By Leora Acoca Goldberg — founder OptimalBody New York and host of Living Life with Leora
What is fat grafting? Fat grafting is a technique in which a surgeon harvests a patient’s own fat through liposuction and reinjects it to add volume, correct contour irregularities, or refine results after breast surgery. Because it uses the patient’s own tissue rather than an implant or foreign material, it’s one of the most reliable tools available for women recovering from explant surgery — used to correct congenital asymmetries, supplement a breast lift, or restore volume for patients who have had implants removed entirely.
I sat during my interview with Dr. Randall Feingold, co-founder of NYBRA (New York Breast Reconstruction and Aesthetic Plastic Surgery), and asked him a question that comes up constantly among women recovering from explant surgery: what can be done using a patient’s own body, without introducing another foreign material? His answer, again and again, was fat grafting — a technique he’s used across a wide range of patients for years, well beyond any single category of surgery.
Key takeaways:
- Fat grafting uses a patient’s own tissue, so the body doesn’t react to it as a foreign object the way it can with implants.
- Dr. Randall Feingold often performs the first round of fat grafting during the explant surgery itself, avoiding a separate trip to the OR and anesthesia.
- A second round can be added later if more volume or refinement is wanted, once the tissue has healed.
- The amount of fat that can safely be added per session is limited by blood supply, not by patient preference.
- Newer cadaver-derived alternatives (like AlloClay) lack the long-term safety data traditional fat grafting has built over decades.
A Tool With Many Applications
One of the things that stood out most in the conversation is how broadly Dr. Randall Feingold applies fat grafting in his practice. It isn’t a niche technique reserved for one type of patient. “My background using fat grafting in cases of young girls with congenital asymmetries of the breast, and in women that want small volume augmentations without implants, and supplementing breast lift” spans several very different patient populations, he explained — from adolescents with developmental breast asymmetry, to women who want modest volume changes without committing to an implant, to women recovering from explant surgery who want their post-surgical breast refined and smoothed.
That range of experience shapes how he thinks about the technique overall. “I use it for a lot of different indications in my practice,” he said, “not just back-filling explanted patients.” For women recovering from explant surgery specifically, fat grafting is commonly used to refine contour after the implant and capsule are removed — smoothing irregularities, softening loose or uneven areas, and adding subtle shape where a breast lift alone doesn’t fully restore it. It’s this refinement role, more than any single dramatic use, that makes fat grafting such a routine part of comprehensive explant recovery.
Should Fat Grafting Be Done During Explant Surgery?
One detail that surprises many women researching this: Dr. Randall Feingold often performs a first round of fat grafting during the explant surgery itself, rather than making patients wait months to return for a separate procedure. This approach spares patients an additional trip to the operating room and another round of anesthesia — a meaningful consideration for anyone who has already been through significant surgery and recovery.
If a patient wants further refinement after healing — more volume, better symmetry, or a fuller final shape — Dr. Randall Feingold can perform a second round of fat grafting once the tissue has settled. This staged approach, first round at the time of explant and a second round later if needed, lets patients avoid an extended stretch of time with a breast that hasn’t yet reached its final shape.
I can speak to this directly, because I went through it myself. As a patient of Dr. Randall Feingold, I had two rounds of fat grafting after my own explant to achieve the shape and fullness I wanted. Looking back, I believe that having the first round done at the time of my explant — rather than waiting six to twelve months with breasts that likely would have looked deflated or empty in the interim — was the better choice for me, both emotionally and psychologically. Recovering from explant surgery is already a vulnerable time, and not having to look at an unfinished result for the better part of a year made a real difference in how I felt during that healing period.
The Real Limiting Factor: Blood Supply
Whatever the reason a patient is undergoing fat grafting, the underlying biology is the same, and Dr. Randall Feingold was direct about the central constraint: transplanted fat needs a healthy blood supply to survive, and there’s a hard ceiling on how much can be added in a single session. “You cannot overfill a breast,” he said. “You’ll overwhelm its capacitance, and all of it will die if you put too much in and pass a certain threshold.”
This is why fat grafting is often staged — smaller, conservative volumes added over more than one session rather than one large transfer — particularly in a breast that’s still healing from explant surgery. Overfilling in a single attempt is the most common cause of fat necrosis, a complication where transplanted fat cells die from inadequate blood supply, so the technical goal is always to work within what the tissue can actually support during recovery.
The Art and Science Behind Fat Grafting
Dr. Randall Feingold described a fairly specific technical approach that reflects how much this field has matured. He harvests fat using ultrasonic liposuction with very small cannulas, a method designed to preserve fat cell viability during collection rather than damaging it. In some patients, he adds growth factors back into the graft — taken either from the patient’s own blood or from the processing of the fat itself — specifically to improve how much of the transplanted fat survives long-term.
“There’s its own art and science to doing fat grafting,” he said, and he was candid that the field’s early years didn’t always produce reliable results. Some of that early inconsistency created hesitancy among both surgeons and patients, but he described that hesitancy as fading steadily as more practitioners dedicate themselves to refining the technique. The result, in his experience, is a much more predictable, much safer procedure than it was even several years ago.
Importantly, Dr. Randall Feingold said fat grafting is never something he pushes on a patient. It’s presented as one of several options for optimizing outcomes after explant — whether that’s alongside a lift, or on its own. “We simply let them know these are options for aesthetic optimization,” he said. “We don’t pressure patients, and we only want to do what they’re comfortable doing.”
What About New Fat Alternatives Like AlloClae?
Part of the conversation turned to a newer product being marketed for quick, in-office fat augmentation using processed cadaver fat rather than a patient’s own tissue. Dr. Randall Feingold had recently reviewed the evidence in depth, having spoken on the topic at an American Society of Plastic Surgeons Patient Safety Committee meeting. He described the material as cadaver-derived and thermally sterilized, with a claimed shelf life of six to twelve months, and noted that the evidence supporting it so far is largely physician observation rather than rigorous, long-term study. Surgeons have seen the material retain volume for a year or more in some patients, he said, but there isn’t yet biopsy or histology data tracking what happens to it in the tissue over time.
For breast tissue specifically, where ongoing imaging and cancer screening are critical, Dr. Randall Feingold was cautious about how a novel filler material might affect long-term surveillance. “I just don’t think we want to take chances and cause problems for another generation of women because this wasn’t extensively studied,” he said, noting that because it’s classified as a tissue transplant rather than a synthetic device or pharmaceutical, it doesn’t go through the same FDA premarket approval process. In his words, its use in practice right now is “way ahead of its understanding.” Traditional fat grafting, using a patient’s own tissue and with decades of accumulated surgical experience behind it, remains the far better-studied option for women recovering from explant surgery.
GLP-1 Medications and Healing
One increasingly common question Dr. Randall Feingold gets involves GLP-1 medications and how they affect surgical healing and fat graft survival, particularly for explant patients considering fat grafting during recovery. He noted that patients on these medications typically need to pause them before surgery because of anesthetic risk, and that there’s a growing appreciation among surgeons that these patients need to prioritize protein intake to heal properly — and may need to delay restarting the medication for several weeks after surgery. He was candid that surgeons don’t yet have a fully standardized protocol for managing this, since the widespread use of GLP-1 medications in surgical patients is still a relatively recent development.
Why This Matters for Recovery
For women recovering from explant surgery, fat grafting is frequently part of a comprehensive recovery plan, not an afterthought. It’s used to smooth contour irregularities, correct asymmetry, and fine-tune the final result using tissue that’s already the patient’s own. Whether a patient is a year removed from her explant and looking to restore some volume, or still deciding how much correction she wants alongside her lift, the same principles apply: conservative volume, attention to blood supply, and a surgical approach built around what the individual patient’s tissue can actually support at that stage of healing.
As Dr. Randall Feingold put it, the goal is never to oversell the technique or its speed. It’s to apply real surgical judgment, patient by patient, to a tool that — when used conservatively and with the right technique — offers one of the safest and most natural ways to refine a breast during recovery, using material the body already recognizes as its own.
This article is based on a recorded conversation with Dr. Randall Feingold, co-founder of NYBRA (New York Breast Reconstruction and Aesthetic Plastic Surgery), and written by Leora Coca Goldberg — founder of Optimal Body New York and host of Living Life with Leora — drawing on her own experience as a patient of Dr. Feingold. It is intended for general educational purposes and is not a substitute for a one-on-one consultation about your individual anatomy, health history, and recovery goals.
For more on fat grafting techniques, candidacy, and recovery, visit NYBRA’s fat grafting resources.