Breast augmentation with dermal fillers | Ask A Surgeon

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Recently, a friend sent me a link with an interesting promise.

"Nonsurgical breast augmentation. No downtime!"

So I decided to check it out.

The link featured a woman with beautifully enhanced breasts (lacking any before and after photos and clearly using a stock image) and claimed that hyaluronic acid (HA) fillers could be used for breast augmentation. It also mentioned the results last 18-24 months and that "cost varies."

The company promotes itself as the leading Hyaluronic Acid Breast Filler provider. They offer a comprehensive range of products to meet all needs, supported by a highly specialized staff.

However, I had to set my friend straight. Even a modest breast augmentation involves at least 150cc. In my practice, breast implants can reach up to 400cc.

• On average, the breast implant sizes I use range between 250-350cc. Considering a syringe of HA filler is just 1cc, that would mean using 150 syringes. At $800 per syringe, this method would be exorbitantly expensive. I find it hard to believe this is the practical approach.

• The ads claim the filler lasts 18-24 months. However, most HA fillers endure a mere 6 months, with some stretching up to a year. What specific HA filler are they using to achieve such longevity? Although some, like Voluma or RH4, suggest they last that long, I often find the actual duration to be less. While there are exceptional cases that last longer, they are rare.

This concept of a "noninvasive, no downtime breast augmentation" with fillers reminds me of the similar "noninvasive, no downtime fillers for the buttocks" using Sculptra injections. Sculptra might be a better option for large volume areas since it can provide more volume and lasts longer. But, like with Sculptra in the buttocks, which lasts 18-24 months and demands a significant amount (costing thousands of dollars), I wouldn't recommend it. Injecting Sculptra into the breast can trigger collagen stimulation resulting in scar tissue, complicating breast cancer screening with mammograms and MRIs. Plus, the cost is prohibitive.

In conclusion, I advised my friend to consider either a fat transfer to the breast (suitable for those with loose skin and sufficient fat to harvest for a modest augmentation) or opt for traditional breast implants. Despite receiving some bad press (much of which is justified), breast implants remain a viable option if one fully understands biofilm, breast implant illness, and ways to mitigate these risks, along with the other associated risks.

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