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November 24, 2025
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Breast implants have served women since the first procedure was performed in 1962. Many were likely leaning towards breast implants when television shows like Baywatch and magazine supermodels made "boob jobs" fashionable in the 1990s.
For a long time, methods to increase the appearance of one's breasts relied on breast or saline implants, which can come with risks.
Today, while breast implants continue to be popular, breast enhancement via fat grafting is increasingly becoming a mainstream breast augmentation alternative.
Breast enhancement via fat grafting
"Fat grafting is relatively unknown locally; many women were unaware that there was an avenue apart from breast implantation back then. Some women wanted a bigger breast size, but the thought of a foreign object in their body and the unnatural and 'fake' appearance held them back – until fat grafting came along," shares Dr Ivan Puah, who was one of the first few doctors to introduce autologous fat grafting to Singapore in 2007.
Dr Puah has also received training in syringe liposculpture and fat grafting under French plastic surgeon, Dr Pierre François Fournier.
Fat grafting to breasts, or fat transfer, can help you achieve natural-looking results by removing unwanted fat from one part of the body and repurposing it to other body parts where it is deficient in a single session.
This method is desirable to those of us who have exercised and starved through fat-loss program only to find our bellies just came along for the ride while our breasts got left behind at the gym.
Stress is another factor that may induce weight loss in all the wrong places – breasts, cheeks, and buttocks tend to hollow out, making us look haggard.
Advantages of fat grafting over breast implants
| Treatments | Breast Implants | Breast enhancement via fat grafting |
|---|---|---|
| Surgery process | An incision, usually in the breast or armpit crease, or around the areola, is made for the implant to be inserted through. The implant will then be placed either behind the pectoral muscle or between the breast tissue and muscle. |
Excess fat is acquired from the abdomen, tummy, or thighs via liposuction and then harvested to maintain the integrity of fat cells. The purified fat will then be injected into the breasts. |
| Cup Size | Increase several cup sizes | Increase 1 to 1.5 cup size in one surgery |
| Feel | Like water balloons. Able to see the implant shape. |
Feels softer and natural. |
| Material | Foreign materials like silicone and saline. | Uses body fat. A study done in 2017 proved that adipose (fat) tissue is biocompatible and easily obtainable [1]. Repurposing your body fat works better than foreign substances as it is 'natural', eliminating the chance of rejection and allergic reaction. |
| Texture | The doctor can either use textured or smooth implants. | Not applicable. |
| Sensation | If you are not naturally less endowed, your breasts may have an unnatural sensation. | Natural. |
| Placement | Your breast implants will either be placed over or under the chest muscles. | The fat graft will be injected directly into the breasts. |
| Recovery | On average, a whole recovery period usually takes about four to six weeks. It's important to refrain from physical activity, lifting heavy objects and overworking yourself during this sensitive time. |
Back to your regime within a few days. |
| Body | No additional body contouring since the objective is to insert the breast implant into the body. | 2-in-1 body sculpting |
| Look | Full | Natural and fuller breasts |
Risks associated with breast or saline implants
| Treatments | Breast Implants |
|---|---|
| Implant Rupture |  Image source [1]: Variations of implant rupture. (A) Intact 1st generation implant with evidence of gel "bleed"; (B) ruptured second generation implant with free silicone leak; (C) intracapsular rupture of silicone implant in a patient who presented with a breast lump. The most common cause of breast implant rupture is iatrogenic damage, meaning the rupture is often caused by implant damage during placement [2], normal wear and tear and capsular contracture, which is the formation of scar tissue around the implant. Evaluation for implant rupture is primarily driven by patient symptoms, including a change in breast shape, size or firmness, capsular contracture, palpable lumps or breast pain [3]. |
| Implant Leakage | Silicone leakage, such as silicone sweating (gel bleed), has been associated with loco-regional effects such as histolytic necrotising lymphadenitis and with systemic disorders such as autoimmune and connective tissue diseases [4]. |
| Capsular Contraction |  Image source [2]: Magnetic resonance imaging (MRI) of a second-generation implant with intra-capsular rupture, there is free silicone liquid within the capsule. Capsular contracture is where scar tissue thickens around the implants, resulting in implant hardening and distortion. |
| Hematoma | Hematomas, solid swellings of clotted blood within the tissues [5]. |
| Wound Infection | Wound infection has been rated as the third most common breast implant complication [5]. |
| Long Recovery | Women who have had breast implants frequently experience local complications during the subsequent five years [5]. |
| High Complication Rate | 23.8% had at least one local complication each after implantation, although complications were significantly less frequent after cosmetic implantation than after implantation following mastectomy for cancer or cancer prophylaxis [5]. |
| Breast Implant Illness (BII) | Symptoms of Breast Implant Illness include: • Lymphomas [6] • Sleep disturbances [7] • Morning stiffness that sometimes may last more than an hour [7] • Fibromyalgia [7] • Muscle weakness can be severe and may render the patient bedridden [7] • Dry eyes and dry mouth, which are typically severe [7] • Severe neurological manifestations [7] • Atopic symptoms, such as sneezing, a runny nose, itchy eyes, red eyes, nasal congestion and post-nasal drip [7] • Occurrence of hives and/or Quincke's edema [7] • Symmetric polyarthritis compatible with a diagnosis of rheumatoid arthritis [8 ,9] • Asthma, pulmonary nodules, interstitial lung disease, pulmonary silicone embolism [10] This has led to a rise in breast explant surgery. |
| Rippling | Stretch marks or 'rippling' on their breasts is a frequent complication following breast augmentation or implant-based reconstruction and results in significant patient dissatisfaction [11]. |
| Not a permanent solution | The rate of rupture increases over the life of the implant. Patients with breast implants need to change their implants every 10 to 15 years. |
| Change in breast size | Saline and silicone implants present some hallmarks that give them away, especially in later years, as the patient ages and their body changes. For example, breast implants look like symmetrical orbs, while natural breasts are pear-shaped and rarely the same shape and size. The positioning of implants on the chest is another giveaway. Implants also don't move like natural fat in the breast tissue and tend to be static. |
| NIpple shifting | Some women have also found that their nipples have somewhat moved away from the equator after the procedure. |
Due to the high risk of complications, patients need to undergo regular clinical examinations. Follow-up after breast implants and the detection of complications by diagnostic methods is highly recommended.
The Emotional & Physical Benefits Of Breast enhancement via fat grafting
Studies reveal that the emotional benefits of breast implants include a boost in self-esteem, body image, and sexual satisfaction.
Meanwhile, physical benefits include larger and fuller breasts, breast lift, firming, revolumisation and symmetry, dealing with breast changes that occur after weight loss or childbirth, and reconstruction, especially after the removal of the breasts due to breast cancer.
These benefits are dependent on the person getting a Breast enhancement via fat grafting procedure. People who undergo such a surgery usually get it for a specific reason – and often leave with the desired results.
A natural and successful fat grafting result lies in the hands of the doctor
"Fat grafting is more than just a 'copy and paste' surgery. I view it as a piece of art that involves 30% science and 70% art. To achieve natural-looking and long-lasting results, the procedure requires a doctor with an artistic perception, attention to detail, a good understanding of body anatomy and years of experience. The doctor must know precisely the amount of fat that needs to be extracted, the best donor site to remove it from, and finally, apply the correct surgical techniques and approach to achieve the optimal aesthetic results for the patient," says Dr Puah.
When it comes to choosing a doctor for your fat grafting treatment, here are some of the criteria to take note of:
- It is essential to choose a doctor with patience, with good interpersonal and communication skills, and who can understand your needs and body goals.
- Choose a doctor that you are comfortable with, who understands the intricacy of fat grafting and places the patient's safety as a top priority.
- Only doctors accredited with liposuction licences in Singapore are allowed to conduct fat grafting.
- Ask to see the before and after photos of cases that the doctor has performed. An experienced doctor should have consistently achieved results for his patients.
- Not only does the doctor play a role, but your pre-surgery and post-surgery preparation and care are also equally important, hence choosing a doctor whose team of medical personnel are experienced, knowledgeable and helpful.
For optimal results and a high patient satisfaction index, opting for a highly trained and experienced doctor who understands how and where to apply the technique of fat tissue injection into the subcutaneous skin layers is imperative.
Breast enhancement via fat grafting is the union of science and art.
