Implant-free options for breast augmentation

Many patients are already familiar with breast augmentation using implants and the results that can be achieved. This may seem like the most well-known option towards achieving ideal breast size or shape, but the truth is that there are other methods available to reach your aesthetic goals.

To gather more insight into the topic of implant-free options for breast augmentation, the ideal patient profile and the results that can be achieved, we spoke with Ashley Howarth, MD, FACS, and Peter Krasniak, MD.

The upward trend of implant-free breast augmentation

While traditional augmentation with implants has ruled as the most popular method of breast augmentation for decades, there is a recent boost in popularity of smaller augmentations, which lends itself to implant-free options.

"Patients are shifting toward more subtle, natural-looking results that complement their physique rather than dramatically change it," said Dr. Howarth. "This might mean smaller volume implants placed subfascially or using their own fat to enhance the breast shape. Today's patients are more educated and intentional than ever before."

A shift in trends toward less-dramatic breast augmentation results has provided more opportunities to use your own tissue instead of implants.

"There has been a shift in the patients in my practice seeking breast enhancements," said Dr. Krasniak. "First, there has been a slight trend towards more modest augmentations from a size perspective. Even with patients who seek implants for augmentation, the trend lately has been towards using smaller implants. This has lent itself to discussing what is called autologous breast augmentation, or using a patient's own tissue to perform breast augmentations, which often leads to a more subtle augmentation look. For these reasons, some patients have started to opt for these implant-free augmentation options."

Implant-free vs implant-based breast augmentation

Breast augmentation using implants can work as a standalone procedure, while implant-free augmentation needs to be paired with another procedure to provide the donor tissue for enlarging the breasts.

"In implant-free augmentations, plastic surgeons utilize a patient's own tissue to enhance the shape and size of the breast rather than a silicone or saline breast implant," said Dr. Krasniak. "There are two main ways this is done – using a patient's own tissue obtained from liposuction to inject into the breast for more volume – known as fat grafting – or at the time of a mastopexy or breast lift, rearranging a patient's own breast tissue to provide a modest augmentation of the shape and projection of the breast."

Think of implant-free breast augmentation as being similar to a Brazilian butt lift, where you need to first extract fat from elsewhere to then reinject where you want to enhance size.

"Implant-free augmentation uses fat transfer – liposuction is performed in one area, and the fat is processed and injected into the breasts," said Dr. Howarth. "Many patients are seeking an option that doesn't require the maintenance or long-term considerations of implants. For patients with breast ptosis or drooping, I often perform auto-augmentation with a lift to maintain their volume while achieving better shape and contour."

Some patients are better suited for one augmentation method over the other.

"Patients who want a modest size increase and have enough donor fat are ideal for implant-free augmentation," said Dr. Howarth. "Those who desire a more dramatic change or have very little natural breast tissue may be better suited for implants. It really depends on the individual's anatomy and goals."

It's important to note that implant-free options do not offer the dramatic increase in size you can get with implants

"When I discuss implant-free breast augmentations with patients, the discussion focuses on the patient's goals for the procedure first, followed by an exam to determine whether those goals are achievable with implant-free techniques," said Dr. Krasniak. "The ideal patient for these procedures is one who is seeking a more modest augmentation, not looking to jump multiple cup sizes, and who has reasonable tissue available to perform liposuction in order to gain the desired volume increase for the breasts. There are also certain patients in whom the breast augmentation is desired to improve the overall shape of the breast, in which case a breast implant is better able to improve the roundness of a breast compared to implant-free options available, and so these patients may not be candidates for this approach."

Results and recovery for implant-free breast augmentation

Another key area of difference is the results that can be achieved via implant as compared to implant-free augmentation. This often ties back to the patient's goals as well, with the approach being tailored to the results they want to achieve.

"The results from implant-free breast augmentations can range from being very subtle to more dramatic," said Dr. Krasniak. "They often tend to be a very natural-appearing result as all the tissue used for augmentation is the patient's own tissue. Again, there is some decreased predictability regarding the final volume of augmentation compared to when using a breast implant, in addition to some risks that are specific to these procedures that your plastic surgeon should discuss. Also, if a very large change in size is requested by the patient, this is often best achieved with the use of a breast implant."

A final notable difference between implant-free augmentation and augmentation via implant is in the recovery following the procedure.

"I discuss a three-week recovery timeline with most of my patients undergoing these procedures," said Dr. Krasniak. "From a timeframe perspective, this is similar to an implant-based breast augmentation. However, the overall recovery and generally the discomfort after the procedure can sometimes be less in the implant-free augmentation patients. The main consideration is that if liposuction is to be used to assist the implant-free augmentation procedure, then there is a longer overall recovery due to a longer need for compression garments after liposuction. However, this does not tend to decrease the time it takes for patients to get back to exercise and physical activity."

From traditional breast augmentation via implant to trending implant-free options such as fat transfer, there are a myriad of methods to create the ideal size and shape breasts for any patient who is considering a breast augmentation.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.