Bigger Breasts (With Fat, Not Implants)

Dr. G (00:02):
You are listening to another episode of All the B's with me, Dr. G and my scrub tech, Bri. All right, back for another episode. Hey Bri, how's it going?

Bri (00:13):
Good morning, happy Friday.

Dr. G (00:15):
Yeah, we love recording on Friday. I think that's going to be our day.

Bri (00:19):
I think so too.

Dr. G (00:21):
Today we're going to talk about some fat transfer to the breasts, which we do a fair amount of, but we've got to do our Daily Mail update first. So I think,

Bri (00:31):
Can't miss that.

Dr. G (00:33):
I think our first headline is Skye Wheatley gives us huge update on our controversial fox eye lift cosmetic surgery as she jets off to Turkey. I mean, can you identify five things wrong with this sentence?

Bri (00:45):
Jetting off to Turkey.

Dr. G (00:47):
Starting with that. I mean, I think if you're wealthy enough, I don't know why you would go to Turkey for plastic surgery, not Turkey in particular, but just a foreign country. It seems like a generally bad idea. If anything doesn't go perfectly, you're going to have to,

Bri (01:04):
What post-op care do you receive out of the country? If you come back after a couple of days, do other doctors, will they see you for post-op care?

Dr. G (01:11):
I mean if you go to an emergency room, they will because they have to, but if you call around to plastic surgery offices, they're not going to see you for free. And what was interesting in this is she talks about previous surgery she had, I can't remember what she had also out of the country that she had to have redone. Maybe it was her breast surgery in the states. So I don't know why then you would turn around and go back to where it didn't go well.

Bri (01:38):
There's a red flag.

Dr. G (01:38):
So alright, so surgical or plastic surgery tourism, I would say I feel strongly about as a bad idea. And then secondly, the fox eye lift, I mean.

Bri (01:54):
I've seen some crazy ones and I can't tell if they settle later on. Like right now she looks good. She doesn't look like super crazy. I assume that's the after picture.

Dr. G (02:06):
I don't know. I think that's her before. It's hard to know honestly.

Bri (02:11):
But I have seen some and their eyebrows are just pulled up so high and I was like, they can't want this look.

Dr. G (02:17):
Right. I mean it just looks, I guess if you're looking for unnatural, that would be an option. I'm not sure the fox eye lift trend is trending anywhere else except amongst very niche influencers or people in a certain industry because it just looks weird.

Bri (02:34):
What's the difference between a fox eye lift and a brow lift?

Dr. G (02:37):
So I think the goal of a fox eye lift is to really make your eyes pointy, the outer corners of your eyes pointy and elevated as opposed to just elevating the tail of your brow to a more natural position. And I guess the other fundamental difference is that if you are having a brow lift or I'm having a brow lift, our brow lifts are going to look different because the surgeon should be maintaining our normal brow position and just elevating it, our normal shape and elevating it. You're not trying to dramatically change the way I look, whereas a fox eye lift implies that you're trying to create a specific look which may or may not match your face. It borders into body modification, which is not generally plastic surgery. I mean we can also embed horns in your head, but I don't think that's a good idea.

Bri (03:33):
It's going to be the procedure of 2025. You heard it here first, folks.

Dr. G (03:39):
With little horns. That would be cute. Or cat ears or something.

Bri (03:42):
Cat ears for Dr. Kat.

Dr. G (03:45):
That's right. They won't come off. Yeah. Anyway,

Bri (03:49):
So we don't love the Fox eye lift. That's going to be, is that a no?

Dr. G (03:53):
That's a no.

Bri (03:54):
Okay.

Dr. G (03:55):
That would be a no procedure. A procedure I will not do. And then of course there's a real housewives icon. I mean they're fodder for Daily Mail looks unrecognizable after going extreme cosmetic surgery procedure, which I mean essentially looks like she had laser resurfacing. She just had the full face done, which of course you're going to look unrecognizable post-op day two. I'll say this is a good PSA because this is exactly how you're supposed to look after CO2 laser resurfacing, eyelid surgery, potentially fat grafting and a facelift. That's what you want.

Bri (04:38):
She also had an upper bleph.

Dr. G (04:40):
Yes. Yeah, she definitely did. But that CO2, I mean I tell our patients you're going to look like a burn victim and she does.

Bri (04:49):
Oh, that's Tamara or Tamra, not Tamara.

Dr. G (04:54):
Tamra Judge.

Bri (04:56):
I used to love her.

Dr. G (04:59):
Yeah, she had a CO2 and blue chemical peel and it's going to be worse those first couple days and then as the swelling goes down, she'll start to be less puffy and then all that brown stuff on her face will flake off and then she'll be a little pink, and by a week to two weeks she'll look completely normal but really glowy and her skin will be tighter and have better fine line, see right there. She actually looks way better.

Bri (05:30):
Much more like herself.

Dr. G (05:31):
Dude, her neck took it hard.

Bri (05:33):
I feel like there's been some patients, at least when I first started here that came in and they're like, can I go to dinner later tonight? Can I put on makeup?

Dr. G (05:41):
I think we'll just send them to this link. This is what you're going to look at, look like. I mean we do have pictures of day two, day three, day five, day seven. And I think that is helpful because people always think that they're the best healer and they're going to be great. And then they're like, oh my God, exactly what you told me happened, because you can't imagine it. So yeah, she's going to have a great result, but yes, you look insane.

Bri (06:10):
And lather that up in sunscreen.

Dr. G (06:12):
Yeah, she, stay out of the sun. I mean there's all the usual comments that are like, look like yourself, fix your internal blah, blah, blah. Okay. If she wants her skin.

Bri (06:24):
Let's not get crazy people.

Dr. G (06:26):
If she wants her skin to look better, do the CO2. I'm sure she takes care of her skin normally and this is another boost for it.

Bri (06:33):
So did she say she had a facelift here or is this just solely the CO2 and maybe some minor cosmetic?

Dr. G (06:40):
I think she had something lifted besides her eyes, which I mean the most dramatic appearance is from the CO2 laser. So the laser resurfacing is what makes you look crazy and a lot of people will combine it with a facelift. It's a great opportunity healing from facelift, eyelids, whatever. And you're not going out anyway unless you're Tamra and you're going to be on Instagram every day.

Bri (07:03):
Our old nurse, she had the CO2 laser and she came home and she was bleeding from her pores and her husband was so like, oh my God, what did you do? And then a week later he's like, oh, you're going to be so hot. He's like, damn. She looked amazing. Her skin looked so good.

Dr. G (07:24):
Yeah, I mean for anybody who's fair enough, it's really at any age, probably after 30 you could easily do it just you have to have the time to take off because your face is going to look wrecked for about five days. And you really have to stay out of the sun during the first couple of weeks.

Bri (07:44):
So worth it though. We say yes to CO2 laser.

Dr. G (07:48):
Yes. Yes to CO2 laser. And then let's see, mom arrested for leaving son alone for hours.

Bri (07:56):
I have so many comments about this that I'm not going to say out loud.

Dr. G (08:00):
Well, let's just start with the state she's from,

Bri (08:05):
She in Florida? Florida?

Dr. G (08:06):
Florida.

Bri (08:07):
That makes sense.

Dr. G (08:08):
Every time.

Bri (08:10):
Why, why, why, why? If you do not have proper childcare, you should not be getting plastic surgery.

Dr. G (08:18):
And also who's going to help take care of your kid while you you're recovering? Yeah,

Bri (08:24):
It looks like she's in a taxi. First of all, that should be its own liability in itself if you just had surgery,

Dr. G (08:30):
I guess that's being arrested, but

Bri (08:33):
Oh, perfect.

Dr. G (08:34):
Then they drive her to the station. Do you remember we did do a labiaplasty once and then, were you still in the office?

Bri (08:45):
I wasn't, but you told me about it and it was just comical.

Dr. G (08:49):
Bananas? And then we got a fax from the sheriff's department.

Bri (08:53):
Wasn't it to call in her meds?

Dr. G (08:55):
It was asking for any limitations, physical limitations for this person because they had been arrested and I was like, what? Within 24 hours. I was like, oh yeah, I mean she's supposed to lay flat for three days. Are you going to be able to accommodate that in jail? She ended up doing great and it was a weird misunderstanding and she healed perfectly despite getting thrown in jail for I don't know what the first 24 hours, but I had a mini, a lot of chest pain over that.

Bri (09:26):
Depending on how chaotic it is at home, maybe she was like, I actually get a good night's sleep in here.

Dr. G (09:33):
I doubt it.

Bri (09:33):
That son looks, okay, that kid looks so young. He doesn't be more than three or four years old.

Dr. G (09:38):
No, he's three. Yeah, so I think they went to where, so she came with her son, Airbnb. This is Florida, a hundred percent. Yeah. I mean you're traveling to Florida, you bring your kid with you to get cheap surgery. Just a lot of bad choices being made. That just sucks. I mean you have to have support and we talk about this when we see patients for the initial recovery. When I see somebody who comes in and I love it when their husband is there because I'm like, so your kids are four and six, who's minding the kids after surgery? And you know we don't put anybody in an Uber after surgery. If you can't find somebody, some of my older patients really are very private and they don't want anybody to know they have surgery. I'm like, I don't care. You got to find somebody. Or you can hire a nurse through a concierge nursing service, but you have to have someone stay with you, pick you up, vouch for you that first 24 hours. Cuz that's already telling me that you don't have the recovery plan set in place if you have little kids or I've fallen for, oh, I don't have kids, but they have two St. Bernard dogs that need to be walked every day.

(10:52):
I mean, you really have to figure out what you're going to do with other either people or pets that depend on you after surgery because you're going to be in no position to take care of them. And it would be super nice if somebody could take care of you for a minute. Alright, let's move on to headlines about fat transfer to the breast, which is what our topic of today is. So I think our first one is these aren't silicone former Married at First Sight star Jessika Power confidently flaunts her fat transfer boob job procedure on Instagram. So awesome.

Bri (11:26):
Oh, those are great.

Dr. G (11:28):
Yeah, she looks good. It all, that's cute that people are saying what it is. I remember when Kim Kardashian went on Oprah or whatever and said, I don't have butt implants and did the x-ray, but oh yes. That was before people were like new what a fat transfer was, I think.

Bri (11:44):
Right. I remember watching that episode and I was so like, oh my God, I can't believe her butt is so real. And then I feel like a couple years ago I was like, she's a liar.

Dr. G (11:54):
I mean she was just stretching the truth, but now people are like, no, this is fat, for reals.

Bri (12:02):
I have to say a fat transfer, it is, you are still all natural. You are just moving fat from one place in your body to another. I feel like that should not count as a surgery. It's fine. It looks great. She looks really good. I'd like to see her before photos.

Dr. G (12:21):
I know she had cheek filler, lip filler and veneers. Good. No one's looking at her teeth right now or cheeks. Yeah, her breasts look great. The one thing about fat transfer that's awesome is that you're not putting an implant in, which we all know is not a lifetime device. So you're almost guaranteed to have a second surgery down the road if you put an implant in. As long as you're committed to that or understand that at some point, maybe not on your timeline, you're going to need an implant exchange or removal or something, then I think that is a great option. But if you're trying to avoid that, then fat transfer is a good option.

Bri (13:02):
Is there a certain amount, like a maximum amount of fat you can transfer? Is that dependent on the patient's tissue or how do you tell if a fat transfer is better for you than a breast aug?

Dr. G (13:12):
Well, yeah, that's a good question. It helps if you have fat to transfer. So a really skinny person, low BMI and very flat chested is probably not the ideal candidate. Somebody who is normal BMI has a little bit of breast tissue just wants to go up a little bit, that's a great candidate, especially if they have stubborn areas of fat around their waist or maybe on their thighs or something. That's a great candidate for a fat transfer. Not saying you can't do it on the skinny mini, but the limitations are the amount of fat we can harvest and then the amount of fat I can transfer. So I think I don't see her befores here, but you have to have breast to tissue. Oh yeah. So she had very nice breast to start with. Those are probably large B's, maybe C's, so you can transfer a significant amount of fat into her breasts because she has a good recipient site.

(14:08):
If she was A cup, just skin on chest wall, you can transfer fat in, but you're limited to the amount of breast tissue that's available to put the fat into. So you could always go up incrementally too. You can do it in stages, but then that starts to be less and less attractive to people to have to go under multiple times. So yeah, she's an ideal patient. She's thin, but I bet you can find some fat somewhere and she has breast tissue that you can transfer the fat into and so she'll get a nice half cup to a cup size larger. The other limitation is you can't really go more than a cup size up with a fat transfer. So if you're trying to go big or go home, you're looking at an implant.

Bri (14:52):
What are your thoughts on doing fat transfer with implants? Or if the patient already has implants, can you do a fat transfer on top of those?

Dr. G (15:01):
Yeah, so that's commonly done in reconstructive surgery because for women who have mastectomies, they're just basically skin over implant if they had an implant-based reconstruction, and so they routinely get fat transfers to the mastectomy flaps to provide kind of camouflage so that you don't see the outline of the implant. And so I use fat transfer. There's some people advocate doing a fat transfer for every augmentation. I mean I think that's the way their practice evolves. That's what they offer. But I think in certain patients it's great. It can camouflage, if you have some chest wall, maybe like a really deep inset sternum, or you're lacking medial cleavage, or your breasts are a little bit wider apart than you want, then you can use a fat to sort of enhance the shape of your breast. The thing about augmentation is when you put an implant in, it augments everything.

(16:01):
So let's say a portion of your breast is a little thinner or more deflated in one quadrant, when you put that implant in, it ends up exaggerating that. So people who maybe have a little deflation on maybe the inner upper part of their breast or inner lower part of their breast, it's a great tool to augment that. Because you can't just put more implant in there, but you can put a little bit of fat, and it does work really well. It's also great for people with asymmetry. So maybe put the same size implant but mask the difference with fat. That's one option. I've done it for people who wanted reductions or lifts, but they like the larger sides. So we do a lift on the larger side, do a lift on the smaller side and then add fat. So it's a really great tool in your toolbox to help with a lot of different problems.

Bri (16:56):
We love that.

Dr. G (16:57):
Next is 90 Day Fiance star undergoes mommy makeover. That includes tummy tuck, liposuction fat transfer to her breasts. This is also extremely popular because you're already doing the tummy tuck, which almost always involves liposuction, so you should put that fat somewhere, whether

Bri (17:15):
Amen. I'm a huge advocate for that. Don't waste that fat, that is gold.

Dr. G (17:22):
Liquid gold. So yeah, so if she put it in her breasts, you can put it in your booty, you can put it in your hands, your face. It depends on what your goals are, but this is a great way of avoiding implants and getting some actual volume. And you're right, you're already there doing liposuction, so why not augment something?

Bri (17:43):
Yeah, I feel like I've heard from a couple of friends who have gone under and they regret it, cuz they wasted all that fat and they're like, now I don't have enough fat to do a fat transfer. They're like, well, I wanted to see how my body was or if I needed implants, and now that's your only option because you have nothing on your body.

Dr. G (18:01):
Right. Yeah. If you're going to go through extensive liposuction, think it through before you throw it all away. I agree. Yes, a hundred percent. We endorse this. Moving on, the last Daily Mail article is I grew my own breast implants from the fat on my tummy. I mean,

Bri (18:21):
Wait.

Dr. G (18:21):
Sure. I don't know that she grew it, but.

Bri (18:26):
The wording on this one, I grew my butt on my stomach. So whatever makes you sleep good at night.

Dr. G (18:37):
I mean, I think what's interesting about her is that she had it done, well she had it done in the UK, but she had it done under local, which is it takes a certain person to suck that up. So she had liposuction and then had that re-injected into her breasts all under local anesthetic, which I've done before. But some people would do great and some people can't stand the tiniest bit of anything under local. So you just have to know yourself and be honest with your surgeon about it. If you're the type of person that essentially needs to go under for dental cleaning, don't tell me you have a high tolerance for pain and you want to do it under local.

Bri (19:17):
Totally. My own personal opinion, just go under general and make everyone's life easier. I feel like the results are going to be so much better if you're doing it under local, like you said, it is hard if you're wincing at every little flinch. Make yourself comfortable. Make everyone comfortable. Just go to sleep.

Dr. G (19:41):
Right, right. I mean there is a type of patient who just is like zen during the whole thing, but if you're not going to be zen and you might not know if you've never had it done before, then you'll get likely better results if you're asleep for anything significant.

Bri (19:56):
Right.

Dr. G (19:56):
Okay. Well let's talk about fat transfer to the breasts more specifically.

Bri (20:02):
Perfect. So what's the process that you like harvest the fat? How do you get the fat and put it back into the breast or the butt?

Dr. G (20:11):
Yeah, so you're my right hand man for this procedure. So you know that we use safe liposuction, which is an acronym that stands for the technique, not the machine, but it uses power assisted liposuction. So power assisted just means that the cannula is vibrating, which helps kind of harvest the fat a little bit easier. And how I do it with a safe lipo suction is during that first stage when I'm infiltrating, I'm also separating the fat. So I am not just injecting the tumescent fluid, which is that numbing fluid that we put that helps prevent, not prevent, but reduces the amount of bruising and bleeding you have from this procedure. So instead of injecting that fluid with a teeny tiny cannula and just kind of blowing up each area, area by area, I'm injecting it with a special basket cannula that's a little bit bigger and it's pushing the fluid in and the cannula is vibrating. So it's kind of breaking up the fat as we're pushing in the fluid. So that's the separation. And then aspiration, it's again under a mechanical power assisted liposuction with different cannulas depending on what we're doing, but to suction the fat, that's pretty straightforward. And then my husband always says, I don't know why when people after surgery after liposuction are like, God, that really hurt. He's like, you're taking basically a steel or metal cannula and inserting it in their abdomen over and over. I'm like, well, not in the abdomen, but yes, into their fat.

Bri (21:44):
I tell all the patients, I don't know why I'm like, this is what her husband says because they do, they come in on day one and they're like, I am the most sore from the lipo. They're like, I did not expect that. And I was like, okay from the mouth of Dave, it's a rod going inside your body in and out. They're like, oh, that does make sense.

Dr. G (22:06):
Yeah, I mean, just putting the fluid in and stretching your tissues a little bit. Sometimes that can stretch nerves. I mean, it's like full contact surgery. So once that fat is removed, then I go back in with that same cannula that vibrates with a little basket tip, but not under suction, and that's the FE or fat equalization of this portion of the procedure. And so what it does is smooths everything out and it also just adds a little bit more trauma, which makes you sore, but helps tighten the tissues. And for people who have a little bit more laxity, I'll add a tightening treatment after that, which we use Renuvion, it's radiofrequency energy to help tighten the tissue that's left behind to help you shrink wrap a little bit better from the area that we're liposuctioning.

Bri (22:54):
Side note, the basket cannula. I think it is so underrated because not saying anything bad, my previous surgeon who did my lipo, great job, but I felt like it was just a little lumpy. It was not as smooth as I wanted. And then you did my arms and you used the basket cannula and it's perfectly smooth. So underrated, but so important.

Dr. G (23:19):
I mean, Dr. Simeon Wall sort of pioneered this technique and he uses, I mean he's a big champion of that cannula, which I found was, it definitely enhances results. So then once the fat is suctioned out, if we're throwing it away, it just goes into a canister. But if not almost becomes Bri's domain, what happens?

Bri (23:43):
Oh yes, we make that fat perfect. So we make it with love. It comes into a big collection canister. We drain off all the extra fluid, we get out all that fibrous stuff and we make it perfect.

Dr. G (23:58):
Yeah, so that's called gravity decanting. But yes, Bri, you really need somebody who knows what they're doing helping you out because you have to connect all the things properly. So we have the tubing that's connected to my cannula going into this sterile canister, but then the canister itself is connected to our suction. So you can imagine that if you mess that up somehow, which that sounds pretty straightforward, but there's a lot of

Bri (24:28):
Moving parts.

Dr. G (24:29):
Yeah, there's a lot of moving parts. And even just simple stuff as making sure that the canister is stable on the back table. Right. I mean,

Bri (24:38):
That is my biggest fear. Ours is pretty good, and I luckily have, I have it down to where I'm confident that it's going to stay. But yeah, that is definitely my biggest fear. We did trial, a fat transfer system.

Dr. G (24:52):
Which will remain unnamed.

Bri (24:55):
Yes, we'll remain unnamed. However, I felt like I had to, I was like, how do I keep this from flying off the table? I was like, there is no stability here. I felt like I had to hold it the entire time. But yeah, there's definitely a lot of moving parts when harvesting the fat. And then if you want to use the fat, say turn it into nano fat or you micro fat, there's different filters and systems that it gets processed through. So the fat very important and you don't want to waste it.

Dr. G (25:26):
Yes. And you cannot underestimate the value of the scrub tech in this. Back when I was

Bri (25:30):
Job security.

Dr. G (25:31):
Back when I was in the Navy, we used to harvest the fat. We didn't have the sterile canister system. We used to harvest it in 20 cc syringes, and then the techs would roll it out on telfa on the back table, and it took forever. And it was like a little mini fat sweatshop on the back table. They would get someone else to, they would get someone else to scrub in and then help because it was sort of almost like a hair transplant. You need a lot of little busy hands. This is definitely, we have ours down to a science, but you're right, when we tried the other system, it reminded me of a different portable system. They're both consumable, so the canister itself is really lightweight. And so when I pull out the cannula from liposuction, the suction creates this whiplash and that can jostle where the canister is. If the canister is this little lightweight Tupperware, you just see that flying off the table and we don't want that.

Bri (26:28):
You lose all your fat.

Dr. G (26:29):
We would cry.

Bri (26:30):
I know. And you don't realize, I think when we first started, there was a couple local procedures, not to throw you under the bus, but it's always so great when I watch her and she's the only one scrubbed in because I sit there for 10 minutes before, I'm like, do you want me to scrub in and help? And it's just so great. I'm like, this itself.

Dr. G (26:51):
It's really hard to do by yourself.

Bri (26:52):
I'm going to ask for a raise after this procedure.

Dr. G (26:56):
It's really hard, especially when Bri is just watching you.

Bri (26:59):
It's great.

Dr. G (27:01):
Yeah, it's messy. So you're after y

Bri (27:04):
You need multiple hands.

Dr. G (27:04):
You clean the fat, and then we're going to pull that fat off of the sterile system from the bottom. And even that, you got to tip it, you got to shake it a little bit, and you're pulling it off into syringes. And again, it's nice if you have somebody to help with that, otherwise you look kind of insane. Alright, so that's kind of our system. And then we have the fat, there's a couple of different ways you can put the fat back in. I generally prefer hand transfer, so put it in a big syringe and a cannula and inject the fat that way. I feel like it gives me a little bit better control. Another popular way to do it is to reverse engineer the power assisted liposuction, and you run the tubing backwards. And so now you're injecting fat with the same cannula you just used to suck it out.

Bri (27:52):
Can you control the rate? I personally have not done that, but you can control the rate that it comes out, or is it just?

Dr. G (27:58):
Yeah, you can slow it down. You really have to though. And I just think, I don't know, it doesn't take me that long to do it by hand. It just seems like it would be a tough go if you're just trying to do two or 300 ccs, that's pretty, it's going to be in there in two seconds and maybe you haven't had a chance to really get it in all the areas. Again, a lot of my background comes from doing it during breast reconstruction where we were injecting that fat with 10 ccs, so little tiny syringes because we didn't have a lot of space to inject to. And so we were very particular about how we laid it in, and I feel like blasting a hundred ccs is probably not going to get me the result I want. And I just feel like I have better control with the hand injection.

Bri (28:46):
And what's the, so the rate of retention for fat, I know people ask this all the time, how much fat actually stays?

Dr. G (28:53):
So I think I quote 60%. So you have to over graft. You got to remember that I'm injecting fat, but some other stuff that's not going to stick around. So some of that's fluid because we're not drying the fat out. So there's a little bit of fluid that goes with it. And then some of the fat is just not going to survive. It's a graft, which means it's dependent on where you put it on that surrounding tissue to keep it alive. And if the blood flow isn't strong enough, then it dies. If it's too much, it can die. If it's, I don't know, you smoke a cigarette right after I guess it could die.

Bri (29:26):
Please don't do that.

Dr. G (29:28):
Don't do that. So yeah. So there are some factors where some of that is going to get absorbed, and so it's not all going to keep, so we tend to over graft by 30 to 40 percent because we know some of that fat is going to reabsorb.

Bri (29:43):
Right. And the fat, when it just dies, does your body reabsorb it? I know we sometimes in office put in drains. How does that help?

Dr. G (29:52):
Yeah, so we put drains in, usually for fat transfers, when we're taking implants out, because some of that fat will inevitably leak into just the space between the breast tissue and the pec muscle and under the pec muscle, the space where the implant was essentially. And so fat just like swimming around is not going to graft to anything and it's just going to sit in the fluid and maybe it gets reabsorbed, but I'm just trying to help your body out by draining whatever fluid accumulates and whatever little particles of fat didn't actually make it into the breast tissue or made it into the breast tissue, but then leaked out into that space. So yeah, the fat generally is absorbed. If it doesn't get absorbed, it can form fat necrosis, which are little lumps that you can feel. Again, that fat should break down over time. I tell patients to massage that area. Significant amounts of fat necrosis can form an infection though. So that's one of the known risks of having a fat transfer and then having it not all survive.

Bri (30:54):
Well, we want the most fat possible, especially when it's going in the butt.

Dr. G (30:58):
So it's really challenging to try to balance, I want the most fat for that patient, so I'm going to over graft. But then that tipping point is putting so much in that not all of it survives. And you have, run the risk of that complication of having fat necrosis that then creates an infection. And it's not very common, but when it does happen, it's a major drag and now the fats spread throughout the breast. It's not like you can just open up and pull it out. It just ends up being a systemic issue. Yeah, and it's the same thing for a BBL, so Brazilian butt lift, when you put that into the butt. Generally that procedure goes pretty well. But I have friends on the East coast that inherit some of these cases that were done overseas, like in the Dominican Republic is a popular place to go, or in Miami where they have chop shops where they just crank 'em out. And again, if that fat gets infected and you have fat now distributed throughout your buttocks, it's really, it becomes a huge mess because you can't just make an incision and get it out necessarily.

Bri (32:02):
And how about after, I know patients on their post-op, they're kind of like, oh my gosh, the fat transfer, it looks kind of crazy. Explain to me how that settles out, cuz it does settle.

Dr. G (32:15):
It does settle. Yeah. So the fat transfer to the breast does look bruised and red, and then the bruising turns different colors and it really just looks like someone punched your breasts over and over again, honestly.

Bri (32:29):
It looks very intimidating the first week, but it does get better. So much better.

Dr. G (32:33):
And I do warn people because otherwise you see the redness and you were worried about infection and it's not an infection. You see the bruising you worry about, I don't know, it looks bananas. It looks a little lumpy. So as long as you don't put ice on the breasts and you stay in a light compression and you can start doing a little bit of massage, usually by two weeks it's settling down and looks more normal, but you just have to be ready for it.

Bri (32:58):
As Dave would say, having a rod shoved in and out of your breast. So why do you suggest not to put ice on fat transfer areas?

Dr. G (33:07):
So what we want to do is increase the circulation to that area and adding ice is going to decrease the circulation. It shrinks your blood vessels down, the cold temperature makes your body bring everything to the center, and so that's decreasing the circulation. So a lot of times we recommend ice. If you have just a straight augmentation ice to that area will reduce swelling. But since it's also reducing circulation, we tell people that's a no-no for any area of fat transfer.

Bri (33:35):
That would decrease the amount of fat? Would you say that would kill off fat cells?

Dr. G (33:39):
Yeah. You're risking losing some of that fat that we've just transferred.

Bri (33:43):
Absolutely not.

Dr. G (33:45):
Yes. We do not want that.

Bri (33:46):
Do not ice the fat. Don't ice the fat that is your baby. Can you tell me a little bit about the recovery of this procedure? How long would I be out for? How long would I need to take off work?

Dr. G (33:58):
So I tell people that although if you're having a straight fat transfer to the breast, although your breast might look crazy those first few days, it really doesn't bother the patients. People are pretty comfortable. And then the most uncomfortable part is just the liposuction, which after a day or so you can get up and move around. We don't want you getting your heart rate or blood pressure up for two weeks, but we want you moving around. It'll help get the fluid off and get the swelling down and then after two weeks you can work out if you feel good. There's no restrictions. I would say if you're working and you're doing a job where you're standing all the time, it really is the liposuction that will make you feel like you can't move around as quickly as you normally can. But for those patients that work from home, they just take a couple of days off and then you can sit at a desk and zoom in.

Bri (34:48):
Yeah, I feel like that's a huge benefit that I hear from people is when you're doing just a fat transfer, you can just go back to resuming daily activities versus a breast aug where if they're going under the muscle, you're cutting that muscle. Mine was even after a week or two, it was so painful, I could barely drive. Mine was a little bit different, but.

Dr. G (35:07):
Yeah, so definitely the recovery is faster for you just need to keep your heart rate and blood pressure down, but there's no restriction. We haven't messed with your pectoralis muscles, so there's no restriction with pushing and pulling and those sorts of things after that two weeks where with breast augmentation, we do restrict your movement for four to six weeks. We don't want you to displace the implants.

Bri (35:26):
We love that.

Dr. G (35:27):
Yes. That's a check in the breast fat transfer. I mean, I feel like you and I, early on, did a case and we were like, why didn't we do this?

Bri (35:34):
I know. So I'm like, even to this day, I mean I want a thousand procedures done, but I'm like, I could just use a little bit more fat. I didn't even know about it, honestly. I didn't even know that was an option when I got implants. I've never heard about it. I didn't even know until I started working specifically in plastics that you could even do that. I've heard of the BBLs, but I didn't know you could transfer it to your breast. And a lot of people don't, I feel like, give you that option. They don't suggest it. So I know we definitely in our office specifically suggest everything you can possibly do versus, oh, we're just going to throw some implants in it. You're fine.

Dr. G (36:14):
Right. Yeah. So the things fat transfer won't accomplish is that upper pole fullness. So people come in and keep saying, natural breast, I want a natural breast, I say, if you mean natural breast as in a kind of a ski slopey effect, then fat transfer will probably work for you. If you're dying, you're really committed to having that upper pole fullness, you want them kind of popping out when you're wearing a strapless gown, then you really need an implant. And if you're trying to go up in size, a significant amount more than a 100 ccs or 150 ccs, so you want your A and you want C or D breasts, then you're not going to get that with a fat transfer. So you need to consider putting an implant in. Implant's going to add volume, and it's going to change the shape. And a fat transfer adds volume. It generally doesn't change the shape of your breast.

Bri (37:01):
And you can literally only put so much in. I watch it and people are like, oh, I wish I could have this much. And it's like, no, your breast only accommodates so much, it will come back out. It's like, your breast tells you when you are done.

Dr. G (37:15):
Yeah, that's true. It does push back out when we've hit our limit on the table. Yeah, we give it our all.

Bri (37:22):
I know we put every little fat cell possible, but can only take so much.

Dr. G (37:28):
If you have questions, you certainly should reach out to us at Restore SD Plastic Surgery and we can give you more information about breast enhancement with fat transfer, and put it in the show notes, DM us, whatever you got.

Bri (37:43):
Any questions, come on in for a consult. I will make your fat as perfect as possible.

Dr. G (37:48):
With love.

Bri (37:50):
With love. We do everything with love here.

Dr. G (37:55):
That's a wrap. If you're listening today and have questions, need info about scheduling, financing, reviews, or photos, check out the show notes for links. Restore SD Plastic Surgery is located in La Jolla, California. To learn more about us, go to restoresdplasticsurgery.com or follow us on Instagram @RestoreSDPlasticSurgery. If you enjoyed this episode, please share it and subscribe to All the B's on YouTube, Apple Podcasts, Spotify, or wherever you like to listen to podcast.