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What would you suggest to accentuate very small breasts?

Q:

I am 22 years old with very small breasts (not even big enough to have cup size).  I was going for breast implants but after finding out that I may need to have them done every 10-15 years, I'm having second thoughts about it.  I have a very active and athletic life, which I  suppose could even damage my implants.  I'm not looking for very large breasts - all I want is something to fill out the place in my clothes.  In my case, what would you suggest, breast implants or fat injections?

A:

Both procedures are very reasonable. The problem with fat injection is that there are very few surgeons doing this a lot  and, thus, there is not a lot of experience with it. Implants have been used for people like you for many years very successfully. Although, officially, implants only have a 15-20 year life expectancy, I have found them much more reliable. I have personally replaced only about 2% of the ones I have put in over the last 30 years. I would suggest for you silicone implants placed above the muscle because of your reduced cover and very athletic lifestyle. Instead of wondering about what you read, see a Plastic Surgeon and discuss your options.

A:

Fat injection to the breasts remains a very controversial procedure despite all of the advances in recent years. Predicting how much of the fat will "take" and sorting out the issues with reading mammograms in breasts injected with fat are only two of the points being debated. On the other hand, with implants you can pick the size you want to be with some accuracy, and if the implants ever do need to be replaced (which they may not) it isn't a big operation. Implants in athletic women have certain important trade-offs however, so see someone with experience. It isn't always as simple as over or under the muscle.

Richard A. Baxter, M.D. - View Other Answers by this Doctor
Mountlake Terrace, WA

A:

Both methods of breast augmentation are available to you provided you understand the limitation of each and the potential risks.

Breast implants size will be limited by your anatomy, the amount of breast tissue , the width of the breast, and the tightness of the skin of the breast.  Breast implants require maintenance, that is you will need surgery in the future after breast implants.  Breast implants have the potential of interfering with mammogram, sensation, and breast feeding.  Breast implants can encapsulate and cause capsular contracture, implant displacement is possible and thus the need for further surgery.

Fat transfer to the breast is at it's infancy.  As plastic surgeons we have been doing fat transfer for years with great success.  Fat graft to the buttocks and the face and to the breast in breast reconstruction has been of great success with great results.

Fat transfer to the breast for breast volume enhancement and for shaping the breast is highly successful.  The average take of the graft is 62% to 80%.  It is very sensitive to the technique used.

Some of the fat dies and leaves micro calcifications; these calcifications can be misinterpreted as breast cancer, though most radiologists say they are able to  differentiate calcifications due to fat necrosis and calcifications due to cancer.  Remember that every time we operate on the breast, as in breast reduction and breast reconstruction, there is fat necrosis and calcifications.

With the fat transfer there is also stem cells which are plenty in the fat.  The fate and behavior of the stem cells in the breast or in the presence of breast cancer, if it is already there, is unknown.

Once you understand all the pros and cons of each procedure then you, and only you, can make an intelligent decision as to which procedure you want.  You must factor in the risks that you are willing to take and accept.

A:

Fat transplantation for natural breast enlargement is still an experimental procedure.  I would not recommend fat transfer for someone so young because we do not know the long-term effects.

According to the FDA 23-25% of patients who have breast augmentation require a revision within 10 years.  However this figure also includes women who simply want larger implants.  Based on that data there is a 75% chance that you will not need a second procedure.

Smaller implants in the 200-250 cc range are often used for small patients who want a minimal enlargement a natural result.

The most important thing is to consult at least 2 board certified plastic surgeons who are experienced at breast augmentation and have very reputable reputation's in your community.

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