Robert Whitfield MD explains how to replace removed breast implants with fat from liposuction. The fat goes into the fatty layer above breast tissue, not the implant pocket, and survives better there. He covers harvesting technique, processing without centrifugation, and targeting volume toward the collarbone.
Questions this video answers
3.4 to 4 millimeters.
4 millimeters (same diameter as harvest tube when returning fat).
Approximately three to nine months.
5–9 cm, with an average of about 7 cm.
Chapters
We're doing liposuction. So we're taking fat out of areas where we don't want it. Our hips, love handles, inner, outer thighs. We're putting it in different places. Think of the craze of the Brazilian butt lift. We're making butts out of fat. So why can't we take out an old implant and replace that volume holistically with your own fat? So it's my holistic mommy makeover. I take your fat out of your hips, abdomen, inner, outer thighs. I improve the shape of the waist. And we take out and perform an explant as we previously described. Then we put fat where it's supposed to be, back in the space where it belongs. It's very important when we put fat back that we place it in the correct position. We don't put it where we took the implant out of because it won't survive there. There's no blood supply for it to live there. There's no matrix or structure to it. When we transfer it back, we put it beneath the skin, but above the breast tissue. So that plane is the fatty plane that everybody has. You can look it up and see the breast conically shaped. And then there's a layer of fat over the breast tissue now that once it heals, which takes three to nine months, we'll say it's going to live with you and change with you. And everybody asks me, is it going to, you know, am I going to grow, grow fat in new place as well? So think of the breast not in this standard conical or cone dimensions, but most of the breast, 2/3 to 3/4 of the breast, is really above the position of the nipple, towards the collarbone. This is where the majority of the fat can be transferred. This is where you get most of your volume restoration. It has the most space versus the area below the nipple complex, which is shorter in distance, maybe 5-9 cm, average of 7 cm to the fold itself. So let me tell you why fat is such a great filler. So fat, once it heals, it's soft, it's natural, it's going to maintain itself over time, provided diet, hormones, other variables can remain as constant as possible. There's a lot of things written about fat not being a good filler. It causes necrosis or cysts. I want to explain to you that fat not only is a good filler, it's a great filler. Why and how you get it to be such a great filler is one, a technical one. How you remove it? I always remove it consistently with the same diameter cannula. That's between a 3.4 and a 4 millimeter cannula. I use a very specific collection system by Wells Johnson. I have no financial incentive to say anything about them in full disclosure. I don't get paid by Wells Johnson. It sits there, it's sterile. We use an antibiotic solution to wash over the fat and rinse it. We have a shaker. We don't centrifuge the fat, which I get asked a lot about why I don't centrifuge fat. And then we place it back. We place it back with the same diameter tube that I took it out with. So the cannula to put it back with is a 4 millimeter cannula. So think of fat. Fat is not like a series of skittles which are all shaped the same. Fat is more like unevenly cooked popcorn or the popcorn you get in the tin at Christmas. There's all sorts of varieties, all sorts of sizes and shapes. When it goes back through those tubes that you took it out with, if it's the same diameter, you cause the least amount of injury. You're not creating a pressure that's going to damage the fat.
