Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Master of Science




Simpson, Andrew M.

2nd Supervisor

Brackstone, Muriel



Primary breast augmentation is one of the most common surgeries performed by plastic surgeons. Breast augmentation, since its inception in 1895, has become a multimillion-dollar industry. Today, the two most common methods include implant-based and fat graft augmentation. Implant-based augmentation includes the use of silicone or saline prosthesis to enhance breast volume or shape. With fat grafting, a patient’s fat is harvested, processed, and injected into the breast to achieve the desired result. This thesis aims to outline the current literature on both methods of breast augmentation, review patient reported outcomes, as well as a proposed clinical trial to gain further understanding into fat grafting to address the current deficiencies in the literature.

Summary for Lay Audience

Patients undergo breast surgery for either cosmetic or reconstructive (breasts removed due to cancer or for lack of normal breast development) indications. Breast augmentation is one of the most common procedures performed by plastic surgeons. Breast implants have been a standard option for breast augmentation for the past 60 years. However, in the past decade a large group of patients are requesting a more ‘natural’ option to enhance their breast, with no prosthetic implant.

Fat grafting provides an option for breast enhancement using the patient’s own tissue. The fat grafting procedure involves liposuction to the abdomen, thighs, or buttocks. The harvested fat is then processed and prepared for injection into the breast. During surgery the fat is injected into the breast, balancing the desired result and limitations of injectable volume. This procedure can produce great initial results; however, long-term fat graft survival can be unpredictable. The injected fat, over time, may not survive. This can result in the body breaking down the non-viable fat, creating hard and painful nodules, and ultimately losing a volume of the injected fat. This has limited the widespread adoption of this technique.

In this thesis the current data is reviewed on the above methods, as well as patient satisfaction surveys. Secondly, a proposed clinical trial looking into fat grafting. This will give us more knowledge on how to treat the fat during surgery, to increase the amount of fat survival after surgery.