Breast · Procedure
There are three ways to add volume to a breast, and the honest version of this consultation is not a preference test. Fat, a silicone implant, or both together. Which of them will work on you is largely settled before you say what you want, by how much of your own tissue there is to cover what is placed beneath it.
Over six thousand breast operations sit behind this page. What that experience mostly buys is not a favourite technique — it is the ability to say early which route your anatomy will not support, and to say it before you have booked a flight.
The Decision
Every route below produces a larger breast. They differ in how much larger, how it feels, how visible the change is to someone who is not looking for it, and what happens over the following decade. Read the last column first.
| Route | What it does well | What it cannot do |
|---|---|---|
| Condense Rich fat transfer ¥1,320,000 |
Your own tissue, so it feels like breast rather than like a device. No implant to replace later. The donor area is improved at the same time, so the silhouette changes in two places. Best for a modest, natural increase and for correcting shape and asymmetry. | It cannot deliver a large increase in one session, it cannot be promised as a specific final volume, and it cannot be done at all without enough donor fat. Roughly two fifths of what is injected does not survive. |
| Silicone implant ¥880,000 |
A defined, predictable volume, chosen in advance and delivered on the day. The most reliable route to a substantial increase, and to projection that a thin patient’s own tissue could never supply. | It cannot become permanent. It is a device with a service life, and roughly a third of patients have undergone a further operation by ten years. It cannot hide itself where soft-tissue cover is thin. |
| Hybrid ¥1,650,000 |
A smaller implant for reliable volume, with fat laid over the upper and inner pole to soften the edge. In a matched comparison of 932 cases it scored significantly better than implant alone for implant visibility and palpability, upper-pole contour and softness, with implant-related complications at a similar rate. | It cannot remove the implant from the equation. Every implant consideration on this page still applies, and you add the graft’s considerations to them. |
Fees are surgical fees in Japanese yen including consumption tax. General anaesthesia, the standard post-operative set and blood tests are additional. The full schedule is further down this page.
Selection
The measurement that governs this operation is the thickness of the soft tissue you can pinch at the upper pole of the breast. It is unglamorous and it is close to decisive, because an implant is only as invisible as the tissue lying over it. Where that layer is thin, the upper edge of the device will eventually be seen or felt, and no choice of manufacturer changes that.
The tissue-based approach that underpins modern implant planning was set out in a 2005 paper describing more than 2,300 primary augmentations. In the reported series of 1,664 cases with up to seven years of follow-up, the overall reoperation rate was 3 per cent, with 0.2 per cent for implant size exchange.
That is a single-surgeon, self-reported figure and it is far better than the population figures further down this page — which is exactly the point being made. The gap between 3 per cent and the 31.5 per cent ten-year reoperation rate reported in a manufacturer core study is not mostly a gap in devices. Much of it is the difference between choosing an implant to fit the tissue and choosing one to fit a request.
Route One
Fat is harvested by liposuction, condensed to remove fluid and oil, and placed in many fine passes across several planes so that each parcel of graft sits close to a blood supply. The technique is the same one described on the UGRAFT page, where the imaging and the safety reasoning behind it are set out in full.
The number that matters is retention, and it is not high. A systematic review of 22 studies and 3,565 patients found mean volume retention of 62.4 per cent, with individual studies ranging from 44.7 to 82.6 per cent. A more recent review of 35 studies and 3,757 women put the average at 58 per cent, ranging from 44 to 83 per cent, and titled itself around the need for clinical caution. Plan on losing something in the order of two fifths of what is placed.
Grafting changes what a mammogram looks like. In a published radiographic series, microcalcifications were seen in 16 per cent and macrocalcifications in 9 per cent after fat transfer, with well-defined cystic lesions in 25 per cent — while breast density and BI-RADS category did not differ significantly before and after in the paired comparison. Experienced breast radiologists distinguish these appearances from suspicious ones; the practical requirement is that whoever reads your imaging is told you have had fat grafting.
On cancer risk itself, the strongest evidence comes from reconstruction after breast cancer: a meta-analysis of nine matched cohorts and 4,247 subjects found no significant difference in locoregional recurrence (incidence rate ratio 0.92). We are not aware of an equivalent large cohort in healthy cosmetic patients, and would rather say so than present reconstruction data as though it answered a different question. Screening on the normal schedule for your age remains necessary either way.
Route Two
A silicone gel implant delivers a volume you choose in advance. It is the most predictable route to a substantial increase, and for a thin patient wanting real projection it is often the only route. What follows is the part of the conversation that tends to be compressed into a sentence elsewhere.
An implant is a device, and devices are replaced. In a ten-year manufacturer core study of 1,788 patients, rupture had occurred in 8.6 per cent of patients, Baker grade III or IV capsular contracture in 13.5 per cent, and 31.5 per cent had undergone a reoperation. More than half of those reoperations were for cosmetic reasons rather than complications — a change of style or size. In a second core study of 715 subjects, 81.8 per cent of augmentation patients still had an original implant in place at ten years.
The largest dataset available, an FDA post-approval analysis of 99,993 patients, gives a seven-year reoperation rate of 11.7 per cent for primary augmentation and capsular contracture in 7.2 per cent. In the same dataset, compliance with recommended long-term MRI surveillance for silent rupture was under 5 per cent, which is worth knowing before you are told that surveillance is straightforward.
General principles
Subglandular placement sits the implant directly under the breast; subfascial adds the pectoral fascia as cover; dual plane and submuscular place part or all of it under the muscle. Deeper pockets give more cover and, in the core study data, lower capsular contracture — 15.7 per cent submuscular against 26.3 per cent subglandular in one, and 3.9 against 6.75 per cent in another. A meta-analysis favoured subfascial over subglandular for haematoma, rippling and capsular contracture, while noting that every included study carried a high risk of bias. Muscle-covered pockets can produce visible movement of the breast on contraction; we are not aware of reliable comparative figures for how often, and will not invent one.
General principles
Textured surfaces were introduced to stabilise position and reduce contracture. They are now inseparable from the lymphoma question below, and the balance of that question has moved decisively. Any surface discussion today is a risk discussion first and a positioning discussion second.
General principles
Round devices distribute volume evenly and are indifferent to rotation. Anatomical devices concentrate volume low, which suits some chests, at the cost of caring where they sit. In thin patients the choice matters less than the cover over whichever is chosen.
General principles
The inframammary fold gives the most direct access and the most controlled pocket, with a scar in the crease. Periareolar hides the scar at a colour border, at the cost of crossing breast tissue. Axillary leaves nothing on the breast at all and gives the least direct control of the lower pocket. Each is a genuine trade-off rather than a ranking.
Which device, which pocket and which incision are proposed for you is decided at consultation from your measurements and discussed before anything is booked. We do not publish a single recommended combination, because a page cannot examine you.
Implant safety
A rare lymphoma of the capsule around an implant, strongly associated with textured surfaces and generally curable when caught early. It is not breast cancer. The risk figures vary by device and by study, and the range is wide enough that a single number would be misleading:
An Australian longitudinal study of 104 cases estimated risk from 1 in 1,947 for one polyurethane device to 1 in 36,730 for an imprinted textured device, with a mean of 6.8 years from implantation to diagnosis and 87.5 per cent presenting at stage 1. A prospectively followed reconstruction cohort of 3,546 women with macro-textured implants reported 1 in 355. A cosmetic augmentation cohort of 1,501 patients reported a prevalence of 1 in 300, with 6.9 cases per 1,000 for one textured device against 1.3 per 1,000 for another. Risk accumulates with years of exposure, which is why cohorts followed longer report higher figures.
A separate and much rarer entity, breast implant-associated squamous cell carcinoma, has been described in 16 reported cases worldwide at the time of the review cited, presenting a mean of 23.6 years after the first implant and occurring with textured and smooth devices alike. There is no denominator for it, so no rate can honestly be quoted.
Some women with implants report fatigue, joint pain, cognitive symptoms and others, and report improvement after removal. The evidence is genuinely unsettled and we will not resolve it for you in either direction.
The FDA post-approval analysis of 99,993 patients found higher-than-expected rates of several autoimmune conditions in silicone implant recipients, and stated that patient-level data would be needed to be conclusive. A qualitative systematic review of 86 papers found two cohort studies suggesting a roughly two-fold increase in systemic sclerosis risk while three case-control studies showed none, and no support for an association with lupus. A prospective blinded study of 150 patients found that 88 per cent reported at least partial symptom improvement one year after explantation, irrespective of the type of capsulectomy — while its own biospecimen analyses found no consistent differences between groups, and its authors raised a nocebo effect as a possible contributor.
What that adds up to: symptoms are real and often improve after removal; a biological mechanism has not been demonstrated; and a patient who is anxious about this should factor it into the decision rather than be reassured out of it.
Route Three
A smaller implant supplies volume that fat cannot reliably deliver. Fat laid over the upper and inner pole supplies cover that the patient does not have. The combination exists because the two routes fail in opposite directions.
The best available comparison is a single-centre study of 932 cases — 302 hybrid, 353 implant-only, 277 fat-only — with propensity-score matching and a mean follow-up of 31.7 months. Against implant alone, hybrid scored significantly better for implant visibility and palpability, upper-pole contour, softness and overall satisfaction, with implant-related complications at a similar rate. Against fat alone, hybrid scored significantly better for shape and symmetry and had a lower incidence of palpable cysts, fat necrosis, oil cysts and calcification.
Where the fat goes is not left to judgement in the moment. A published standardisation divides the region between the implant and the clavicle and parasternal area into three zones and estimates the graft volume for each from the implant volume. In a series applying that approach with small implants in slim patients — mean body mass index 19.3, mean implant 180 cc, mean 125 cc of fat per breast — graft retention at one year was roughly 73 to 77 per cent, with localised oil cysts in 8 per cent of breasts and no rippling or malposition observed.
That retention figure is well above the pooled figures quoted in the fat transfer section. Small volumes placed over a firm base, in a very small single-surgeon series, are close to the best case — not the average one.
Candidacy
A history of breast cancer, a strong family history, or a current finding on imaging does not automatically rule anything out, but it changes the assessment and sometimes the order of operations. Tell us at the enquiry stage rather than on the day.
The Operation
Recovery
Evidence
The least flattering figures are included deliberately. There is no randomised trial comparing fat transfer against an implant for primary cosmetic augmentation, and anyone who tells you the question is settled is describing a preference.
| Study | Finding |
|---|---|
| Systematic review of fat grafting in cosmetic breast augmentation, 22 studies, 3,565 patients | Mean volume retention 62.4 per cent (range 44.7–82.6). Pooled complication rate 17.2 per cent. Microcalcifications on mammography in 9.0 per cent, macrocalcifications in 7.0 per cent. Patient satisfaction 92 per cent. |
| Systematic review of fat grafting in breast augmentation, 35 studies, 3,757 women | Average retention 58 per cent (range 44–83). Overall complication rate 27.8 per cent, with fat necrosis accounting for 43.7 per cent of complications. Included studies carried a moderate risk of bias. |
| Ultrasound follow-up of fat transfer, 100 patients, 167 breasts, at three months | Palpable nodules in 12.6 per cent of breasts. Hypoechoic cysts visible on ultrasound in 49.7 per cent. Number of grafting sessions correlated positively with fat necrosis. |
| Ten-year manufacturer core study, 1,788 patients, 3,506 implants | Rupture 8.6 per cent by patient, Baker III/IV capsular contracture 13.5 per cent, reoperation 31.5 per cent. More than half of reoperations were for cosmetic reasons. |
| FDA post-approval analysis, 99,993 patients | Seven-year reoperation 11.7 per cent for primary augmentation; capsular contracture 7.2 per cent. Higher-than-expected rates of several autoimmune conditions were observed, which the authors state require patient-level data to be conclusive. Long-term MRI surveillance compliance was under 5 per cent. |
| Australian longitudinal study of BIA-ALCL, 104 cases | Risk from 1 in 1,947 for one polyurethane device to 1 in 36,730 for an imprinted textured device. Mean 6.8 years from implantation to diagnosis; 87.5 per cent presented at stage 1; 70 per cent had had primary cosmetic augmentation. |
| Cosmetic augmentation cohort with textured devices, 1,501 patients | BIA-ALCL prevalence 1 in 300; 6.9 cases per 1,000 for one textured device against 1.3 per 1,000 for another; mean event-free time 9.2 years. |
| Propensity-matched comparison of hybrid, implant-only and fat-only augmentation, 932 cases | Hybrid scored significantly better than implant alone for implant visibility and palpability, upper-pole contour, softness and overall satisfaction, with implant-related complications at a similar rate; and better than fat alone for shape and symmetry, with fewer palpable cysts, fat necrosis, oil cysts and calcification. |
| Meta-analysis of oncologic safety of fat grafting in breast reconstruction, nine matched cohorts, 4,247 subjects | No significant difference in locoregional recurrence (incidence rate ratio 0.92, 95 per cent confidence interval 0.68–1.26). Note that this population is reconstruction after cancer, not healthy cosmetic augmentation. |
These figures describe published study populations authored by others. They do not describe results at this practice and are not a prediction of your individual outcome. Full citations are listed at the foot of this page.
Fees
| Procedure | Fee (JPY, incl. tax) |
|---|---|
| Fat transfer augmentation, Condense Rich (2 donor areas) | ¥1,320,000 |
| Fat transfer augmentation, second session | ¥990,000 |
| Silicone implant augmentation | ¥880,000 |
| Hybrid augmentation (fat transfer with implant) | ¥1,650,000 |
| Fat transfer with implant removal | ¥1,540,000 |
| Implant removal | ¥385,000 |
| Décolletage fat grafting | ¥660,000 |
| Additional | |
| General anaesthesia | ¥165,000 |
| Standard set (anaesthetic, medication, compression garment) | ¥66,000 |
| Blood tests | ¥11,000 |
| 3D simulation | ¥3,300 |
All figures are standard prices, not monitor prices. Where a breast lift is combined with augmentation it is charged separately; those fees are on the mastopexy page. Your written quotation is the binding figure and is issued before you book travel. See the full fee schedule and process for international patients.
Guarantee
Condense Rich fat transfer breast augmentation carries a guarantee for one year after surgery. It covers re-examination by your operating surgeon at no consultation charge, post-operative treatment, and adjustment where you wish it and the operating surgeon judges it appropriate from six months onwards, once volume has settled.
Implant augmentation is not covered by that guarantee. An implant is a regulated device that carries its own manufacturer warranty terms, which are separate from anything this practice offers and which are explained to you as part of consent for the specific device proposed. We would rather set that out here than let you assume the two are the same thing.
Being outside Japan does not void the guarantee, but making use of it means returning to Japan. Please plan on that basis.
Risks
This is elective surgery, it is not covered by health insurance in Japan, and its outcome cannot be guaranteed.
Questions
Neither, as a general statement. Fat gives a smaller, softer, less predictable increase using your own tissue and improves the donor area at the same time. An implant gives a defined volume reliably but is a device with a service life. The choice is made from how much soft tissue you have to cover an implant, how much donor fat you have available, and how large an increase you actually want. There is no randomised trial comparing the two for primary cosmetic augmentation, so anyone who answers this question in the abstract is describing a preference.
Published averages are 58 to 62 per cent, with individual studies ranging from about 44 to 83 per cent. Plan on losing roughly two fifths of what is placed. Retention is not directly comparable between clinics because it is measured differently, and it cannot be promised in advance by anyone.
With fat, a second session is planned for rather than treated as a failure, and is priced at ¥990,000. With an implant, further surgery at some point is likely: in a ten-year core study, 31.5 per cent of patients had undergone a reoperation, and more than half of those were for a change of size or style rather than for a complication. If the prospect of further surgery is unacceptable to you, an implant is the wrong choice.
There is no fixed expiry date, and routine replacement at a set interval is not required. What the data shows is attrition: rupture had occurred in 8.6 per cent of patients at ten years in one core study, and 81.8 per cent of augmentation patients in another still had an original implant in place at ten years. Treat an implant as something you will probably deal with again, at an unpredictable time.
It is a rare lymphoma of the capsule around an implant, strongly associated with textured surfaces and usually curable when found early. It is not breast cancer. Reported risk ranges from about 1 in 300 in one cosmetic cohort with textured devices to 1 in 36,730 for one imprinted textured device in a national study, with risk accumulating over years of exposure. It is a reason to discuss surface texture seriously and to investigate any late swelling around an implant promptly, rather than a reason to abandon implants.
Symptoms reported by patients are real, and improvement after removal is documented: in a prospective blinded study, 88 per cent of patients reported at least partial improvement one year after explantation. What has not been demonstrated is a biological mechanism, and the same study found no consistent differences in its biospecimen analyses and raised a nocebo effect as a possible contributor. Large registry data has found higher-than-expected rates of some autoimmune conditions, which the authors themselves describe as not conclusive. If this concerns you, it is a legitimate reason to choose fat rather than an implant.
Both implants and grafted fat change the appearance of breast imaging, and both make it more important, not less, that screening continues on the normal schedule for your age and that whoever reads it knows what you have had. After fat grafting, calcifications and cysts are commonly seen; experienced breast radiologists distinguish these from suspicious findings. Evidence that fat grafting does not increase cancer recurrence comes from reconstruction patients rather than from healthy cosmetic patients, and we would rather tell you that than present it as a settled answer to a different question.
Often, yes, and where the nipple has descended it is frequently the only way to get the result you actually want, because volume alone does not lift. Combining the two in one operation asks more of the tissue than either alone, so whether it is done together or in stages is decided from your skin quality and the degree of descent.
This is the constraint that surprises people most often. A very slim patient frequently has the strongest aesthetic argument for fat and the least of it available. Two donor areas are included in the standard fat transfer fee, and whether they will yield enough for the increase you want is assessed at consultation. Where the answer is no, an implant or a hybrid is the honest alternative.
Plan for at least two weeks after surgery. That covers the early phase and at least one in-person follow-up before you are cleared to fly. Your arrival date before surgery is set separately in your written plan.
Condense Rich fat transfer augmentation is ¥1,320,000 including tax, with a second session at ¥990,000. Silicone implant augmentation is ¥880,000 and hybrid augmentation is ¥1,650,000. General anaesthesia, the standard post-operative set and blood tests are additional. Your written quotation states the total and is issued before you book travel.
Condense Rich fat transfer breast augmentation is. Implant augmentation is not; an implant is a regulated device carrying its own manufacturer warranty terms, which are separate from anything this practice offers and are explained as part of consent for the specific device proposed.
References
Retrieved from PubMed. The figures quoted above come from these studies, which describe study populations authored by others rather than results at this practice.
Next
The consultation is held online, in English, before you commit to any travel. You will be told which of the three routes your measurements actually allow — including, where it applies, that the increase you have in mind is not available without an implant, or not available at all.