Overview
The abdomen and inner thighs are very common fat harvest sites because they can provide accessible fat for grafting while also allowing body contouring.
In one study of 25 women, Padoin and colleagues found that the lower abdomen and inner thigh had relatively high concentrations of processed lipoaspirate cells compared with several other donor areas. [1]
However, donor-site cell concentration does not necessarily predict how much transferred fat will survive. Rohrich and colleagues found no significant difference in immediate fat-cell viability among the abdomen, thigh, flank, and knee. [2]
The quality of the harvested tissue and the way it is harvested, processed, and injected may all affect the final graft.
Donor-site selection is also an aesthetic decision: liposuction changes the contour of the area from which the fat is taken.
[PHOTO: Soft adipose tissue compared with more fibrous fat]
1. Why does fat quality matter in fat grafting?
Fat grafting involves moving living adipose tissue from one part of your body to another. After transfer, the graft must obtain nutrients and ultimately establish an adequate blood supply in its new location.
For that reason, I try to minimize unnecessary trauma to the fat during harvesting, processing, and injection. Lower-pressure harvesting has shown advantages in some laboratory studies, although the clinical literature has not established one universally superior harvesting method.
Fibrous areas - fat that is more fibrous and slightly more difficult to remove - can also be technically more difficult to harvest compared to softer areas. This is one reason I consider not only how much fat an area contains, but also how easily it can be harvested and what contour improvement the patient wants at the donor site.
2. Is the abdomen the best donor site for fat grafting?
The abdomen is my first choice for many fat-grafting cases, but that is a clinical preference rather than a rule that abdominal fat always survives better.
Padoin and colleagues, reporting in Plastic and Reconstructive Surgery in 2008, sampled six liposuction zones in 25 women. They found that the lower abdomen had a higher concentration of processed lipoaspirate cells than several other areas, with no significant difference between the lower abdomen and inner thigh. [1]
These processed lipoaspirate cells include stromal and progenitor cell populations that have generated considerable interest in fat-grafting research. However, a higher cell concentration should not be interpreted as proof that fat from that donor site will produce better clinical graft retention.
The abdomen has another practical advantage: many patients simply have more available fat there.
Rohrich and colleagues studied fat from the abdomen, thigh, flank, and knee in five subjects and found no significant difference in immediate adipocyte viability among the donor sites. [2] Other studies have likewise questioned whether donor site alone substantially determines long-term graft retention.
3. Are the inner thighs a good donor site for fat grafting?
Yes. Inner-thigh fat is another useful donor source.
In the Padoin study, the inner thigh and lower abdomen did not differ significantly in processed lipoaspirate cell concentration. [1] The practical limitation is usually volume: many patients have considerably less harvestable fat in the inner thighs than in the abdomen.
Lower abdomen
Often provides a relatively large reservoir of fat
Had a high processed lipoaspirate cell concentration in the Padoin study
Can provide simultaneous abdominal contour improvement
Inner thigh
Also had a relatively high processed lipoaspirate cell concentration in the Padoin study
Usually provides less total fat than the abdomen
Requires careful contouring because skin and soft-tissue anatomy vary considerably among patients
4. Is the bra roll worth harvesting?
It can be, but it’s more fibrous.
Upper-back and bra-roll fat may be more fibrous and technically different to harvest than abdominal or inner-thigh fat. I often consider this area when reducing the bra roll itself would improve the patient's overall contour.
In other words, I do not select donor sites solely according to which area I expect to provide the most fat. I also consider what the patient would like improved and whether removing fat from that area is likely to produce an attractive donor-site result.
5. Do the arms and knees provide usable fat?
They can, but they are usually supplementary donor sites rather than my primary source for larger-volume fat grafting.
The arms and knees generally contain smaller deposits than the abdomen or thighs. For a case requiring substantial graft volume, I usually need a larger donor area or a combination of areas.
[PHOTO: Donor sites marked before a hybrid case]
6. Why do donor sites matter for hybrid breast augmentation?
In hybrid breast augmentation, the implant provides much of the volume and projection, while fat grafting can be used selectively to soften implant edges, improve contour transitions, and address areas where additional soft-tissue coverage is desirable.
The donor-site plan therefore serves two purposes: obtaining enough fat for grafting and improving body contour where the fat is removed.
[LINK: Is Hybrid Breast Augmentation in San Francisco the Best Way to Get Natural Results?]
[LINK: How Long Does Fat Grafting Last for San Francisco Patients? 10 Survival Facts]
Three Myths About Fat-Grafting Donor Sites
Myth: Fat is fat, so the harvest site never matters.
Different fat deposits have different biological and physical characteristics. Padoin found differences in processed lipoaspirate cell concentration among donor sites, although clinical studies have not established that one donor site consistently produces superior graft retention. [1,2]
Myth: The surgeon should simply take fat from wherever the patient wants it gone.
Patient preference matters, but donor-site selection also depends on available volume, tissue characteristics, skin quality, contour goals, and how much fat is required.
Myth: If I don't have enough fat, someone else can donate it to me.
Standard fat grafting is autologous: the fat comes from your own body. Fat from another person is not used as a routine substitute for your own tissue.
Frequently Asked Questions
Which donor site has the most stem cells?
There is no universally established winner. In the Padoin study, the lower abdomen had a higher processed lipoaspirate cell concentration than several other sites, with no significant difference compared with the inner thigh. [1] Other research has produced different donor-site findings.
Will liposuction leave loose skin?
It can. The result depends on factors including your existing skin elasticity, the amount and location of fat removed, and the characteristics of the overlying skin.
Is transferred fat permanent?
Some transferred fat is resorbed after surgery. Fat that successfully survives and integrates into the recipient area can provide long-lasting volume, but the amount retained varies among patients.
Do the donor sites hurt more than the breasts?
Patients can experience soreness, swelling, and bruising in both the donor and recipient areas. The pattern and intensity vary from patient to patient and with the extent of liposuction performed.
Summary
There is no single donor site proven to produce the best fat-grafting survival in every patient.
For many of my patients, the lower abdomen is particularly useful because it can provide a substantial amount of fat and allows simultaneous abdominal contouring. The inner thighs can also provide useful graft material. Flanks, bra rolls, arms, knees, and other areas may supplement these sites when their contour would also benefit from fat removal.
Ultimately, I choose donor sites based on the amount of fat needed, the patient's anatomy and skin quality, tissue characteristics, and the body-contouring result we are trying to achieve.
References
Padoin AV, Braga-Silva J, Martins P, et al. Sources of processed lipoaspirate cells: influence of donor site on cell concentration. Plastic and Reconstructive Surgery. 2008;122:614–618.
Rohrich RJ, Sorokin ES, Brown SA. In search of improved fat transfer viability: a quantitative analysis of the role of centrifugation and harvest site. Plastic and Reconstructive Surgery. 2004;113:391–395.
Ready to Schedule a Consultation?
Call 415-362-1846 or email info@drkim.com to schedule a consultation and donor-site examination.
My San Francisco office is at 450 Sutter Street, Suite 1440, San Francisco, CA 94109. My Alameda office is at 1403 Park Street, Alameda, CA 94501.