Blog — Notes of a Plastic Surgeon

Welcome to my blog. I am a plastic surgeon in Seattle and have been in private practice since 1991. I've seen more than a few interesting faces and cases through my years spent in the exam room, the operating room and the emergency room. And I have an opinion on just about everything relating to plastic surgery (and a lot of unrelated stuff). If you like my blog, let me know. Thanks for reading! Lisa

Category: Fat Transfer to the Breast

Fat transfer to the breast FAQ: What happens with weight changes?

August 30th, 2018 — 2:16pm

I’ve now been doing fat transfer to the breast for over seven years.  I remain enthusiastic about this procedure in patients with favorable anatomy and realistic expectations.  One FAQ relates to changes in the breast with weight changes.  So here is what I have observed so far in my practice:

Yo-yo is a no-no for fat transfer!

If patients lose weight, the transferred fat shrinks and the patient loses volume in her her breasts.  This also goes for patients who lose fat but maintain their weight.  I have seen this in a couple of patients who did not have a major weight loss but who really leaned out with vigorous exercise.  They both became Crossfitters and both lost a lot of the volume they gained after fat transfer.  One went on to have implants.  The other did not.  I am thinking about adding “do not join Crossfit” to my post-op instructions!

Conversely, if a patient gains weight, the fat that was transferred to the breasts will expand and the breasts will get larger.  I have seen this in a couple of cases.  One case was a middle aged flight attendant who gained about 7 lbs on a cruise (this is why I do not go on cruises!) and became alarmed at how large her breasts became.  I assured her that her breasts would go back to their pre-cruise size when she lost that extra weight and indeed they did.  In another case, a patient gained just a few pounds and rather than going to her saddle bags as it usually did prior to fat transfer, she was delighted to see that it mostly went to her chest!

So whenever we are moving fat around, it’s best to have surgery when you are at a healthy and sustainable weight.  I do not recommend fat transfer in patients who yo-yo.  Significant weight fluctuations make for fluctuating results.

Thanks for reading and did you notice I did not say “ideal” weight?  Sustainable and healthy weight is more important and more obtainable than ideal for most of us who are over 25 years old!

Dr. Lisa Lynn Sowder

I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.


Breast Contouring, Fat Transfer to the Breast

Will I be happy with fat transfer to the breast?

October 23rd, 2014 — 12:47pm

Check out these el cheapo breast enhancers.

blog fat transfer sizingThose of you familiar with my web site and this blog know that I really like to emphasize that fat transfer to the breasts is much different than a breast implant procedure.   Fat transfer results in a much more subtle and natural appearing enhancement compared to breast implants.   Here is a great way to determine, in the privacy of your own home,  if you will be happy with fat transfer.

There are a bajillion kinds of breast enhancers (we used to call them falsies when I was in high school) on the market.  I keep the June Tailor Beautiful You enhancers in two sizes in my office to help patients visualize that fat transfer can do.  These enhancers are available at Joanne Fabrics and they are very reasonably priced.  The larger size is pretty representative of the size increase a woman with a little breast laxity and  nice juicy donor sites (hips, tummy, thighs) can expect.  The smaller size is a pretty good idea of what a smaller, slimmer woman with tight breasts can expect.

So if you are thinking about fat transfer to the breasts, buy a pair of enhancers and wear them around for a few days.  And if you come in for a consultation, make sure to bring your enhancers with you.  That will give me a good idea of what sort of volume increase you will be happy with and help me determine if you are a good candidate for fat transfer to the breast.

Thanks for reading!  Dr. Lisa Lynn Sowder






Breast Contouring, Fat Transfer to the Breast

Fat transfer to the breast – 3 year follow-up

September 12th, 2014 — 4:22pm
blog fat transfer

Left to right: Before fat transfer, one year post-op and three years post-op.

Seattle Plastic Surgeon is happy with her long term fat transfer to the breast results.

This week I saw one of my very first fat transfer to the breasts patients.  I was delighted to see her and to get this three year follow-up.  I beg my fat transfer patients to come in once a year but they, like all modern women, are just busy, busy, busy.

This particular patient wanted me to take a look at a little something on her face and I did.   But then I asked her to pose for photos.  As you can see, her fat transfer has held up well.  The left image is before fat transfer, the middle image one year post-op and the right image is three years post-op.  She has had no volume loss.  She has had a teeny, tiny bit of sagging but that’s just gravity for you.

And she told me an interesting story about her breasts.  Over the holidays, she had put on about 5 pounds (sound familiar?), and she says her breasts got quite large.  The fat I transferred to her breasts had come from her hips and normally that was the place she gained weight first but now that fat was in her breasts.   Her hips stayed slim but her chest went a little crazy.  She took off the extra weight over a couple of weeks and her breasts went back to their post-op size.

Her story illustrates why it is so important for body and breast contouring patients to maintain a healthy and stable weight.  I told her if she experiences the same weight gain this holiday season to come on in for photos!

Thanks for reading!  Dr. Lisa Lynn Sowder




Breast Contouring, Fat Transfer to the Breast

What breast shape do you like?

June 5th, 2014 — 2:38pm

Seattle Plastic Surgeon explains how different breast implants influence breast shape.

Take a look at these different breast shapes.  It is important to know what type of shape a patient prefers when doing a breast augmentation consultation.  The size and shape and projection of breast implants influences the final shape of the breast.  Other factors include the original size and shape of the breast and whether or not a lift will be done.

The French Breast.  If a woman likes this shape, she may do really well with just some fat transfer to boost her maybe a cup size and fill in the upper part of the breast just a little bit.  The French Breast can impersonate a Could Have Occurred In Nature breast with a well fitted and lightly padded bra.  Oo, la, la.

Let’s Stop Traffic!  This shape will likely require either a medium or high profile round  implant.  These implants give a big boost to the upper pole of the breast.  Some women like this look.  Most men like this look although not all men will admit to it.

Could Have Occurred in Nature.  This shape is likely to be achieved with a medium profile implant.  This provides a nice full slope to the upper breast but not a bulge.  Ladies with this shape of breast can get Let’s Stop Traffic! with a push up bra.

Tennis Anyone?  This sporty shape is most likely achieved with either fat transfer or a low profile implant.  This breast has some medial fullness to get a little cleavage and some lateral fullness to balance the hip but does not have a lot of projection.  This shape may also be achieved with a breast lift or a breast reduction.   This breast shape is preferred by many mature ladies because big, projected breasts make most mature ladies look (gasp) fat.


breast shapes

The French Breast——–Let’s Stop Traffic!———Could Have Occurred In Nature——–Tennis Anyone?

So there you have it, Breast Enhancement 101 on a single blog entry!  When I see patients in consultation, I try to show them lots of examples of my work to get an idea of what they like and to give them an idea of what I can do.

Thanks for reading!  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Implants, Breast Lift, Breast Reduction, Fat Transfer to the Breast

Breast Implants vs. Fat Transfer for Breast Enlargement

April 17th, 2014 — 3:41pm

Breast implants vs. fat transfer for breast enlargement.  Seattle Plastic Surgeon compares the two operations.

I have been doing fat transfer to the breast for about three years now.   When I started practice in 1991, fat transfer to the breast was dismissed as ineffective.  And indeed it was because the technique did not lend itself to long term viability of the fat.  These days, thanks to fat transfer pioneers like Dr. Sydney Coleman and Dr. Richard Ellenbogen, we know how to harvest, handle and inject the fat in such a way that most of the fat survives in its new location.   Fat transfer has become an important addition to my breast enhancement practice.  Based on my experience, here are the main differences between breast implants and fat transfer for breast enhancement.

2014-04-17 14.39.36

For most patients, there is a clear choice between these procedures but a few patients are really torn about which way to go.  In consultation, I provide as much information as I can about each procedure and make sure that patients understand the limitations of fat transfer and also the long term consequences of having breast implants.

Thanks for reading and check out my other blogs on fat transfer to the breast.

Dr. Lisa Lynn Sowder

Breast Contouring, Breast Implants, Fat Transfer to the Breast, New Technology

Why fat transfer to the breast takes a lot of time and a lot of patience.

May 7th, 2013 — 11:32am

Fat transfer to the breast by Seattle Plastic Surgeon takes time and patience.

Fat transfer to the breast doesn’t seem like it would be a time consuming procedure but it is if done properly.    Here is what’s important and why fat transfer takes time and patience:

Patience - one of my few virtues.

Patience – one of my few virtues.

  •  The fat must be harvested very gently at a low vacuum.  This is a much slower process than regular liposuction.
  • The fat is often harvested from the posterior hip and buttock and lateral thigh area with the patient prone.  This means that a position change is necessary and that also takes time.
  • The fat must be handled with great care when it is transferred into injection syringes.  It’s important to have a patient and detail oriented assistant.
  • The fat must be injected in small aliquots into the breast, making sure to inject into several different layers.   This tedious technique pays off in the long run because it gives the fat a much better chance of survival compared to injecting big blobs of fat that probably won’t survive.  It has to do with blood supply.  That’s another blog topic.
  • The areas of injection vary with the shape of the breast.  When doing an augmentation with an implant, there is very little control of the breast shape but with fat transfer, the shape of the breast can be altered.  This also takes time and multiple visual assessments with the patient sitting up.

Some surgeons do not have the temperament to do procedures as tedious as fat transfer to the breast.  But I do!

Thanks for reading.  Dr. Lisa Lynn Sowder


Breast Contouring, Fat Transfer to the Breast

Nice result with fat transfer in an older patient.

October 5th, 2012 — 3:21pm

Fat transfer to the breast is looking like a great operation to this Seattle Pastic Surgeon.

Before (left) and after (right) fat transfer to the breast in a 60 year old jazz vocalist.

Here is yet another satisfied fat transfer to the breast patient.  I slimmed down her muffin top and added some fat to her breasts.  She went up one cup size and also got a bit of a lift, not only in her bustline but also in her spirit!

Her recovery was quick.  She was back to all her normal activities in about 3 weeks.

It has been sooooo rewarding doing this new procedure for the past year and a half and seeing what a difference it can make in selected patients.

Thanks for reading.  Dr. Lisa Lynn Sowder

Breast Contouring, Fat Transfer to the Breast, New Technology

More good news about fat transfer to the breast.

June 14th, 2012 — 4:56pm

Seattle Plastic Surgeon finds that fat transfer to the breasts allows for subtle improvements in breast shape.

Before fat transfer

After fat transfer

The more cases of fat transfer to the breast I do, the more I appreciate some of the advantages of fat transfer over breast implants.  There are the obvious advantages of no cost or upkeep of implants, no need for anything other than teen tiny incisions and the improvement in the shape of the fat donor sites.

       Another advantage that is nicely shown in these photos, is the ability to subtly improve the shape of the breast.  This is possible because specific areas of the breast can be targeted for injection.  In this case, before fat transfer, the bottom of the breasts was quite square.  After fat transfer, the bottom is more rounded.  Also, the fat filled up the upper part of her breasts.  I think I hit a home run on the right side.  She may be coming back for a little more to get that left side looking as good as the right.

        After 20+ years in practice, it has been so exciting and enjoyable learning this new procedure and being able to offer it to selected patients.

Thanks for reading!  Dr. Lisa Lynn Sowder

Breast Contouring, Fat Transfer to the Breast, New Technology

Fat transfer to the breast – I’m getting enthusiastic.

March 8th, 2012 — 12:26am

Seattle Plastic Surgeon is seeing some very nice results from fat transfer to the breast.

Left side : before fat transfer. Right side : 3 months after fat transfer. She has gone from a B to a C cup.

It takes quite a bit to get me enthusiatic about “new stuff” because “new stuff” pops up every day and more often than not, the reality does not begin to live up to the hype.  This tends to make one (me, for instance) a bit skeptical.

As discussed on my website and previous blogs, fat transfer to the breast is a new procedure that I am now offering to very carefully selected patients.   And now I am starting to get some sort of longish term follow-up and I am starting to get, well, a little bit excited.

This lovely mother of two darling boys had her fat transfer last fall and her size is holding steady.  She was a B cup before transfer and a C cup three weeks after transfer and today is a C cup three months after transfer.  She is thrilled and so am I.

She not only has no implant to maintain, she has virtually no scars on her chest and she has a subtle improvement in her breast shape.  No, she’s not going to stop traffic with this chest but that was never her intent.

And another cool thing about fat transfer – it’s really a twofer.  In this patient’s case, I took the fat off of her posterior hips and she is much slimmer in that area and with the increase in her breast volume, is much better balanced between her upper and lower body.  SWEET!

Thanks for reading!  Dr. Lisa Lynn Sowder

Breast Contouring, Fat Transfer to the Breast, New Technology

I’m really liking fat transfer to the breast and so are my patients.

November 28th, 2011 — 10:15pm
Before and after fat transfer from the abdomen and hips to the breasts. Note the increased fullness of the upper pole of the breast and the uplifting effect.

Before and after fat transfer from the abdomen and hips to the breasts. Note the increased fullness of the upper pole of the breast and the uplifting effect.

Seattle Plastic Surgeon blogs about her early results of fat transfer to the breast. 

Lately I am getting a lot of inquires about fat transfer to the breasts.  There must be a “BUZZ” out there.  And I am soooo glad that I have started doing this procedure.  I was skeptical (it’s my Germanic nature) until I attended the annual meeting of the American Society for Aesthetic Plastic Surgery (ASAPS) last May in Boston.

I attended every presentation on fat transfer to the breast and became convinced that, in the right patient, this was a procedure I wanted to add to my practice.

I am now starting to see some of my early postoperative results and I am even more convinced that this procedure has a place among the many breast operations I do.

This lady on the left has given me permission to use her photos.  The after photos were taken 3 months after her surgery.  Her breasts are completely soft and natural feeling and looking.  I do not think she had any significant residual swelling.  I will be following her and all of my fat transfer patients closely for several years to observe the long term size and shape of the breasts.

I am eternally grateful to this lovely young mom who agreed to be one of my first patients.  I do not take the trust she showed in me lightly.

Thanks for reading!  Dr. Lisa Lynn Sowder

Breast Contouring, Fat Transfer to the Breast

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