What makes a great pair of boobs? Ask Dr. Jonathan Kanevsky, MD, FRCSC, and he’ll tell you it’s not necessarily about going bigger. For the past decade, the award-winning, board-certified Beverly Hills plastic surgeon has made a career out of creating some of the best chests in the business: actresses, models, influencers, and a few of your favorite Playmates. He can’t name names (HIPAA, obviously), but let’s just say a few of the breasts you’ve admired on screen owe him a thank-you.
For a man behind Hollywood’s most admired cleavage, however, his philosophy is pretty unconventional: he refuses to use silicone implants — one of plastic surgery’s most reliable moneymakers.
“The last implant I placed was [in] June 2019,” he says. “And to go so hard against the core of what the industry was definitely brought some backlash. Even today, still, I get hate from plastic surgeons online.” What he offers instead is fat transfer, a technique that sounds almost too good to be true. Take fat from somewhere you don’t want it (via liposuction) and put it somewhere you do (in this case, your rack). Rather than introducing a foreign object into your body, Dr. Kanevsky works with the patient’s own tissue to add volume that is, biologically speaking, already hers.
Of course, fat transfer isn’t new. Surgeons have been removing and reinserting fat around the body for more than a century, and fat grafting, as it’s also called, has long been a fixture of breast reconstruction after mastectomy. The problem when it comes to fat transfers for breast augmentation has been getting the transferred fat to stay. By Kanevsky’s own estimate, only 50 to 80 percent of the grafted fat will survive, while the rest disappears and reabsorbs into the body. Other estimates put that success rate at about 20 to 80 percent.
In hopes of improving those odds, Kanevsky developed a seven-step protocol that combines his own specialized devices with techniques intended to help the transferred fat stick around. For instance, he infuses antibiotics into the harvested fat to reduce infection risk, uses red-light treatment (photobiomodulation) to improve fat survival, and employs custom cannulas and vibration-assisted devices to distribute the fat more precisely. Radiofrequency skin tightening adds another element, using heat to stimulate collagen production in hopes of leaving the skin in your new boobs firmer. “It’s my special sauce,” Kanevsky explains.
But even with the most elaborate protocol, there’s still a limit to what fat transfers can do. Unlike implants, they typically won’t take, say, an A to a DD in a single session — though for a growing number of patients, that may not matter so much. “I’m getting a lot more interest [in fat transfers],” says Dr. Rukmini Rednam, MD, FACS, a board-certified Houston-based plastic and reconstructive surgeon who’s been in practice for 11 years. “And a lot of it is that people are way more educated on their options now.” Part of that education involves understanding the fine print about silicone; for instance, that it’s not a one-and-done purchase. You may need to replace silicone implants every 13 to 15 years, according to Dr. Deniz Sarhaddi, MD, a board-certified plastic surgeon at St. Louis Cosmetic Surgery who offers both implants and fat grafting.
Online, the case against silicone has only gotten louder, too. One rare but recognized risk you may have seen in the news is breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a rare lymphoma linked mostly to textured implants (including Allergan’s BIOCELL line, which was recalled in 2019). Then there are the horror stories about what’s informally become known as “breast implant illness”: a laundry list of side effects sufferers have attributed to their silicone implants, including fatigue, joint and muscle pain, rashes, brain fog, and unexplained weight changes.
“It’s this constellation of symptoms, and we don’t know exactly who gets [BII],” Rednam says. Even though doctors like Rednam and Kanevsky (and even the FDA) acknowledge patients’ reports of these symptoms, BII isn’t a formally recognized medical diagnosis, and researchers can’t say for sure whether implants cause it. Still, that hasn’t stopped the term from entering conversations between women and their plastic surgeons. “I personally am seeing a lot more ladies who maybe have had implants for a long time and they feel like they might have that diagnosis and they remove them,” Rednam says.
Not every skeptic is running from health complications, however. As beauty standards in the GLP-1 era shift away from the cartoonishly bombshell look, patients are increasingly after a more subtle, ‘I was born with it,’ result — and the cosmetic industry is adjusting its approaches accordingly.
In Sarhaddi’s practice, “20% of my breast augmentation patients want fat transfer alone, but a large proportion of my implant-based patients get fat transfer on top,” which can soften the bolt-on bombshell into a more inconspicuous, born-with-it bounce. There’s also alloClae, a body filler made from donated cadaver fat that can fill out large areas like your hip dips or cleavage, no liposuction required. That said, there’s less research on how alloClae holds up over the long term. Not to mention, “it’s a whole other level of expensive,” Rednam adds.
Which brings us back to the original question: what makes a great pair of boobs? Ask a dozen surgeons or patients, and you’ll likely get a dozen different answers. There’s no universal one anymore, and that’s kind of the beauty of it. For the first time in decades, the implant finally has competition — and Kanevsky, for one, already picked his favorite.
“My goal is that no woman would ever want to get an implant again when a fat transfer is a good and safe option.”
