Fat grafting for correction of tuberous breast: a narrative review
Rasmus Blaabjerg Ahm Sørensen
, Wahida Chakari
, Jørn Bo Thomsen
Contributions: (I) Conception and design: All authors; (II) Administrative support: None; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: RBA Sørensen; (V) Data analysis and interpretation: RBA Sørensen; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.
Background and Objective: Tuberous breast deformity is a congenital condition characterized by breast hypoplasia, constricted base, herniated areola, and high inframammary fold position. Traditionally managed with implant-based surgery, autologous fat grafting has increasingly gained attention as a potential alternative. The objective of this narrative review is to examine the current literature on the use of fat grafting for the correction of tuberous breast deformity, highlight outcomes, and discuss its advantages, disadvantages, and role compared to conventional approaches.
Methods: This narrative literature review examined studies published in the PubMed database prior to March 31, 2025, reporting outcomes of fat grafting for the correction of tuberous breast deformity. Studies needed to be available in English. It generated 66 studies, of which 23 met the inclusion criteria. The majority of included studies were retrospective case series.
Key Content and Findings: Fat grafting has shown promising results in both aesthetic outcomes and patient satisfaction, with several studies reporting improvements in breast volume, contour, and symmetry. BREAST-Q scores demonstrated significant increases in satisfaction, psychosocial, and sexual well-being post-treatment. Volume retention rates varied, with most studies citing 60–70% graft survival within 6 to 12 months. However, achieving the desired result often required multiple sessions due to partial fat resorption and limited tissue capacity. Limitations include donor site availability and volume projection. The presence of fibrous tissue in tuberous breasts poses a challenge, often necessitating fasciotomies.
Conclusions: Fat grafting shows promise as a feasible option for the correction of tuberous breast deformity, with particular advantages in avoiding the use of prosthetic materials. While it may not serve as a direct replacement for implants, it represents a valuable alternative that can be adapted to suit individual patient preferences and clinical circumstances. However, due to the limited and heterogeneous nature of the current literature, further prospective and comparative research is warranted. Patients should be thoroughly informed of the benefits and limitations of fat grafting and other available treatment options.
Keywords: Tuberous breast deformity; breast reconstruction; breast augmentation; fat grafting; lipofilling
Received: 01 July 2025; Accepted: 11 December 2025; Published online: 26 December 2025.
doi: 10.21037/abs-25-33
Introduction
Tuberous breast is a congenital condition that significantly affects breast development during adolescence and can have a profound psychological impact (1). The condition was first described by Rees and Aston in 1976 (2). While the exact etiology remains unclear, it is believed to be underreported, with an estimated prevalence of up to 27.6% in the general female population (3,4).
Tuberous breast deformity becomes apparent during puberty and is characterized by a conical breast shape due to the presence of a fibrous ring at the breast base. This structural abnormality results in hypoplasia or absence of the lower breast quadrants, herniation of the areola, an enlarged nipple-areola complex, a higher-than-normal inframammary fold, and skin deficiency (5). To date, eight different classification systems have been proposed to categorize the severity and morphological variations of this condition with the Grolleau classification system being the most frequently utilized (3,6).
Various surgical techniques have been employed to correct tuberous breast deformities (3). Traditionally, treatment has relied on implants and more extensive reconstructive procedures. However, there is a growing trend toward using autologous fat grafting, or lipofilling, as the primary corrective procedure for tuberous breast, with fat grafting as the sole procedure reported in 9% of patients (6) (Figure 1). This shift reflects a broader transition away from more invasive surgical techniques in favor of autologous approaches, which may provide more natural aesthetic outcomes with fewer long-term complications.
At our department, the correction of tuberous breast deformities is increasingly performed using fat grafting, either as a standalone procedure or in combination with a secondary mastopexy. Given this trend, we aimed to review the existing literature to assess the experiences and outcomes reported by other institutions regarding the use of fat grafting for correction of tuberous breast deformities. To our knowledge, no previous reviews have specifically addressed the use of fat grafting for the correction of tuberous breast deformity, highlighting a gap in the literature that this review seeks to address. We present this article in accordance with the Narrative Review reporting checklist (available at https://abs.amegroups.com/article/view/10.21037/abs-25-33/rc).
Methods
In April 2025, we conducted a literature search in PubMed to identify relevant studies on the use of fat grafting for the correction of tuberous breast deformity (Table 1). The search strategy included the following terms: (tuberous breast OR tubular breast OR snoopy breast OR herniated areolar complex OR domed nipple OR narrow breast base OR constricted breast OR lower pole hypoplasia) AND (lipofilling OR lipotransplantation OR fat grafting OR fat transplantation).
Table 1
| Items | Specification |
|---|---|
| Date of search | 1st April 2025 |
| Database searched | PubMed |
| Search terms used | (tuberous breast OR tubular breast OR snoopy breast OR herniated areolar complex OR domed nipple OR narrow breast base OR constricted breast OR lower pole hypoplasia) AND (lipofilling OR lipotransplantation OR fat grafting OR fat transplantation) |
| Timeframe | Prior to March 31, 2025 |
| Inclusion and exclusion criteria | Studies were included if they reported on the use of lipofilling in the treatment of tuberous breast deformities as a standalone procedure or in combination with other secondary surgical techniques. Reviews, case series, cohort studies, and clinical trials were considered for inclusion, while conference abstracts, letters, and articles not available in English were excluded. Furthermore, studies that did not report on the surgical outcomes of fat grafting as a treatment for tuberous breast were also excluded |
| Selection process | The selection of studies included in this review was conducted by the main author (R.B.A.S.), who performed a comprehensive search of the relevant literature. The process was conducted independently to ensure an unbiased selection of studies. Inclusion and exclusion criteria were established prior to the selection process, based on relevance to the topic of fat grafting for the correction of tuberous breasts. The main author reviewed titles, abstracts, and full-text articles to identify studies that met these criteria |
| Additional considerations | The author was unable to retrieve one study that likely met the inclusion criteria |
This search generated 66 results. Titles and abstracts were screened for relevance. Studies were included if they reported on the use of fat grafting in the treatment of tuberous breast deformities as a standalone procedure or in combination with other secondary surgical techniques. Reviews, case series, cohort studies, and clinical trials were considered for inclusion, while conference abstracts, letters, and articles not available in English were excluded. Furthermore, studies that did not report on the surgical outcomes of fat grafting as a treatment for tuberous breast were also excluded. After screening of all titles and abstracts 23 studies were included in this review (Table 2) (1,6-27). The majority of studies were excluded because fat grafting was not the primary treatment. Five were excluded as they were not accessible in English. Full-text articles of the selected studies were reviewed to extract relevant data regarding surgical techniques, surgical outcomes, patient outcomes, and long-term follow-up findings.
Table 2
| Study [year] | Type | Patients with TB†/patients [n of TB†] | Classification (distribution of TB) | Age (years), mean [range] | BMI (kg/m2), mean [range] | Session, mean [range] | Fat volume (mL), mean [range] | Follow-up |
|---|---|---|---|---|---|---|---|---|
| Papadopoulos et al. [2024] (1) | Retro. series | 13/24 [15] | Grolleau (2 I, 8 II, 5 III) | 21.3 [17–34] | 25.7 [16.5–35] | 2.67 [1–5] | 358 [130–640] | 65.8 mo |
| Surcel et al. [2024] (7) | Retro. series | 94/129 [–] | Grolleau (34 I, 38 II, 22 III) | 25.4 [16–54] | 24.5 [18.1–39.1] | 2.4 [1–5] | – | 6.3 yrs |
| Alvaro et al. [2023] (6) | Systematic review | – | – | – | – | – | – | – |
| Gentile et al. [2023] (8) | Retro. series | 33/65 [61] | Grolleau (20 I, 23 II, 20 III) | 39 [18–60] | – | [1–2] | 500 [250–750] | 2 yrs |
| Moltaji et al. [2023] (9) | Retro. series | 9/49 [15] | – | – | – | 1.14 | 372 [150–870] | 20 mo |
| Abboud et al. [2022] (10) | Prospective | 47/47 [78] | Grolleau (20 I, 31 II, 27 III) | 26 [19–42] | 23 [18–27] | 1.28 [1–2] | 212 [100–325] | 48,7 mo |
| Papadopoulos et al. [2021] (11) | Retro. series | 10/10 [12] | Grolleau (1 I, 7 II, 4 III) | 22.1 [17–34] | 25.8‡ [23.5–30.2] | 3.3 [1–5] | 358 [301–433] | 3, 6, 12 mo |
| Andjelkov et al. [2021] (12) | Retro. series | 19 /125 [34] | – | 36 [21–49] | – | – | – | 4–12 mo |
| Gentile et al. [2021] (13) | Retro. series | 8/105 [14] | – | 38 [18–58] | 26.5 [18–35] | [1–2] | 180 [80–280] → 130 [80–180] | 3 yrs |
| di Summa et al [2021] (14) | Retro. series | –/65 [20] | Grolleau | 33 [18–52] | 22.9 [18–33] | 1.3±0.5§ | 339±140§ | 23 mo |
| Bonomi et al [2020] (15) | Case report | 1/1 [2 TB] | Von Heimburg | 19 | – | 1 | 140/80 | – |
| Gutierrez-Ontalvilla et al. [2020] (16) | Retro. series | 9/9 [–] | Grolleau | 14.9 [14.4–15.4] | – | 1.8 | 220 [0–485] | 21 mo |
| Rigotti et al. [2019] (17) | Retro. series | 22/22 [–] | – | 30 [16–42] | – | [1–4] | Range, 150–200/session | 3.5 yrs |
| Claudio Silva-Vergara et al. [2018] (18) | Retro. series | 11/11 [19] | Grolleau (3 I, 13 II, 3 III) | 24 | 23.4 [20.2–33.6] | 2 [1–3] | Mean: 413 | 29.7 mo |
| Tenna et al. [2017] (19) | Retro. series | 4/88 [4] | Grolleau | 25 [13–48] | 23.25 [19–30] | – | 113.5 [50–210] | 5.67 yrs |
| Brault et al. [2017] (20) | Retro. series | 15/– [27] | Grolleau (9 I, 14 II, 4 III) | 21.1 [15–28] | – | 1.6 | 286 [40–600] → 254 [140–450] | 17 mo |
| Klit et al. [2015] (21) | Cohort | 11/11 [11] | Grolleau (1 I, 5 II, 5 III) | 18 [17–25] | 24‡ [20–27] | [1–3] | 210 [95–370] | 13 mo |
| Delay et al. [2015] (22) | Retro. series | – | – | – | – | – | – | – |
| Derder et al. [2014] (23) | Retro. series | 3/10 [6] | – | 18.3 [17–19] | – | 1.33 [1–2] | 367 [300–500] | 1 yr |
| Ho Quoc et al. [2013] (24) | Retro. series | –/1,000 [–] | – | – | – | – | – | – |
| Delay et al. [2013] (25) | Retro. series | 31/31 [49] | Grolleau (3 I, 19 II, 9 III) | 23 [15–47] | 21.9 [18–26] | 1–2 | 158 [90–253] → 226 [100–316] | 6.5 yrs |
| Del Vecchio et al. [2011] (26) | Prospective | –/25 [–] | – | – | – | – | – | 6 mo imaging |
| Coleman et al. [2007] (27) | Retro. series | 1/17 [2] | – | 28 | – | 2 | 347 [300–380] | 58 mo |
†, Treated with fat grafting; ‡, median; §, mean ± standard deviation. BMI, body mass index; mo, months; Retro., retrospective; TB, tuberous breast; yrs, years.
Discussion
The use of fat grafting in combination with other surgical procedures is well established, particularly as an adjunct to enhance volume and contour as an adjunct to breast reconstruction and aesthetic surgery (6,7). Traditionally, fat grafting has been utilized as a secondary corrective measure, complementing techniques such as implant placement, glandular flaps or mastopexy. However, emerging evidence suggests that fat grafting alone may be a viable primary corrective procedure for tuberous breast deformity. The existing studies suggests that fat grafting as a standalone technique can effectively address the characteristic deficiencies associated with tuberous breasts (8,14,22). These results challenge the conventional reliance on breast implants and support the hypothesis that autologous fat grafting may provide a natural and aesthetically pleasing correction while minimizing the potential complications associated with prosthetic devices, such as capsular contracture and exchange of implant over time due to displacement or changed volume of the breast.
Age at the time of fat grafting surgery
Patients with congenital breast abnormalities often seek advice around the time of puberty (5). In this study we also find that lipofilling is most commonly performed on younger individuals, with a mean age typically between 20 and 25 years (1,7,11,18-20,25). The youngest patient reported was 13 years old (19), while the oldest was 54 years old (7). Although more treatments are typically required initially, successful lipofilling eliminates the need for repeated surgeries, such as implant exchanges, which is especially important given the young age of the majority of these patients (7).
Number of sessions and volume distributed in fat grafting
The number of fat grafting sessions required in lipofilling procedures can vary, with patients undergoing between 1 to 3 sessions in most studies (Table 2). A retrospective case series including 94 patients with tuberous breasts by Surcel et al. found that number of interventions and volume grafted was not associated with patient body mass index, but was dependent on the severity of the deformity (7). In contrast, a retrospective case series by Papadopoulos et al., which included 13 patients with a total of 15 tuberous breasts, found no significant difference in the number of fat grafting sessions among the different Grolleau-type groups. However, the limited number of cases in this study makes it difficult to draw definitive conclusions (1). The differences observed between studies by Surcel et al. and Papadopoulos et al. may partly reflect variations in surgical experience, technique, and patient selection. As surgeon expertise and procedural planning evolve, these factors could influence both the number of required sessions and the aesthetic outcomes achieved.
In most studies the mean fat grafting volume was 200–400 mL per breast (Table 2). Some authors advocate for the use of external pre-expansion to optimize (9,26). Pre-expansion was believed to improve graft survival and allow for larger volume transfers by preparing the recipient site in several ways. However, although the technique seemed promising, the use of pre-expansion has not gained traction at a larger scale for fat grafting of the breasts. Factors that may contribute to this include patient discomfort, the time-consuming nature of device use, and high costs. In our experience, despite the sound theoretical rationale, pre-expansion has provided limited additional benefit in achieving improved graft retention.
The intervals between sessions generally range from 3 to 6 months (6,17,19). The need for repeated fat grafting sessions initially increases the number of general anesthesia exposures compared to implant-based reconstructions. However, it is worth noting that implant-based reconstructions also typically involve multiple surgeries over a patient’s lifetime, including future implant exchanges. Patients should be made aware of this when considering treatment options.
Fat distribution
Fat placement in lipofilling for tuberous breast correction is performed by injecting fat in multiple layers from deep to superficial planes to ensure graft survival (8,11,16,20,25). A retrospective study including 9 patients with tuberous breasts by Gutierrez-Ontalvilla et al. describe how they inject the fat in a layered fashion, starting above the pectoralis major muscle progressing toward the subcutaneous tissue. Fat was injected only until slight skin tension was observed to avoid ischemia of the transplanted fat (16). Like Gutierrez-Ontalvilla et al. most authors perform fat injections above the pectoralis muscle, but in a retrospective study including 31 patients by Delay et al. emphasized using the pectoralis major muscle as a recipient site due to its excellent vascularization (25).
Techniques also vary in the number and location of entry points: some authors use three designated sites (16), while others use multiple tunnels and seven different entry points to ensure uniform fat distribution (8). Overall, the consensus is to layer the fat grafts carefully to maintain vascularization and minimize ischemia and thereby preventing the formation of oil cysts and areas of fat necrosis.
To account for potential displacement of the nipple-areolar complex, a periareolar mastopexy may also be considered, as described by Gentile et al. (28). Especially in patients with ptosis.
Fasciotomy
The underlying cause of tuberous breasts is a fibrous ring through which the breast tissue protrudes. During fat grafting, this fibrous ring can create tension, potentially leading to ischemia and associated complications. To prevent tension percutaneous fasciotomies are commonly recommended by authors (11,20,21,25) (Figure 2). In the study by Delay et al. involving 31 patients with tuberous breasts, fasciotomy was performed using V-shaped incisions made with a 14-gauge trocar to cut fibrous bands that had been placed under maximum tension using a double-hook retractor. The breasts were then sutured with fine, rapidly absorbable threads (25). Fasciotomy were also used for lowering the inframammary fold (11,20,21). Ho Quoc et al. note that aggressive fasciotomies risk decreasing skin vascularization and can lead to complications such as wounds, infections, and fat necrosis. However, they also report that there were no local complications to fasciotomies in their retrospective case series including 1,000 cases (24). The PALLL technique, introduced by Abboud et al., is also relevant in the context of surgical release of constricted tissues in tuberous breast correction. PALLL, which stands for power-assisted liposuction, loops, and lipofilling, is a three-step approach that uses power-assisted liposuction to release fibrous constrictions and prepare the recipient tissue, followed by the placement of internal sutures (“loops”) to reshape the breast footprint, reposition the inframammary fold, and address areolar herniation, and concludes with lipofilling to restore breast volume and improve contour (10). In their study involving 47 patients with tuberous breasts have shown promising results (10).
Fasciotomy has been shown to provide excellent aesthetic results and improve breast shape without scarring (24). However, fasciotomy should be carefully considered in patients with a tendency for keloid formation, and the number of incision sites should be minimized as much as possible.
Volume maintenance following fat grafting in tuberous breast correction
The long-term maintenance of breast volume following fat grafting is a key factor in evaluating the durability and success of this technique for tuberous breast correction. Across multiple studies, volume retention has consistently been shown to be stable over time.
A retrospective study by Gentile including 33 patients with tuberous breast evaluated volume maintenance after fat grafting using magnetic resonance imaging and ultrasound. The study found that patients who underwent a single fat grafting session demonstrated a volume maintenance of approximately 68% at 6 months, which slightly decreased to 60% after 1 year, in cases where no additional fat grafting was performed. Those who received a second session after 6 months showed improved retention, with 75% of the augmented volume maintained after 1 year, arguing there might be an advantage of iterative procedures for more enduring outcomes (8). However, the small sample size and absence of precise measurements make it difficult to draw definitive conclusions.
Further evidence supports a graft take of around 60–70% following the initial fat grafting session (9,16,22,26). Notably, the volume stability appears to persist beyond the short term. Though only including 10 patients a retrospective study by Derder et al. found volume gains to be stable over time with a minimum follow-up of 1 year (mean: 3.5 years) (23). Around 46% of the breasts only had a single session with lipofilling. Except for one case the rest of the patients had two sessions. Moreover, cup size was shown to remain unchanged after at least 5 years in patients treated with autologous fat transfer for congenital hypoplastic breast anomalies, suggesting long-term volume maintenance (23).
Collectively, these findings suggest that while some degree of resorption is expected, the majority of the grafted fat remains viable. Long-term outcomes according to the included studies seems to demonstrate sustained volume, arguing that fat grafting is a reliable technique for achieving lasting correction of the tuberous breast deformity.
Fat grafting and breast cancer detection
The use of fat grafting in breast surgery has historically been controversial. Based on experimental studies concerns was raised that fat could stimulate cancer cells (29). However, a matched case-control study by Petit et al. including 644 patients showed no increase in risk of local events, axillary node metastasis, distant metastasis or contralateral breast cancer in patients receiving fat grafting after breast cancer (29). Therefore, it seems that fat grafting is safe and does not seem to stimulate development of breast cancer.
Furthermore, there are concerns that necrosis and calcifications may interfere with breast cancer detection (30). A study by Coleman and Saboeiro addresses this topic. They argue that calcifications are known to occur after various interventions, such as breast biopsy, implant procedures, radiation therapy, breast reduction, and liposuction, with an incidence of up to 50% within 2 years and therefore argue that fat grafting appears comparable to other surgical techniques (27). A retrospective study by Delay et al. including 49 cases of tuberous breast found no micro- or macrocalcifications after fat grafting on 1 year follow-up with mammograms and ultrasound (25).
Surgical outcomes of fat grafting in tuberous breast correction
Fat grafting for the correction of tuberous breast deformity has been consistently associated with good surgical outcomes and a low complication profile. Across numerous studies, no major complications, such as infection or hematoma, were reported in patients undergoing fat grafting (1,11,12,16,17).
In contrast, implant-based reconstruction was associated with higher rates of complications and revision surgeries. One retrospective comparative study including 129 patients compared implants versus fat grafting for correction of tuberous breasts. It found that while the implant group required fewer surgeries initially (mean 1.2 vs. 2.4 for lipofilling; P<0.001), the long-term need for re-operations was significantly greater (46% vs. 21% in the fat grafting group; P=0.044). The study found the overall complication rate in the implant group was 17%, compared to 0% in the lipofilling group, where complications were defined as requiring re-operation or hospital admission (7).
Among patients treated with fat grafting, minor complications such as oil cysts, seromas, or temporary fat necrosis were observed, with reported rates ranging from 14% to 25% (13,25). These were mostly asymptomatic and resolved spontaneously or with conservative management, but may cause concern for the patient, as it can occasionally be felt as a lump (11,14,16).
Donor site morbidity was minimal, with only minor side effects such as bruising, edema, or mild discomfort reported, and cosmetic satisfaction was high at donor site (11,17). Although it may require more initial sessions to achieve the desired aesthetic outcome, fat grafting appears to offer a relatively stable result over time, with potentially fewer long-term complications and revisions (7,14). Surgeons rated results highly, highlighting natural shape and improved symmetry (8,25).
Patient satisfaction following fat grafting for tuberous breast correction
Patient satisfaction with fat grafting in the treatment of tuberous breast deformity is consistently high across multiple studies, with many patients reporting satisfaction with regard to breast softness, texture, volume contours, and natural appearance (8,13,16,21).
In studies utilizing the BREAST-Q questionnaire, fat grafting resulted in significant improvements in breast satisfaction, psychosocial well-being, and sexual well-being (1,11). The BREAST-Q questionnaire is a validated tool that measures patient-reported outcomes in breast surgery (1). Scores range from 0 to 100, with higher scores indicating greater satisfaction or well-being. A retrospective case-series study including 24 patients reported a ninefold increase in breast satisfaction and a more than threefold increase in psychosocial and sexual well-being after fat grafting (1). Another retrospective study including 10 patients showed statistically significant increases (P<0.01) postoperative in scores concerning breast satisfaction, psychological well-being, and sexual well-being (11).
In a long-term follow-up study (mean 6.5 years) including 31 patients, participants were asked to rate the results after fat grafting on 1 year follow-up on a 4-point scale: very satisfied, satisfied, moderately satisfied, or dissatisfied. 94% of patients were very satisfied with the results of fat grafting, and the remaining 6% were satisfied (25). Similarly, in a cohort study including 11 patients treated for congenital hypoplastic breast anomalies, 10 of 11 women said they would recommend fat grafting to others, and all preferred or strongly preferred fat grafting over implants (21).
Interestingly, studies comparing fat grafting and implant-based surgeries revealed that while implant procedures may offer higher satisfaction after a single surgery, fat grafting patients often achieve equivalent or better results after two sessions (1,8,14). However, all of these studies were retrospective case series involving a total of 106 patients, and included individuals with conditions other than tuberous breast deformity.
A retrospective study by Brault et al. including 15 patients found that patients did not find fat grafting to meet expectations (20). The study found that implant-based correction yielded slightly higher outcome satisfaction in some aspects (20). However, this was not a universal finding. Similar to Brault et al., Papadopoulos et al. also assessed patient satisfaction using the BREAST-Q questionnaire, comparing implant-based correction with fat grafting and did not find implant correction to be superior to fat grafting (1). In their retrospective study of 24 patients, the average number of fat grafting sessions was 2.67, compared to 1.6 interventions reported in Brault et al.’s study. The higher satisfaction levels observed may be related to the increased number of grafting sessions allowing for more detailed correction. These findings suggest that when fat grafting is chosen for the correction of tuberous breast deformities, it is important to inform patients that multiple sessions may be necessary to achieve the desired outcome.
In summary, fat grafting for tuberous breast correction seems to result in high levels of patient satisfaction, especially in the long term. Although achieving the desired result may require multiple sessions, patients seem to be satisfied with the results following lipofilling due to a natural appearance, low complication rate, and avoidance of foreign material.
Limitation
This narrative review has several limitations that must be considered when interpreting the results. Firstly, the overall body of literature on fat grafting specifically for the correction of tuberous breast deformities remains limited. While interest in fat grafting has grown, high-quality studies focusing exclusively on tuberous breast remain scarce.
Secondly, not all included studies addressed tuberous breast cases exclusively. Many involved mixed cohorts of patients with various congenital breast anomalies such as hypoplasia or asymmetry. As a result, it was not always possible to isolate data specific to tuberous breast correction, which may affect the precision of the findings presented in this review.
Additionally, nearly all the available studies were retrospective case reports or small case series, which limits the strength of the evidence. These types of studies are subject to selection bias and often lack standardized outcome measures or long-term follow-up. Furthermore, heterogeneity in surgical techniques, the number of fat grafting sessions, volume retention assessments, and follow-up duration further complicates cross-study comparisons and the generalizability of conclusions.
Future research should aim to address these gaps through prospective, controlled studies with well-defined inclusion criteria, consistent outcome reporting, and a focus specifically on tuberous breast deformities to better evaluate the role and efficacy of fat grafting in this patient population.
Advantages of fat grafting in the treatment of tuberous breast
Fat grafting offers several distinct advantages as a treatment for tuberous breast deformity, particularly in young patients. One of the primary benefits is its minimally invasive nature and the low complication rate associated with the procedure. Studies have shown that fat grafting alone can achieve satisfactory aesthetic outcomes (1).
Compared to implant-based techniques, a retrospective study found that fat grafting involved shorter operative times, and required shorter recovery period (1). The procedure is also purely autologous, eliminating the need for foreign materials such as implants, which can lead to complications and may require future revision surgeries—a relevant concern for young patients in their teens or early twenties (8,11,18).
In addition to aesthetic correction, fat grafting seems to provide a natural breast shape, consistency and may provide results that respond to physiological changes in body weight over time (11,18). The reproducibility of the technique allows for further sessions if needed, making it a flexible option for staged correction (8,14). Furthermore, fat grafting offers improved symmetry with the contralateral breast and can help refine contour irregularities, while also providing secondary benefits from liposuction at the donor site (8,14).
Disadvantages of fat grafting in the correction of tuberous breast deformity
While fat grafting offers several advantages, there are also important limitations and disadvantages to consider. A primary drawback of fat grafting is the need for multiple procedures, thus added time for surgery over time. Due to partial fat resorption and the limited volume that can be safely injected per session, due to the restricted capacity of the breast, patients often need multiple procedures to reach and preserve the desired breast volume and contour (1,13).
Projection may also be suboptimal in some cases, as fat alone does not provide the same structural support or fullness as implants making it a less ideal option for patients seeking a significant increase in projection (13). The technical challenge of fat grafting is amplified in tuberous breasts due to the presence of dense fibrous tissue. These fibrotic bands can hinder even fat distribution and reduce graft survival, although fasciotomies can release the bands in the majority of cases (14). In very slender patients, the lack of adequate donor fat may further limit the feasibility of the procedure or the amount of volume that can be safely transferred (14). The oncological safety of fat grafting has been debated amongst other reasons due to postoperative fat necrosis which can result in intra-parenchymal calcifications, potentially complicating future breast cancer screening, particularly in young patients. However, it has been recognized that fat grafting to the tissue adjacent to the glandular tissue and not in the glandular tissue makes it possible to avoid any confusion regarding imaging interpretation of calcifications (27).
Conclusions
Fat grafting appears to be a promising alternative to implant-based correction in the treatment of tuberous breast deformity. While it may not necessarily replace implants, it can serve as a suitable option for patients, particularly those who prefer an autologous approach. Available evidence suggests that fat grafting can yield satisfactory aesthetic and patient-reported outcomes, especially when performed over multiple sessions.
Nonetheless, fat grafting comes with its own set of considerations, such as variable resorption rates, the potential need for repeat procedures, and technical challenges in patients with limited donor tissue or extensive fibrous breast architecture. Given the variety of available techniques and individual patient factors, it is important that patients are presented with a balanced overview of the potential benefits and limitations of fat grafting, as well as alternative methods for correcting tuberous breast deformities. A personalized, informed approach remains essential in guiding treatment planning.
Acknowledgments
Figures are made by Dr. Wahida Chakari.
Footnote
Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at https://abs.amegroups.com/article/view/10.21037/abs-25-33/rc
Peer Review File: Available at https://abs.amegroups.com/article/view/10.21037/abs-25-33/prf
Funding: None.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://abs.amegroups.com/article/view/10.21037/abs-25-33/coif). J.B.T. serves as an unpaid editorial board member of Annals of Breast Surgery from December 2025 to December 2027. The other authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
References
- Papadopoulos S, Colpaert SDM, Vidovic G, et al. Correction of the Tuberous Breast with Fat Grafting and Implant: Techniques, Evaluation with BREAST-Q, and Preliminary Results. Aesthetic Plast Surg 2024;48:4953-64. [Crossref] [PubMed]
- Rees TD, Aston SJ. The tuberous breast. Clin Plast Surg 1976;3:339-47.
- Lozito A, Vinci V, Talerico E, et al. Review of Tuberous Breast Deformity: Developments over the Last 20 Years. Plast Reconstr Surg Glob Open 2022;10:e4355. [Crossref] [PubMed]
- Klinger M, Caviggioli F, Giannasi S, et al. The Prevalence of Tuberous/Constricted Breast Deformity in Population and in Breast Augmentation and Reduction Mammaplasty Patients. Aesthetic Plast Surg 2016;40:492-6. [Crossref] [PubMed]
- Forlini V, Franchelli S, Romanini MV. Tuberous Breast and Poland Syndrome: An Underestimated Association? Eur J Pediatr Surg 2025;35:9-14. [Crossref] [PubMed]
- Alvaro AI, Willet JW, Dounas GD, et al. A Systematic Review of Outcomes and Complications of Tuberous Breast Surgery. Aesthet Surg J 2023;43:NP1001-9. [Crossref] [PubMed]
- Surcel ES, Merkkola-von Schantz PA, Öhman H, et al. Long-term results of the tuberous breast: What to expect after the primary correction process? Scand J Surg 2024;113:246-53. [Crossref] [PubMed]
- Gentile P. Tuberous Breast, Deformities, and Asymmetries: A Retrospective Analysis Comparing Fat Grafting Versus Mastopexy and Breast Implants. Aesthetic Plast Surg 2023;47:1683-94. [Crossref] [PubMed]
- Moltaji S, Hoffbauer S, Brown MH. Large-Volume Fat Grafting to the Breast With External Expansion Assist. Aesthet Surg J 2023;43:NP401-12. [Crossref] [PubMed]
- Abboud MH, Abboud NM, El Hajj H. A Novel Approach for Tuberous Breast Correction Using Power-Assisted Liposuction, Loops, and Lipofilling (PALLL). Aesthet Surg J 2022;42:NP613-29. [Crossref] [PubMed]
- Papadopoulos S, Colpaert SDM, Goulis DG, et al. Treating Anisomastia and Tuberous Breast with Fat Grafting: Technique and Evaluation of Outcomes Using BREAST-Q Surveys. Aesthetic Plast Surg 2021;45:2729-41. [Crossref] [PubMed]
- Andjelkov K, Music N, Mosahebi A, et al. Management of Nipple-Areola Deformity. Aesthetic Plast Surg 2021;45:1407-15. [Crossref] [PubMed]
- Gentile P. Breast Silicone Gel Implants versus Autologous Fat Grafting: Biomaterials and Bioactive Materials in Comparison. J Clin Med 2021;10:3310. [Crossref] [PubMed]
- di Summa PG, Osinga R, Sapino G, et al. Fat grafting versus implant-based treatment of breast asymmetry, a single surgeon experience over 13 years: a paradigm shift? Gland Surg 2021;10:1920-30. [Crossref] [PubMed]
- Bonomi R, Johnson M, Toussoun G. Refining aesthetic approaches to tuberous breast using combined minimally invasive approaches to treat moderate asymmetric tuberous breast. J Surg Case Rep 2020;2020:rjaa373. [Crossref] [PubMed]
- Gutierrez-Ontalvilla P, Naidu NS, Blanco EL, et al. Autologous Fat Grafting with Percutaneous Fasciotomy and Reduction of the Nipple-Areolar Complex for the Correction of Tuberous Breast Deformity in Teenagers. Aesthetic Plast Surg 2020;44:264-9. [Crossref] [PubMed]
- Rigotti G, Chirumbolo S. Biological Morphogenetic Surgery: A Minimally Invasive Procedure to Address Different Biological Mechanisms. Aesthet Surg J 2019;39:745-55. [Crossref] [PubMed]
- Claudio Silva-Vergara C, Fontdevila J, Weshahy O. Fat Grafting Technique, A Paradigm Shift in the Treatment of Tuberous Breast. World J Plast Surg 2018;7:72-7.
- Tenna S, Cagli B, Brunetti B, et al. Management of Tuberous Breast Deformities: Review of Long-term Outcomes and Patient Satisfaction with BREAST-Q. Aesthetic Plast Surg 2017;41:1249-58. [Crossref] [PubMed]
- Brault N, Stivala A, Guillier D, et al. Correction of tuberous breast deformity: A retrospective study comparing lipofilling versus breast implant augmentation. J Plast Reconstr Aesthet Surg 2017;70:585-95. [Crossref] [PubMed]
- Klit A, Siemssen PA, Gramkow CS. Treatment of congenital unilateral hypoplastic breast anomalies using autologous fat grafting: A study of 11 consecutive patients. J Plast Reconstr Aesthet Surg 2015;68:1106-11. [Crossref] [PubMed]
- Delay E, Guerid S. The Role of Fat Grafting in Breast Reconstruction. Clin Plast Surg 2015;42:315-23. vii. [Crossref] [PubMed]
- Derder M, Whitaker IS, Boudana D, et al. The use of lipofilling to treat congenital hypoplastic breast anomalies: preliminary experiences. Ann Plast Surg 2014;73:371-7. [Crossref] [PubMed]
- Ho Quoc C, Sinna R, Gourari A, et al. Percutaneous fasciotomies and fat grafting: indications for breast surgery. Aesthet Surg J 2013;33:995-1001. [Crossref] [PubMed]
- Delay E, Sinna R, Ho Quoc C. Tuberous breast correction by fat grafting. Aesthet Surg J 2013;33:522-8. [Crossref] [PubMed]
- Del Vecchio DA, Bucky LP. Breast augmentation using preexpansion and autologous fat transplantation: a clinical radiographic study. Plast Reconstr Surg 2011;127:2441-50. [Crossref] [PubMed]
- Coleman SR, Saboeiro AP. Fat grafting to the breast revisited: safety and efficacy. Plast Reconstr Surg 2007;119:775-85; discussion 786-7. [Crossref] [PubMed]
- Gentile P. Modified peri-areolar mastopexy and fat grafting in complex breast ptosis: A randomized open-label controlled trial. J Plast Reconstr Aesthet Surg 2024;98:190-200. [Crossref] [PubMed]
- Petit JY, Maisonneuve P, Rotmensz N, et al. Fat Grafting after Invasive Breast Cancer: A Matched Case-Control Study. Plast Reconstr Surg 2017;139:1292-6. [Crossref] [PubMed]
- Report on autologous fat transplantation. ASPRS Ad-Hoc Committee on New Procedures, September 30, 1987. Plast Surg Nurs 1987;7:140-1.
Cite this article as: Sørensen RBA, Chakari W, Thomsen JB. Fat grafting for correction of tuberous breast: a narrative review. Ann Breast Surg 2025;9:33.
