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SIEF
(Simultaneous Implant Exchange with Fat Grafting)
Breast fat grafting uses autologous adipose tissue to refine contour, restore volume selectively and improve symmetry, emphasising anatomical support, tissue quality and long-term balance rather than relying on fixed implant volumes.
For patients considering breast augmentation as a primary procedure, implants remain the most reliable option for meaningful volume change. Fat grafting in that context is best understood as an adjunct rather than a substitute, or for small volume changes - discussed further on the breast augmentation page.
My Approach
Many women choose to remove their breast implants - whether due to discomfort, capsular contracture, aesthetic changes, or simply a desire for a more natural feel. Simultaneous Implant Exchange with Fat Grafting (SIEF) replaces the implant with the patient’s own fat in the same operation, restoring shape and volume naturally without the need for new implants.
SIEF was first described and validated as a revision option for patients wishing to avoid new implants, with early studies demonstrating clinical utility and improved patient outcomes. A subsequent series of 131 patients confirmed no serious complications and high patient satisfaction.
SIEF can also be used after breast reconstruction with implants, when patients experience implant-related issues or prefer a more natural long-term solution. By replacing the implant with one’s own tissue, SIEF offers a softer, warmer, and more natural result that continues to age harmoniously with the body.
Planning & Technique
During SIEF, the capsule surrounding the old implant is removed as completely as possible to restore a healthy, flexible pocket. Capsulectomy at the time of implant removal is a safe procedure with a low complication rate and high patient satisfaction, particularly in patients with systemic symptoms attributed to their implants such as generalised discomfort and tightness.
Fat is then gently harvested from areas such as the abdomen or thighs, purified, and carefully grafted into the breast to recreate volume and contour. This method restores natural shape and improves comfort without introducing new implants.
Recovery & Expectations
Most patients resume light daily activities within a week or two. Swelling or mild bruising may occur around the liposuction and grafting sites, but typically subsides within two weeks. Light exercise can resume after three to four weeks, while more strenuous activity should wait until about six weeks.
Support garments are recommended during recovery to help maintain shape as the tissues settle. The grafted fat gradually integrates over several months, resulting in a soft, natural contour that ages naturally with the body.
Complementary Procedures
SIEF can be combined with:
- Nanofat rejuvenation - to improve skin texture and tissue quality
- Liposuction - as part of overall body contouring, using harvested fat for both enhancement and balance
Post-operative care extends beyond routine reviews - it is an integral part of Dr Ng’s surgical philosophy. Through Doctor Stitch, an aftercare service founded to ensure seamless continuity and comfort, every patient is followed up personally by Dr Ng for attentive, discreet, and consistent care throughout the recovery journey.
Frequently Asked Questions
1. Who is a good candidate for SIEF?
SIEF is most suitable for patients who wish to remove their existing implants and restore breast volume naturally, without replacing them with new implants. Good candidates have adequate donor fat available for harvest, realistic expectations about the degree of volume achievable with fat grafting alone, and a clear motivation - whether due to implant-related concerns, a desire for a more natural feel, or both.
2. Can SIEF fully replace the volume of my current implants?
Not always. Fat grafting typically achieves more modest volume than implants, and graft survival varies between patients, around 50% of the transferred volume is retained long term. Volume retention is influenced by fat processing method, injection technique, and patient characteristics; centrifugation-based preparation has been associated with higher retention rates. SIEF works best for patients who are happy to accept a smaller, softer result rather than maintaining the same volume as their existing implants. This is discussed honestly at consultation.
3. What happens to the capsule during SIEF?
The capsule surrounding the implant is removed as completely as possible during SIEF. In patients with symptoms such as discomfort, tightness, or concerns about implant-related illness, a more extensive capsulectomy may be performed as part of a comprehensive management plan.
4. Is SIEF suitable after breast reconstruction with implants?
Yes, SIEF can be considered for patients who have previously undergone implant-based breast reconstruction and wish to transition to an autologous solution. Each case is assessed individually given the different tissue conditions following reconstruction.
5. Is SIEF covered by Medisave or insurance?
The fat grafting component of SIEF is generally considered cosmetic and not Medisave or insurance claimable. Where capsulectomy is performed for a medical indication, partial claimability may apply and this will be discussed at consultation based on your individual circumstances.
Related Reading
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Treatment options after capsulectomy - for patients considering implant removal and natural reshaping
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Breast reconstruction - for delayed or staged reconstruction after mastectomy
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Liposuction - learn about the approach and thinking behind the use of liposuction in fat harvest
References
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Del Vecchio DA. "SIEF"--simultaneous implant exchange with fat: a new option in revision breast implant surgery. Plast Reconstr Surg. 2012 Dec;130(6):1187-1196. doi: 10.1097/PRS.0b013e31826d9c3c. PMID: 23190803.
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Ohashi M, Yamakawa M, Chiba A, Nagano H, Nakai H. Our Experience with 131 Cases of Simultaneous Breast Implant Exhange with Fat (SIEF). Plast Reconstr Surg Glob Open. 2016 Apr 25;4(4):e691. doi: 10.1097/GOX.0000000000000601. PMID: 27200253; PMCID: PMC4859250.
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Katsnelson JY, Spaniol JR, Buinewicz JC, Ramsey FV, Buinewicz BR. Outcomes of Implant Removal and Capsulectomy for Breast Implant Illness in 248 Patients. Plast Reconstr Surg Glob Open. 2021 Sep 7;9(9):e3813. doi: 10.1097/GOX.0000000000003813. PMID: 34513545; PMCID: PMC8423394.
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Hu S, Xu H. Volume retention rate after breast autogenous fat grafting and related influencing factors: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2024 Feb;89:105-116. doi: 10.1016/j.bjps.2023.12.003. Epub 2023 Dec 12. PMID: 38160589.
