Benefits of Fat Transfer Immediately Following Breast Explant Surgery

Ideal candidates for fat transfer after an explant procedure are individuals with sufficient fat to donate and some existing breast tissue to accommodate and supply blood to the transferred fat. Thin patients with large implants and minimal breast tissue present more challenges. However, most patients have enough fat to donate and sufficient breast tissue for the procedure.

It is important to note that replacing the entire implant volume with fat is very difficult. The primary goal is to create a beautiful, full breast with good shape, size, and symmetry while preventing complications from explantation, such as excess skin, deflation, and adhesions to the chest wall.

How Is A Fat Transfer After An Explant Performed?

The key component of this procedure is liposuction. Dr. Burns uses tumescent liposuction with gentle extraction techniques. He does not recommend VASER® or laser assistance except in extenuating circumstances, such as thin areas, poor skin quality, or secondary cases, as these methods can damage the fat cells necessary for a good result. Maximizing the body's acceptance of the fat graft is critical. While it is often impossible to replace as much fat as the removed implant, most cases result in enough fat surviving to fill out the skin and create a pleasing shape and size.

Since most patients are thin, it is best to harvest fat from multiple areas, such as the abdomen, flanks, and thighs. Liposuction is performed using a technique called skimming, where fat is removed from the deep layer using a small cannula with multiple passes from different vectors or access points. This ensures maximal fat harvest with minimal risk of contour irregularities.

The fat is harvested into a cylindrical canister placed on a vibrating platform to separate the fat from blood and fluid. The fluid is drained, and the remaining fat is treated with antibiotics before being reinjected into the breasts. The system is closed, meaning the fat is never exposed to the environment and is kept in a sterile environment, ensuring efficiency so the harvested fat spends minimal time outside the body.

Fat is reinjected using a small cannula through one access point located in the breast fold at the medial aspect. This method is safe because the ribcage is barrel-shaped, and the cannula always passes away from the rib cage and lungs. Fat is placed into the breast tissue with extreme care to avoid injecting fat into the pocket where the implant was removed. It is essential to thread the fat throughout the breast to expose it to as much blood supply as possible, ensuring maximal survival. Overfilling the breast must be avoided as it can decrease blood flow and result in scar tissue formation, known as fat necrosis. A pressure monitor on the injection system prevents high injection pressures. By following these principles—fat purification, efficient technique, closed sterile system, safe injection technique, and layering of fat in the breast for maximum blood supply—the results are very good, reliable, and reproducible.

What Is The Recovery Time For Explant with Fat Transfer?

Recovery is generally swift, primarily stemming from the liposuction part of the procedure. While the breasts may appear swollen and bruised, they are usually less uncomfortable than the liposuction areas. Most patients describe liposuction discomfort as a bruised and stiff sensation. After the first day or two, the discomfort diminishes, leaving most patients feeling just swollen and stiff.

Most patients take a week off work, although many return sooner. After several weeks, patients can resume light activity, but it is important to allow the chest muscle to fully adhere back to the chest before weight lifting, which takes about three months. Light activity is encouraged during this period.

Patients can alleviate discomfort and swelling with manual lymphatic massage or Endermologie, which help push fluid to the lymphatic system. Light activities such as walking also aid this process. Post-liposuction, patients need to wear compression garments for about six weeks—tight surgical garments for the first three weeks, followed by looser Stage II garments like Spanx or Lululemon for the next three weeks. Self-massage is also recommended to help smooth the skin after liposuction.

Out-of-town patients typically arrive the day before their procedure and stay for 2 to 3 days afterward before flying home. We have a strict DVT prophylaxis protocol to help prevent blood clots after surgery.

Initially, your breasts will appear overly full due to swelling and fluid in the fat graft.

Over the first month, your breasts will lose volume as the fluid and swelling dissipate.

At one month, you will see the results of the fat graft, with most patients retaining about two-thirds of the graft.

The final result from the explant and fat transfer becomes evident at six months, at which point standardized photos are taken and compared to the before photos.

Liposuction results also take six months to fully manifest. Swelling typically peaks at about two weeks and then rapidly decreases. Approximately two-thirds of the swelling resolves in the first two months, with the remaining swelling subsiding over the next several months.

What happens to my implants after explant surgery?

In most cases, the implants are discarded. However, if you would like the implants returned, our staff will wash them and give them back to you on the day of your procedure. Many patients request to have their implants returned.

Do I need drains with an explant and fat transfer?

Absolutely. After the implant is removed, there's a significant space left behind. It's crucial to ensure this space remains free of blood or fluid accumulation so that the tissues can properly adhere, leaving no room for fluid collection.

What if I don't have a lot of fat to begin with?

Nearly all patients will have sufficient fat available for a fat transfer procedure. Dr. Burns employs a technique called skimming, which delicately removes fat from various areas such as the abdomen, flanks, and thighs. This method typically yields enough fat for a successful transfer.

How soon can I work out after explant with fat grafting?

During the initial weeks following your procedure, it's important to prioritize rest. Starting around weeks 2 or 3, patients can gradually introduce light activities such as walking into their routine. Progressing further, low-impact exercises like the elliptical trainer, stationary bike, stairmaster, or continued walking can be incorporated. At the three-month mark, patients can initiate low-impact training and gradually transition to full exercise routines over the subsequent months.

How soon can I fly after surgery?

Most patients typically return home within 2 to 3 days after their procedure. Adhering to a stringent deep vein thrombosis (DVT) protocol is crucial to prevent blood clots. Patients should prioritize staying well-hydrated, wearing compression socks, and engaging in regular walks during their flight. Upon returning home, patients should aim to walk every 2 hours for the following 2 weeks. Additionally, some patients may require a blood thinner injection called Lovenox if they are in a higher-risk category.

I live in another country. Will I have to come back for follow-up appointments?

Not at all. Our out-of-town patients receive all their scheduled follow-up appointments virtually, utilizing platforms such as FaceTime, Zoom, Google Meet, or WhatsApp. Ensuring you have access to all necessary follow-up appointments and information is essential for a smooth recovery and optimal outcome.

What if I don't want fat injected into my breasts after explant? 

Many patients opt for explantation alone initially to assess their appearance. Fat transfer can be pursued as a secondary procedure following explantation. Alternatively, some patients may elect to undergo a breast lift procedure, which not only lifts the breast but also removes excess skin. Various options are available to tailor the approach and achieve the best results for each individual.

Should I gain weight before the procedure?

Typically, no. Dr. Burns recommends that you maintain your average weight, as it's likely where you will naturally settle following your procedure.

For various reasons, numerous women opt to have their implants removed without replacement. While implants offer volume and a rounded shape, they also stretch the skin and underlying tissues. Upon removal, breasts may appear deflated and saggy, with excess skin potentially forming awkward adhesions. Hence, it's crucial to address both the volume loss and excess skin to achieve optimal outcomes.

Ensure your journey to natural beauty is in the most capable hands. Choose a board-certified plastic surgeon with proven experience in explant with fat grafting procedures and embark on a path to confidence and well-being.

Read More: Dr. John Burns Named Among America's Best Plastic Surgeons by Newsweek in 2024

Dr. John Burns Named D Magazine's Best Doctors 2023

Explant Surgery Gave Me Amazing, Natural Results

"I had an implant removal with capsulectomy, breast lift, and fat grafting reconstructions. I chose Dr. Burns because of his excellent reviews on this particular type of surgery, knowing that I wanted to be in the msot capable and trustworthy hands. 

If you are a person looking for implant removal due to suspected illness or because you no longer want implants, you can rely on Dr. Burns to carefully and safely implement the surgery. [...] I look and feel better, and I have incredible peace of mind knowing my body no longer has the weight and risk of implants."

Breast Implant Removal: 22.yo. Implant Removal and Transfer

"Dr. John Burns is a miracle worker!! His bedside manner was awesome and the results he achieved exceeded my expectations. His staff was vvery king and understanding. So glad I had my surgery with Dr. Burns."