Large-Volume Breast Autologous Fat Transfer Entirely Under Tumescent Anesthesia: Experience With 87 Patients Over 6 Years

Autologous fat transfer (AFT) provides a natural alternative to implants for breast augmentation. While most large-volume AFT is performed under general anesthesia, experience with fully tumescent local anesthesia is limited. This study evaluates the safety, efficacy, and volumetric outcomes of Breast Autologous Fat Transfer Entirely Under Tumescent Anaesthesia (BAFTEUTA) and examines the role of pre-expansion versus enrichment in graft survival.

In this prospective single-center study, 87 patients (174 breasts) underwent large-volume AFT under local tumescent anesthesia between 2018 and 2024. Preoperative expansion used either rigid dome systems or negative-pressure wound-therapy (NPWT) dressings. Fat was harvested manually or mechanically, processed without centrifugation, and injected in multiple subcutaneous planes. Volumes were measured by 3-D imaging and water displacement. Outcomes included percentage of successfully grafted fat (%SGF), final increase in size at 6 months (%FIS), and complications.

No infections, hematomas, or systemic complications occurred. Five patients (6.25%) developed benign fat granulomas, all unilateral ( ≈3% of breasts). Median graft survival was 82%. Dome expansion achieved higher mean %SGF (84.5% vs 79.5%) and %FIS (193% vs 158%) than NPWT, with strong correlation between expansion hours and %FIS (r ≈ 0.9, p < .001). Smaller breasts and nulliparous women showed greater proportional gains. The mean satisfaction scores were 4.7 to 5.0 across domains.

Large-volume breast fat transfer can be safely and reproducibly performed under tumescent anesthesia. Pre-expansion-particularly with dome systems-is the most critical determinant of graft survival, enabling durable, natural results without stem-cell enrichment, general anesthesia, or implants.