What Really Sticks? Understanding Long-Term Volume Retention after Breast Fat Grafting
In the ever-evolving world of breast augmentation, autologous fat grafting has carved out a respected place as a natural and versatile technique. But one question is continually asked by both patients and plastic surgeons: How much fat actually stays long-term after grafting?
A groundbreaking study published in Plastic and Reconstructive Surgery by Ørholt et al. sheds light on this exact question with three years of prospective MRI follow-up. In my published discussion of this paper (Jejurikar & Kumar, 2025), I explored not only what the data tells us but also how we should be applying these findings to our clinical practice.
The Key Takeaway: 46% Retention at 8 Months, Then BMI Takes Over
Using serial magnetic resonance imaging, the authors found that fat volume retention in the breasts stabilizes by approximately 8 months postoperatively, averaging 46%. Beyond that point, changes in body mass index (BMI) emerged as the dominant factor influencing retention. A 1-point increase in BMI resulted in an average 57% increase in retained graft volume, while a 1-point drop decreased it by 22%.
This is incredibly relevant to patient counseling and preoperative planning. Many patients embarking on body contouring or breast enhancement journeys are simultaneously losing weight, whether through diet, GLP-1s, or bariatric surgery. For these individuals, the likelihood of reduced fat retention is significant and should shape expectations from the outset.
Preoperative Breast Volume: Another Unsung Hero
The study also highlighted that a higher graft-to-recipient volume ratio (essentially, how much fat is injected relative to the starting breast volume) correlates with more noticeable augmentation. Interestingly, even at ratios approaching 2:1, there was no observed plateau in volume gain which suggests that larger injections may continue to yield better volume outcomes if the breast envelope allows.
These findings align with recent work by other authors who have found that for every 100 cc increase in preoperative breast volume, fat graft retention improved by 4–8%, likely due to increased vascularity and capacity of the recipient site.
Clinical Application: Weight, Volume, and Shaping Expectations
So how do these insights affect everyday surgical practice?
-
Patient Selection and Counseling: For patients planning future weight loss or actively on weight reduction therapies, especially GLP-1 agonists, the likelihood of decreased fat retention should be explicitly discussed. Consider deferring fat grafting until weight stabilizes.
-
Fat Volume Strategy: Don’t fear higher fat volumes—especially in patients with the recipient capacity to handle it. A 2:1 ratio isn’t just feasible; it may actually maximize aesthetic impact without an increased risk of complications.
-
Satisfaction Beyond Volume: Perhaps most importantly, the study found that volume retention did not correlate with patient-reported satisfaction scores. Using the BREAST-Q, patients reported significant improvements in appearance and sexual well-being—even when the actual retained volume was modest. This reinforces what many of us already intuitively know: shape, contour, and symmetry matter more than raw volume numbers.
Complication Risk: Technique and Processing Still Matter
Although this specific study did not find clinical signs of fat necrosis or oil cysts, it also did not use imaging to detect subclinical complications. A recent systematic review by Seth et al. (2024) reported a 27.8% overall complication rate for fat grafting to the breast, with fat necrosis accounting for 43.7% of those events.
This opens the door for further research into processing techniques such as lipoaspirate washing, filtration, or enrichment with platelet-rich plasma and stromal vascular fraction, which some studies suggest may enhance volume retention and healing.
Final Thoughts: Aesthetic Goals Over Absolute Volume
While MRI data and volume retention percentages are vital from a scientific perspective, the real clinical endpoint remains aesthetic success and patient satisfaction. This study reminds us that “less volume retained” doesn’t necessarily mean “worse result.” Surgeons should aim for beautiful, natural contours that align with patient goals and should not just focus on a magic percentage of retained fat.
Reference
Ørholt M, Weltz TK, Hemmingsen MN, et al. Long-term volume retenthttps://journals.lww.com/plasreconsurg/fulltext/2025/06000/discussion__long_term_volume_retention_of_breast.11.aspxion of breast augmentation with fat grafting depends on weight changes: a 3-year prospective magnetic resonance imaging study. Plast Reconstr Surg. 2025;155(6):947–954. Link to full article
