with the aesthetic outcome was also high, with 21 cases (60%) rated a 5 (very satisfied) on a 1-5 scale and 13 cases (37%) a 4 (somewhat satisfied).
Conclusion:
Based on a 10-year single surgeon experience, awake autologous fat transfer is a safe and effective alternative to traditional breast augmentation for the prosthetic-averse, smaller-breasted patient whose main priority is improving upper pole fullness. The technique also offers the benefit of simultaneous body contouring without general anesthesia. Furthermore, patient and surgeon satisfaction ratings are high. While larger longitudinal studies are necessary to elucidate the long-term advantages and disadvantages, this study provides a fundamental safety and outcome profile of a unique, growing aesthetic surgical offering.