Failed Fat Grafting to the Breast: Causes, What You Notice and What Can Still Be Done
We speak of failed fat grafting when too little volume is left, the breast has become uneven, or hard lumps have formed. Part of the fat always disappears. That belongs to the treatment and is not a failure. In most cases the result can still be improved, with an extra session or another technique. Judge the result only after three to six months, and share your worries with your surgeon.
In this article
What is fat grafting (lipofilling) and what is a normal result?
With fat grafting (also called lipofilling or fat transfer) the surgeon moves your own fat from your belly, your thighs or your flanks to the breast. He cleans the fat and injects it in small amounts and in thin layers. In this way every bit of fat gets enough blood and has a better chance to stay alive.
Not all of the fat stays. Usually 40 to 70 percent of the injected fat stays permanently. Your body simply absorbs the rest in the first months. That is normal and not a failure. Your surgeon takes this into account beforehand. This is why several sessions are sometimes needed, with three to six months in between.
So a good result does not mean that all the fat stays. It means the shape is better, the breast feels soft and you are happy with it. The fat that survives behaves like normal fat. It changes along with you when you gain or lose weight.
When is fat grafting to the breast 'failed'?
There is no hard line. Usually we speak of a disappointing or failed result in these situations:
Too little volume. Much more fat has disappeared than expected. The dent, or the difference between your breasts, is still clearly visible.
An uneven result. The breast feels full in one place and empty in another. Or a new irregularity has appeared.
Hard lumps (fat necrosis). Part of the fat gets too little blood and dies. This can leave a hard spot that you can feel. It is usually harmless, but it does need to be checked.
Oil cysts. Dead fat can form a small pocket of oil. It feels like a soft or firm bump under the skin.
Calcifications. Small spots of calcium in the fat. You usually cannot feel them, but they can show up on a mammogram (breast X-ray).
Infection (rare). Redness, warmth, pain and sometimes fever in the first weeks. This is uncommon, but it needs quick treatment.
A hard spot does not mean that the whole treatment has failed. Often the shape has improved and the problem is small and solvable.
Why does fat grafting sometimes not work?
Whether the fat survives depends on your body and on the technique. Nobody can predict it exactly beforehand. The main causes:
Irradiated tissue. Irradiated tissue is tighter and gets less blood. Less fat fits in per session, and less of it stays. After radiation, several sessions are more often needed.
Smoking. Smoking narrows the blood vessels. The fat gets less oxygen and dies sooner.
Too much fat in one session. If too much fat goes into one place, part of it lies too far from a blood vessel. That fat dies and can turn into a lump or an oil cyst.
Little donor fat. Are you very slim? Then there is little fat to harvest, and the volume per session is limited.
Weight change. The transferred fat is simply fat. If you lose a lot of weight, the breast shrinks with it. If you gain weight, it becomes fuller.
What you notice and when you will know
Right after the procedure the breast looks fuller than the final result. That is swelling. It goes down in the first weeks. In the months after that, your body absorbs part of the fat. So the volume first becomes a little less, and then stays stable.
So do not judge the result too early. After three to six months it is usually stable. Only then can you and your surgeon say whether it is enough, or whether a next step is needed.
If it has gone less well, the dent comes back, the breast feels hard or lumpy in places, or the difference between your breasts stays clear. Do you feel a new hard lump? Always have it checked.
Tests: ultrasound or mammogram for lumps
A hard spot after fat grafting is usually dead fat (fat necrosis) or an oil cyst. That is not dangerous. But a lump in a breast that has had cancer must always be examined.
Your doctor usually starts with an ultrasound, and sometimes a mammogram (breast X-ray). An experienced radiologist can usually tell fat necrosis and calcium spots apart from something suspicious. Sometimes extra tests are still needed, such as an MRI or a biopsy (taking a small piece of tissue). That gives certainty.
Always tell your radiologist that you have had fat grafting. And keep going to your regular check-ups.
What can still be done after failed fat grafting
A disappointing result can almost always be improved:
An extra session. The solution chosen most often when there is too little volume. There are at least three months between two sessions.
Draining an oil cyst. An oil cyst that bothers you can often be drained with a thin needle, usually in the outpatient clinic.
Removing a lump. A hard spot that hurts or keeps bothering you can be taken out through a small cut. Often this is not needed.
Another technique. Is the shortage too large for fat alone? Then an implant or a reconstruction with your own tissue (such as a DIEP flap) may fit. Fat grafting often refines the shape afterwards.
Symmetry surgery on the other breast. Sometimes a reduction or a lift of the other breast is the simplest way to balance. Then you leave the treated breast alone.
Waiting. Small irregularities are not medically harmful. You may also leave things as they are, or use a bra with some padding.
There is no best choice for everyone. Talk with your surgeon about what suits you.
How to improve your chance of success
Stop smoking. Preferably well before the procedure, and until the small wounds have healed. This is the most important step you can take yourself.
Keep your weight stable. Do not lose or gain a lot of weight just before or after the procedure. That keeps the result predictable.
Choose several smaller sessions. Small amounts of fat survive better than one large amount. This asks for patience, but it gives a better result.
Wait after radiation. Fat grafting is best done six to twelve months after the end of the radiation. By then the tissue has settled.
Ask about preparation from the outside. For a full reconstruction with fat, some surgeons first use a device that gently stretches the breast (BRAVA or EVE). More fat often stays then.
When to call your doctor
Contact the hospital if:
your breast, or the area the fat was taken from, becomes quickly swollen, tight and very painful;
the skin becomes red, warm and painful, or fluid keeps coming from a small wound;
you get a fever (38 degrees Celsius or higher);
you later feel a new, hard lump in your breast. That is usually harmless (fat necrosis), but always have it checked.
Frequently asked questions about failed fat grafting
When is fat grafting to the breast a failure?
Part of the fat always disappears; that is normal. We speak of failed fat grafting when, after three to six months, far too little volume is left, the breast has become uneven, or bothersome hard lumps or oil cysts have formed. In most cases this can still be improved.
How much fat stays after fat grafting to the breast?
Usually 40 to 70 percent of the injected fat stays permanently. Your body absorbs the rest in the first months. In irradiated tissue, or if you smoke, less fat often stays. That is why several sessions are sometimes needed.
What is fat necrosis after fat grafting and is it dangerous?
Fat necrosis is fat that got too little blood and died. It can leave a hard spot that you can feel. It is not dangerous and often becomes smaller on its own. Still, always have a new lump checked with an ultrasound, so that you know for sure what it is.
Can failed fat grafting be done again?
Yes, usually it can. An extra session is the solution chosen most often when there is too little volume. There are at least three months between two sessions. If the shortage is too large for fat alone, your surgeon may suggest an implant, a flap, or surgery on the other breast.
What are the experiences with fat grafting to the breast?
Many women are happy, because the result is soft and natural and there are almost no extra scars. The disappointment named most often is that part of the volume disappears again. Women who are prepared for that, and who have patience for an extra session, are usually pleased with the final result.
Can fat grafting after a breast reconstruction also fail?
Yes. After a reconstruction with an implant or a flap, the fat can also survive less well, especially in irradiated tissue or if you smoke. The problem is then often a dent or a hard spot. That can usually be improved well with an extra session.
Is fat grafting to the breast safe after breast cancer?
The research so far shows that fat grafting does not increase the chance of breast cancer coming back. It is done only once your cancer treatment is finished, and in agreement with your oncology team. Always tell your radiologist that you have had fat grafting.
How long does it take to see the result of fat grafting?
Right after the procedure the breast is fuller because of swelling. That goes down in the first weeks. After that, your body still absorbs part of the fat. After three to six months the result is usually stable. So do not judge it earlier.
Questions to ask your surgeon
Is my result already stable, or do I still need to wait?
Is this hard spot fat necrosis, and are tests needed?
Do you expect one extra session to be enough, or would another technique suit me better?
How much of my own fat is still available?
What can I do myself to make the next session more successful?
Related articles
Fat Grafting (Lipofilling) for Small Breast Defects After Lumpectomy and Radiation
Fat Grafting for Total Breast Reconstruction: Building Your Breast with Your Own Fat
How Radiation Therapy Affects Your Breast Reconstruction Options
Breast Symmetry Surgery After Lumpectomy, Mastectomy, or Reconstruction
Written by Dr. Mahyar Foumani, plastic and reconstructive surgeon specializing in breast reconstruction. Based on the book 'Breast Reconstruction Explained.'
This article is education, not medical advice
This article explains in plain words how breast reconstruction works. It is meant to help you understand what is possible, so that you and your doctor can make a good decision together. It does not replace personal medical advice.
Every situation is different. What is best for you depends on your body, your illness, your treatment and your own wishes. So always follow the advice of your own doctor or care team. Do you have symptoms, or are you unsure about something? Please contact your doctor or GP. In an emergency, call your local emergency number.
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