Fat Grafting at Implant Removal (Explant Surgery)
Some women reach a point where they want their breast implants removed and not replaced. The reasons vary. Some have had their implants for many years and no longer want them. Some have developed a complication. Some have made the decision for personal or health reasons. Whatever the reason, choosing to remove implants is a valid decision, and it does not have to mean choosing between implants and no volume at all.
For suitable patients, I can perform fat transfer breast augmentation (Augmentation mammoplasty autologous fat grafting) at the same operation as implant removal (explant surgery). Fat is taken from another area of your body by liposuction (suction-assisted lipectomy), prepared, and grafted into the breast after the implants come out. It will not replicate the volume of an implant. What it can offer is a modest amount of your own tissue in the breast, placed in the same operating time as your explant.
This page covers what the combined operation involves, what fat grafting can and cannot do in this setting, and how to find out whether it suits you.
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What the operation involves
The combined operation has two parts, done under one general anaesthetic at Maitland Private Hospital.
Implant removal comes first
I remove both implants, usually through the existing scar where possible. Where the capsule around the implant needs to be removed as well, I perform a capsulectomy at the same time. Whether a capsulectomy is needed depends on the state of the capsule and the reason for your explant, and I assess this with you before surgery. The detail of explant surgery itself, including capsulectomy, is covered on the implant removal (explant surgery) page.
Fat grafting follows
Once the implants are out, I harvest fat from a donor area, commonly the abdomen, flanks or thighs, using VASER ultrasound assisted liposuction (suction-assisted lipectomy). The harvested fat is filtered and prepared for grafting, then injected into the breast tissue in small amounts across multiple layers. Placing the fat this way gives each graft the best chance of picking up a blood supply and surviving.
The donor area is a decision we make together at consultation, based on where you carry fat and what will graft well. You will wear a compression garment over the donor area afterwards, and a support bra over the breasts.
For a full description of fat transfer breast augmentation (augmentation mammoplasty autologous fat grafting) as a procedure, see the fat transfer breast augmentation (Augmentation mammoplasty) page.
What fat grafting can and cannot do after explant
This is the part of the page to read most carefully, because the operation only makes sense if your expectations match what fat grafting delivers.
Fat grafting does not replicate implant volume. An implant provides a fixed, predictable volume. Grafted fat does not. If you remove implants and graft fat at the same operation, your breasts will be smaller than they were with implants in. For most patients the change from grafting is a modest increase in volume compared to explant alone, with some softening of the contour where the implant used to sit.
Not all grafted fat survives. A proportion of the fat placed at surgery is resorbed by the body over the first few months. How much survives varies between patients and cannot be predicted precisely beforehand. The result you see at around three to six months is close to the result you keep.
Repeat sessions are possible. Where more volume is wanted than one session achieves, further grafting can be done as a separate procedure once the breast has settled. Some patients plan for this from the start.
Weight changes affect the result. Grafted fat behaves like fat anywhere else in your body. Significant weight loss after surgery will reduce the grafted volume.
If predictable volume is your priority, replacing the implants is the more reliable route, and that is a different operation: [removal and replacement of breast implants (implant exchange)]. Fat grafting at explant suits patients who have decided against implants and accept a modest, variable change in exchange for using their own tissue.
Disclaimer: 3D imaging is a visualisation aid used to support discussion during your consultation. It is a general guide only. It does not predict or guarantee your actual surgical result, and results vary between patients. All surgery has complications, get a 2nd opinion
This is not auto-augmentation
Patients researching explant options often come across mastopexy with auto-augmentation and assume it is the same thing as fat grafting. It is not, and the difference matters when implants are being removed.
Auto-augmentation is part of a breast lift (mastopexy). Your own breast tissue is rearranged within the breast during the lift to add fullness where it is wanted. No tissue is moved from elsewhere in the body. I do not perform auto-augmentation at implant removal, because rearranging breast tissue at the same time as an explant puts the blood supply to that tissue at risk.
Fat grafting at explant is a different procedure. The volume comes from fat harvested elsewhere in your body, placed into the breast in fine layers. It does not involve rearranging the breast tissue itself, which is why it can be done at the same operation as implant removal.
If you are weighing these options, the explant versus auto-augmentation article works through the decision in more detail.
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Is this operation right for me?
Adding fat grafting to your explant is an individual decision, and not every explant patient is suited to it or wants it. At consultation I assess:
- Donor fat. You need enough fat in a suitable donor area to make grafting worthwhile. Very lean patients may not have enough to harvest.
- Breast tissue quality. The state of your breast tissue after the implants come out affects how well grafted fat takes and where it can be placed.
- The state of the capsule. Whether a capsulectomy is planned changes what is sensible to do in the same operating time.
- Your expectations. The operation suits patients who understand the change will be modest and variable, as covered above.
- Your general health. As with any operation under general anaesthetic.
Some patients look at all of this and choose explant alone, without grafting. That is a reasonable path, and nothing about removing implants obliges you to replace the volume. Others prefer to plan grafting from the start, or to leave it as a possible second procedure once the breast has settled after explant. Each of these is a workable approach, and the right one for you comes out of the consultation.
Your pathway
GP referral
A referral from your GP is required before any consultation. This is standard for my practice and keeps your GP involved in your care from the start.
Consultation
We meet at my Lorn clinic, or by Zoom if distance is an issue. I examine your breasts and donor areas, go through your implant history and general health, and we talk through what fat grafting at explant can realistically achieve for you. Whether the combined operation, explant alone, or a staged approach suits you best is decided here, not before.
Pre-operative imaging
Breast imaging is arranged before surgery. The type of imaging depends on your age, with mammography for older patients and ultrasound for younger patients.
Pre-operative bloods
A standard panel is taken before surgery, and your GP is copied in on the results.
Surgery
The operation is performed at Maitland Private Hospital under general anaesthetic. Your anaesthetist will usually consult with you by phone beforehand, with the physical assessment on the day.
Follow-up
My nursing team and I review you closely in the first two weeks, then at milestone visits at four weeks, three months, six months and twelve months. Your GP receives a formal handover at the four week visit. After hours, Maitland Private Hospital runs a nurse led phone line for concerns.
Recovery and risks
This is invasive surgery combining two procedures under one general anaesthetic, and it carries the risks of both. On the explant side these include bleeding, infection, seroma and changes in breast shape and skin. The grafting side adds donor site bruising and contour change, oil cysts and firm areas in the breast where fat has not survived, and the possibility that less volume takes than hoped. Recovery takes time, involves a support bra and a compression garment, and varies between patients.
I keep the full detail on dedicated pages rather than compressing it here:
- Fat grafting recovery page for the week by week recovery course
- Fat grafting complications page for the risks of grafting in detail
- Implant removal (explant surgery) page for the risks and recovery of explant, including capsulectomy
Read these before your consultation. They are part of making an informed decision, and we go through the risks that apply to you in person before anything is booked.
Cost
The cost of fat grafting at explant depends on the extent of the grafting, whether a capsulectomy is performed, and your individual surgical plan, so I quote it after consultation rather than as a flat figure. The fat transfer breast augmentation (augmentation mammoplasty) cost page explains how the fee is structured and what it includes. Medicare and health fund eligibility is assessed individually, as item number criteria apply to some explant scenarios and not others.