It is your own fat, in three steps: it is harvested with gentle liposuction, purified to remove blood, anaesthetic and oil, and infiltrated into the breast in small amounts and in several planes.
It is not an augmentation, it is a correction of shape: it fills the lower pole, rounds out the tubular contour, reduces the protrusion of the areola and evens out mild asymmetry.
Between 100 and 250 ml per breast is grafted, and between 20% and 30% is reabsorbed in the first few weeks: counting on a second session is normal, not a surprise.
It has clear limits: there has to be enough donor tissue (abdomen, flanks, thighs), and in severe cases — type III — it does not replace full surgery but is combined with other techniques.
On its own it does not release the fibrous band that constricts the gland, so it is usually accompanied by redistribution of the gland. The result starts to show in the third week and settles between 3 and 6 months.
Fat transfer has established itself as an effective, safe technique within breast surgery, particularly in tuberous breasts. This congenital malformation, also known as tubular breast, requires a reconstructive approach that restores volume, shape and harmony to the breast. Although breast implants were for years the standard solution, autologous fat transfer is today a valid alternative for certain patients who want a more natural result or who wish to avoid implants.
At the Instituto de Cirugía Plástica del Mediterráneo, in Valencia, we use fat transfer as part of an advanced protocol for correcting tuberous breasts, carefully selecting the cases in which it can be used as the only technique or in combination with others.
Fat transfer involves taking fat from the patient’s own body by means of gentle liposuction, processing it to purify it and then injecting it into specific areas of the breast in order to add volume or correct defects of shape.
In the context of tuberous breasts, that fat is used to:
Fill areas deficient in volume, particularly the lower pole.
Round out the breast contour, removing the tubular appearance.
Increase the thickness of the tissues, improving the cover over an implant if one is used.
Correct mild asymmetry, without having to resort to implants of different sizes.
The fat integrates into the tissues as living part of the body, which allows for a lasting, natural result.
When is it indicated in tuberous breasts?
Fat transfer is not applicable in every case of tuberous breast. It is particularly indicated when:
The patient does not want breast implants.
The deficiency in volume is not severe, and can be corrected with her own tissue.
There is mild to moderate asymmetry between the two breasts.
The aim is to complement redistribution of the gland with an improvement in the contour.
The cover over an implant needs improving in thin skin or complex cases.
It is also essential that the patient has sufficient donor areas (abdomen, flanks, thighs and so on) and is in good general health.
The advantages of fat transfer
Applied correctly, fat transfer offers a number of benefits over other breast augmentation techniques:
Natural shape and feel: because it is your own fat, the result is extremely natural both to look at and to touch.
No artificial materials: no implants are placed, which avoids the possible complications associated with them.
Correction of irregular contours: it allows precise treatment of depressed or poorly formed areas, particularly in the lower pole.
Improvement of the skin and subcutaneous tissue: a fat graft can improve the quality of the skin in damaged or thinned areas.
A double aesthetic benefit: because it is harvested from areas with excess fat, it also improves the body in those areas.
The operation is usually carried out under sedation and local anaesthetic, or general anaesthetic, depending on the volume of fat to be transferred. It has three stages:
Selective liposuction:
Fat is harvested with fine cannulas from areas such as the abdomen, the flanks, the lower back or the thighs.
Processing the fat:
The fat is purified to remove blood, anaesthetic and oil. This step is key to improving the viability of the graft.
Controlled infiltration into the breast:
The fat is injected into multiple planes of the breast and subcutaneous tissue, in small amounts and with specific techniques that encourage it to integrate and develop a blood supply.
The procedure can take between 1 and 3 hours, depending on the complexity and the volume treated.
Fat transfer is not an injection of fat but three linked steps. First it is harvested with gentle liposuction from the abdomen, flanks or thighs. Then it is purified to remove blood, anaesthetic and oil: whether the graft takes depends on that step. And finally it is infiltrated in small amounts and in several planes, rather than in a single deposit, because each portion needs to be surrounded by tissue that can supply it with blood. Even so, between 20% and 30% of the graft is reabsorbed in the first few weeks, which is why a second session may be needed. Diagram by the Instituto de Cirugía Plástica del Mediterráneo, simplified for information purposes.
How much fat can be grafted?
In a standard session it is possible to transfer between 100 and 250 ml per breast, although these figures can vary with the patient’s anatomy and the donor tissue available. It is important to bear in mind that part of the graft (around 20% to 30%) is naturally reabsorbed during the first few weeks, so a second session may be needed to consolidate the results.
What results can you expect?
Fat transfer makes it possible to:
Soften the tubular appearance of the breasts.
Redefine the lower pole, giving a rounder, better-balanced shape.
Reduce the protrusion of the areola, by redistributing the volume.
Improve the symmetry between the two breasts.
Achieve a breast that is harmonious, natural and in proportion to the body.
At our clinic in Valencia we carry out a personalised assessment of each case, including digital simulations to help visualise the possible results. We also plan carefully the volume of fat needed to achieve the best balance between safety, effectiveness and a natural look.
Fat or implant in the tuberous breast: what the data say
It is the question to ask before deciding, and the honest answer is not the most flattering for fat. A study comparing the two routes in patients with tuberous breasts — 62 cases, 37 of them assessed with the BREAST-Q questionnaire — found that those treated with an implant were significantly more satisfied, both with the result in the breast (p = 0.002) and with the overall result (p = 0.00008), and that fat transfer required on average more procedures (1.6 against 1.36), although that difference did not reach statistical significance.
That finding does not rule out fat: it puts the conversation where it belongs. Fat transfer does not compete with the implant on volume or on number of sessions, but it offers something the implant does not — your own tissue, no foreign material and a minimal scar. Which matters more is each patient’s decision, not a technical superiority of one route over the other.
There is also a technical point that decides much of the result: fat alone does not correct a tuberous breast. What constricts the lower pole is a fibrous ring at the base of the breast and, if it is not released, the graft expands nothing. In a series of nine adolescents (mean age 14.9) treated by combining percutaneous fasciotomies to release that ring, lowering of the inframammary fold and reduction of the areola, with an average of 1.8 sessions and around 220 cc of fat per breast, all were satisfied and there were no serious complications, with a mean follow-up of 21 months.
Put another way: when fat transfer works in a tuberous breast, it works because it is accompanied by release of the ring, not because more fat has been injected.
Important considerations
It does not replace full reconstructive surgery in severe cases. In type III tuberous breasts, combination with other techniques is usually necessary.
The result is stable, but it can be affected by changes in weight or by later pregnancies.
It is not an aggressive breast augmentation technique, but a strategy of anatomical correction with moderate volume.
On its own it does not remove the fibrous band that constricts the gland, so it is usually accompanied by redistribution of the gland.
Follow-up and recovery
Recovery after fat transfer is generally quick and well tolerated. The patient can return to her usual routine within a few days, although we recommend:
Wearing a compression garment on the donor areas.
Avoiding pressure on the breast for at least two weeks.
No intense exercise for a month.
Attending the follow-up appointments so that the integration of the graft can be assessed.
The final result starts to become apparent from the third week and settles between 3 and 6 months afterwards.
Fat transfer in tubular breasts is a useful, safe and effective technique when applied in the right context. It not only makes it possible to correct defects of shape and volume without implants, but also delivers a more natural, lasting result. At the Instituto de Cirugía Plástica del Mediterráneo we analyse each case on both medical and aesthetic criteria in order to offer our patients the best possible solution. If you are considering this technique or would like to explore your options for correcting tuberous breasts, we will be glad to help you with a fully personalised plan.
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Brault N, Stivala A, Guillier D, Moris V, Revol M, François C, Cristofari S.Correction of tuberous breast deformity: A retrospective study comparing lipofilling versus breast implant augmentation. J Plast Reconstr Aesthet Surg. 2017;70(5):585-595. PMID 28341593 — 62 patients: greater satisfaction with an implant on the breast (p = 0.002) and outcome (p = 0.00008) modules; fat transfer required more procedures.
Gutierrez-Ontalvilla P, Naidu NS, Lopez Blanco E, Condiño Brito E, Ruiz-Valls A.Autologous Fat Grafting with Percutaneous Fasciotomy and Reduction of the Nipple-Areolar Complex for the Correction of Tuberous Breast Deformity in Teenagers. Aesthetic Plast Surg. 2020;44(2):264-269. PMID 31673737 — nine adolescents, 1.8 sessions and around 220 cc per breast: the key is releasing the constricting ring with fasciotomies, not simply injecting fat.
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