Trish: Okay, we’re back on. I’m really sorry, that was my fault because my iPhone got hot. So, I’ll just invite Dr Kalus on again. And okay. So, hopefully, Dr Kalus, you’ll see me, you’ll see that little invite again?

Dr Kalus: Yes, following, follow.

Trish: You have to accept that little invite again and then I’ll press okay.

Dr Kalus: Okay.

Trish: Awesome. Awesome. So we are back on.

Dr Kalus: Okay.

Dr Allan Kalus

Dr Allan Kalus

Trish: Sorry about that, it’s really funny, what actually happened is my phone got hot, so it said emergency only, so I had it backed up against the computer, so sorry about that. Steph and any of the other admins, if you can let the ladies know that we are back on, but they’ll have to refresh their screen and it will go into another post, as opposed to the post that we were. So hopefully the admin girls have picked that up, and they can see that we’re on again. Bear with me a sec, I’ll just switch this off. Put that on mute. Okay, great, all right.

So, I’ll ask you the next question, then.

Dr Kalus: What was I up to, Trish, when we were cut off?

Trish: We were up to:

How big can a patient go with breast fat transfer, how many cup sizes can increase, the second operation, and how much the second operation costs.

Dr Kalus: Okay. So, I may be repeating part of it, but the second operation is about two-thirds of the cost of the original operation. You know, most people go up about one, one and a half cup sizes. We have gone as high as three, but not everyone will be able to achieve that. But it’s interesting, you know, with breasts it’s not all about size, and I think breast implants have made us very greedy about breast volume, because you can choose virtually any volume you want. But when breast implants first were introduced, we used to put in about 160mls. Then I remember 200mls was a big implant to put in, which is about what we do with fat transfer. But then of course we were able to put 225, 250, I remember a surgeon say that he would never put in more than 300mls because of all the stretching of the breast tissue and the complications, but we’ve gone through 300, 350, 400. One of the surgeons at our clinic put in a 700cc implant the other day.

Trish: Wow.

Dr Kalus: Wow. And someone rang wanting a 900cc implant. And they just want that very stylized look, and women think, they just want these huge breasts that really just look silly. But really, breasts don’t have to look like that. There are a lot of articles now in the women’s magazines which say that B is the new beautiful in breast size. For a woman who’s slim and athletic, a nice, full B. So long as they’ve got a bit of cleavage, a little bit of upper pole fullness, and women find that after they’ve had their family and they’ve breastfed, they often lose just that little bit of volume, that little bit of [inaudible 00:03:46] of the breast, and that’s ideal, because fat will replace that exactly. It will exactly replace that. And many women say to me afterwards, you know, “I feel exactly how I was before I had children. And sure, I’d like to be larger, what woman wouldn’t like to be larger? But I feel I’m restored to how I was.” So I’m beginning to see fat transfer now as a replenishing procedure, as a restorative procedure, a very natural procedure. And if a woman comes to me and says, you know, “I want 400cc implants,” I don’t even talk fat transfer.

Trish: Yeah. Makes sense. If you want that, you’re going to need to get implants. It’s just a nice, subtle, little bit. All right, let’s move on.

So can breast fat transfer help with tuberous or asymmetrical breasts?

Dr Kalus: Yes, in fact the very first case I did back in 2013 was exactly that. A girl with a breast asymmetry. And it was about almost a cup size asymmetry, so quite significant, but she didn’t want implants, and she was happy with her larger breast but just didn’t like the smaller breast. And I put I think 140mls of fat into her smaller breast, and the result was just as perfect as I could have hoped for, it was a perfect match to the other breast. Much better than I could achieve with an implant. So certainly for breast asymmetry, it’s the ideal way to correct it, and indeed if someone has an asymmetry and they want to go much bigger, and they want implants, rather than have two different implants I think they’re better off having a hybrid procedure where the asymmetry is corrected on the smaller side with a fat transfer and then the same size implants are put into each breast.

But tuberous breasts, they are fantastic. Tuberous breasts are a real problem with implants, the risk of a double bubble, you sometimes need to do a mastopexy or some sort of lift. And if you put fat into the crease around a tuberous breast, the whole breast becomes normal again, and it’s a wonderful operation for a tuberous breast.

Trish: Okay. I have seen some amazing results, recently actually one of our surgeons had some fantastic results through for tuberous breasts, and I’m pretty sure he did a little bit of fat transfer with it as well, I can’t remember, but I’ve seen some great results with implants too.

Dr Kalus: Correct.


Are there any risks with the breast fat transfer procedure?

Dr Kalus: So every operation carries risks, but you know, the risks are a lot less than with breast augmentation using implants. And in fact, all of those implant-associated risks, rippling and capsular contracture and leakage, and all those risks, are off the table with fat transfer. The one thing that we were most worried about, lumps in the breast, has proven not to really be such a common outcome. In fact, in our series now of over 400 procedures, it’s less than 3% of women get any lump that lasts more than the first two or three weeks. If a woman does get a lump in the breast, it’s usually a little cyst, a fatty cyst, which can be aspirated easily with a needle. And certainly an ultrasound and a mammogram will tell you that it is a fatty lump, so you just don’t need to worry and eventually it’ll go away.

It’s possible that women will get little micro-cysts in the breast after the procedure, cysts that we don’t even know about, not even palpable, but which may show up on a mammogram. And I discussed this specifically with a radiologist who runs breast screen in Victoria, and she said, “Look. These are clearly fat cysts. They’re very common in the breast. We see them after breast reductions and after breast biopsies.” And I said, “Is this a reason, perhaps, not to do fat transfer?” And she says, “Not at all. These are very minor changes, and we see much worse changes in women who’ve had breast implants.” So really, the changes to the breast, any negative change in terms of cysts seems to be very, very mild and not of any consequence.

Otherwise, the complication may relate to the donor site, because we’re struggling often to take fat from some areas, and what worries me is the possibility of getting a little hollow or an irregularity in the tummy or in the thigh after fat’s been taken from that area. We’ve very, very careful to avoid that possibility, but if it were to occur, you can just do a little fat graft into that area and smooth it out. So it’s not a major problem that can’t be corrected.

So really the risks with fat transfer are far, far less than with breast augmentation using implants.

Trish: Okay, all right.

So is the liposuction to graft the fat done at the same time as the breast fat transfer procedure?

Can you just give a bit of a run down about what the process is?

Dr Kalus: Yes. Obviously we do the fat harvesting first, and then the purification, and then the transfer to the breast all in the one procedure. The interesting question is whether some excess fat could be stored for use later on. I have actually tried this on behalf of another surgeon who’d had some fat stored and he asked me would I be so kind as to graft his stored fat into the patients. But my experience is that none of the stored fat survived. So I think the idea that you can take fat and freeze it and then hope to use it a few months down the track, at the moment that time hasn’t yet arrived for us. I think if you understand the fat cell, it’s a cell with a very, very thin membrane, which is the wall, surrounding a globule of fat. And that membrane can be so easily disrupted. In fact, in people who are obese, the fat cells are much larger, and they don’t survive as well as in a person who is thin, and the fat cells are small, and they transplant extremely well.

Trish: Yeah. And look, everybody knows that fat freezing gets rid of fat, so that’s not even an option.

Dr Kalus: Yeah, that’s right, well there you go.

Trish: Yeah.

So how does the costs of the breast fat transfer procedure compare with a breast augmentation with implants?

That’s probably a really hard question to answer, because the prices of implants vary.

Dr Kalus: The price of implants varies so much, you know, I think they vary from about $5,000.00 to about $50,000.00. I should imagine that’s the range of prices for implants. So I think most surgeons sit somewhere in between that range. Now with fat transfer, it does take longer because we have to harvest the fat and purify the fat, so there’s additional time in the operating theatre, which is charged by the half-hour. I think fat transfer in most surgeons’ hands is going to cost a little more than breast augmentation usually does, but the trick is to keep it not that much more by being very efficient with the procedure. That’s also what we’ve tried to do, to be efficient with it, so the price can be kept in the reasonable, affordable amount.

Trish: Yup. And also I suppose with the fat transfer you’re actually getting two procedures, you’re getting lipo.

Dr Kalus: Oh, absolutely.

Trish: So you’d think it would be more, and if I was getting breast implants for $5,000.00 I’d be pretty worried where I was going.

Dr Kalus: That’s true.

Trish: It’s probably a bit dearer than that, the starting point. So the next question is:

What are the scars that come with a breast fat transfer, and how do these compare to a breast augmentation with implants?

Dr Kalus: Okay, so there are different techniques for breast fat transfer, and some surgeons make little punctures all around the breast to put the fat in. We actually make just two little 3mm puncture wounds just next to the midline of the breast, and use just that one tiny, tiny, virtually it’s a needle prick, a 3mm wound to put the cannula in to graft fat. So that scars are, to my mind, almost negligible, and they heal very, very well. Compare that to a breast implant scar which is maybe 4cm or 5cm sometimes. But remember there are also some scars on the donor site, so the hips and the thighs, and to put the cannula in, it’s a scar which might be seven or eight millimetres, and there might be a few of those little tiny scars around the thighs and hips where we take the fat from.

Trish: Okay. So just like normal little lipo scars.

Dr Kalus: Correct, correct.

Trish: Okay.

Dr Kalus: So much less than with breast implants.

Trish: Yeah. And I have seen the tiniest little scar with breast implants as well, they can do phenomenal things as well, but obviously a lot smaller with the lipo.

Dr Kalus: But show me what you mean by tiny. How tiny?

Trish: Oh, a female’s tiny.

Dr Kalus: Two and a half centimetres?

Trish: Yeah, probably about two, three centimetres?

Dr Kalus: Well, so fat transfer, 3mm.

Trish: Yeah, right. Okay. All right, great. Now next one:

What is the recovery like from a breast fat transfer procedure? How does it compare with an augmentation with implants?

Dr Kalus: Yeah.

Trish: That’s probably a bit of an open question.

Dr Kalus: No, it’s a great question, they’re all great questions, Trish. So, the breasts are a-

Trish: Sorry. That was your phone.

Dr Kalus: The breasts are a lot less sore after fat transfer, and they’re swollen, and most women like the fact that they’re swollen. But they’re a lot less sore, but you’re a little bit bruised in the thighs and tummy. And you have to wear a compression garment. So there’s that aspect, you feel a little bit stiff and sore in the thighs, but you know, the recovery is a lot quicker than with breast implants, because breast implants are often put under the muscle, the muscle has to heal, really some surgeons don’t allow much movement of the arms and chest for the first few weeks. We don’t have any of those restrictions after fat transfer, so people can drive straight away, they can do things straight away. So the recovery is actually a lot faster.

Trish: All right.

What about compression garments? Do you wear compression after the fat transfer?

Dr Kalus: I think surgeons will differ in what they believe in. We like a woman to be in a firm bra, and maybe just a tube over the top of that, just so the breasts are immobilised, because after the graft we want it to heal, but it’s not to the same extent of immobilisation as after breast implants.

Trish: Okay. Okay. Yeah, because when I had my breast reduction I was asked to wear no compression bra, but I really wish that I had have, because I felt really insecure, so I wondered what it was like with the fat transfer. So you still do wear something.

Dr Kalus: Yeah. So a nice supportive bra, you’re just more comfortable, and sometimes a little more compression. I think if ever you’re a little bit bruised, in any part of the body, a little pressure makes you feel a bit better. Supports the tissues.

Trish: Yeah, totally. I agree. All right, let’s move on. It’s crazy how it takes a whole lot longer than what you think, hey.

Dr Kalus: I know.

Trish: So I’m really mindful of your time.

Dr Kalus: No, no no, it’s fine.

Trish: When we’re done I’m going to go watch. I’ve got to watch catch-up, Married at First Sight, MAFS, it’s waiting for me too.

All right, so Emma’s asked, “I have had capsular contracture twice now. I’m going to start looking into surgery this year for my second contracture that I have, and I would like to know if fat transfer is a better option to get instead of implants.

Would there be less risk of another contracture because it’s your own fat and not a foreign object being put into your body?”

Dr Kalus: 100%. So there’s no risk of capsular contracture with fat transfer, and if she’s had recurrent capsular contractures in the past, her chance of getting another one is very high, and I would definitely recommend fat transfer for her. The only problem might be that she may not be as large as she can be with implants. So there comes a time in one’s life when you have to realise, well perhaps I can’t have everything, I can’t have a double D bust, because it’s going to be hard and unnatural. I’d rather have a C cup which is soft and natural.

Trish: Yup. Okay, well that makes a lot of sense too. All right, so we had a couple of other questions come through, and I’ll check the feed again in a sec, so excuse me going from left to right, but I just want to make sure that I don’t miss any questions. So one of them was,

“Do you see the full result straight away or does it take time to settle like implants?”

Dr Kalus: So it’s a bit different, initially there’s a bit of swelling, so you see a bit more than the final result, but by about two weeks the swelling has settled, and that’s pretty much the fat that’s in the breast, but of course then it can grow, and what we’re doing now-

Trish: Sorry.

Dr Kalus: We try to experiment with different ways of how can we make the fat grow in the breast. And in fact, as I mentioned we’ve had now a few women, I think two or three, who have grown their breasts more than they really wanted to, and we’re now having to do a bit of liposuction to remove some of the fat. So this growth phase afterwards is something which the woman can be in control of. So there’s no final, no finality with this. It’s just a woman’s life, she goes on and if she puts a bit of weight on her breasts will grow, perhaps more than she would have expected.

Trish: Yup. Okay. See, that’s one good thing about putting on weight, ladies, your boobies get bigger. If you want them to. All right, another question that came through was,

“Can you do a breast fat transfer at the same time as a breast lift?”

Dr Kalus: Yes, so we nearly always do a fat transfer with breast lifts these days. It’s a lovely addition, and of course it’s much, much better to do a fat transfer with a breast lift than to put an implant in with a breast lift, because an implant expands the skin, and stretches the scars of the breast lift. If you’re doing a breast lift, you usually can’t put a large implant in, you’re forced to use a fairly small implant. So I said, “Well, why not use fat in those situations?” And remember also that when we’re doing a fat transfer there are numerous stem cells in the fat. Millions of stem cells. And these stem cells seem to improve the healing of a woman having a mastopexy, and the breasts just look soft and beautiful afterwards, and we get much better results with our mastopexys when we add some fat. So we always do it now with a mastopexy.

Trish: Okay. Okay. So for the ladies that don’t know, mastopexy is a breast lift. All right, and this is the last question.

Is there a risk of fat transfer to the breasts giving a lumpy result? How do you make sure that the shape of the breasts results in an even and good-shaped breast?

Dr Kalus: So that’s a great question. It’s very, very technique-dependent, and I think surgeons starting out in this will get lumps in the breast, and will have to deal with them by aspiration or whatever. Our technique now minimises the chance of getting lumps, because we’ve got a number of ways in which we disperse the fat throughout the breast. But we do like usually to put a bit of extra fat in the cleavage, because that’s such an important area, and a little bit perhaps in the upper pole. But with really good surgical technique we can avoid lumpiness 99% of the time. It’s rare to get a lump anywhere. But of course, it’s a possibility. Always a possibility.

Trish: Okay, okay. All right, well look, actually that last question was a really good question, they’re all really good questions, you’re right.

Dr Kalus: They’re all great questions.

Trish: Well that’s awesome, so before we close off, has anybody else got any other questions out there? I know that I’ve messed up because my phone went hot, so it stopped everything, so let me just refresh my screen on the big machine and just see if there’s any other updated questions. I’ll just have a look. Oh, I really don’t like looking at myself on video, but anyway, that’s okay. Looks like there’s no other questions I don’t think. Last one. No, that’s good.

Oh, well thank you so much for your time, Dr Kalus, that’s been wonderful, I really appreciate. We had lots of questions came through, and people are quite shy, they don’t necessarily want to post them as you’re speaking, but that’s been really fantastic.

Dr Kalus: Trish, they can always call our office, and all our staff can answer all their questions, and they’re eager to do so. Everyone is just so keen about the procedure, and so positive about it.

Trish: Yeah. And we’ve also got a few of your patient stories on Plastic Surgery Hub as well.

Dr Kalus: Oh great.

Trish: With some photos as well, so we’re wanting to get some more up as well as soon as we can get ladies who want to share that as well. So thank you so much for your time.

Dr Kalus: So there’s one more question, one more thing that I would mention.

Trish: Yes, yes.

Dr Kalus: So what about the unhappy patient? Can someone be, because this is what women worry about. What happens if I don’t like the result of the operation? And it can happen with any operation. And you know, in all of our cases, we’ve had maybe two patients I think who really have been unhappy. They didn’t like the scars on their thighs, or they just didn’t feel they got the result they were expecting. When you go into it, often they may have lost a lot of weight after the procedure, so some of the volume is lost from their breasts. They may have other things going on in their lives. So it’s very important, if you’re having aesthetic surgery, plastic surgery, don’t do it at a time of your life when lots of other things are happening, lots of things are going wrong. Make sure that you’re stable, you’re well-supported by family and friends. It’s an emotional time going through surgery, the healing process, and we do all we can to support our patients, but it’s important that you have someone as a patient who’s there to support you as well. And remember the healing takes time, and if you’re in a good situation, and it’s something that you really feel would make a difference in your life, then you can become a very suitable candidate for this sort of procedure.

Trish: Yup. That’s so true, I mean I’ve had surgery when I probably shouldn’t have, and got over it eventually, but you’re absolutely right. You’ve got to make sure that all your ts are crossed and your is are dotted and have that support network around you.

Dr Kalus: And Trish, I’d just like to say, not just for me but on behalf of all the plastic surgeons in Australia, what a great job you are doing. Not for us-

Trish: Oh, stop it, thank you, thank you.

Dr Kalus: But for all the people out there who want to know these things, and all the trouble you’ve gone to to get me here at 8 o’clock at night, you know, to come and talk. It’s been lots of fun.

Trish: It was so funny today.

Dr Kalus: And I hope it’s been informative.

Trish: It was, it was. It’s been great.

Dr Kalus: And you’ve done an amazing, amazing job. So thank you so much on behalf of all of us.

Trish: Thank you. Thank you so much, I really do enjoy what I do, and I’ve met some of the most amazing women, and men, on the way as well, so I can’t imagine doing anything else. So thank you so much once again.

Dr Kalus: Thanks Trish.

Trish: So ladies if you want to find out a bit more about Dr Kalus, you can find him on our website, in the search bar just put in Dr Allan Kalus, and you’ll find some real stories and his bio, or if you’re looking at another practitioner that you want to find out about as well, a few doctors are doing combination treatments as well, but Dr Kalus has got 400+ under his belt, so yeah. Thank you all for staying on, and especially for all you girls that are addicted to Married at First Sight, you can go and watch it now and catch up. So, see you later. Bye Dr Kalus.

Dr Kalus: Bye Trish.


Trish is a plastic surgery blogger. She is passionate about wellbeing, health and beauty, and doesn't mind a little bit of 'help' from the amazing cosmetic and beauty procedures that are available today. Trish spends her days talking to women and men who are looking for suggestions and advice on procedures that are available to them. Cutting through the sales pitch and hype, a down-to-earth response on general information is what you will get.

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