Breast augmentation surgery with implants has been performed for many decades now. The implants have improved from generation to generation, and now we are at the fifth generation of implants, the safest and most durable of them all. The procedure delivers impressive results and allows for a considerable increase in the volume of the breasts. At the same time, the procedure is associated with different risks and potential complications, just like all plastic surgeries. For patients who want to augment their breasts without using implants, we’ll discuss breast augmentation with fillers. When it comes to using fillers for augmentation purposes, patients have different ideas about how this could work. Many patients ask about hyaluronic acid or Macrolane. Some plastic surgeons give saline solution injections to the breasts to help the patient get bigger breasts for a limited time or for the patient to get an idea about how big their breasts can look after augmentation. The saline is injected into the breasts in different areas and creates more volume, but it is reabsorbed by the body over the next 24 hours. This is not a practice I encourage as the tissues of the breasts can be damaged and it is not a procedure with sustainable results. When it comes to hyaluronic acid, the cost of this procedure will be very high if it would be performed and the results are just not worth it as they won’t last for more than a few months. Aquafilling, Macrolane, and other fillers of hydrogel type should be avoided as they can trigger complications. These fillers are not natural substances and should not be injected into very sensitive areas such as the breasts. If you want to achieve natural results and avoid the complications associated with implants, the best solution for you would be to try fat grafting. Fat transfer, also known as lipofilling, uses the patient’s own fat tissue as a filler substance. This means that fat cells are collected from other parts from the patient’s body, go through a purification process, and are then injected into the breasts to create a more beautiful shape and add more volume. Just like the saline solution, the fat cells transferred to the breasts will be absorbed by the body in a certain percentage. However, when the procedure is performed by an experienced, board-certified plastic surgeon, a vast majority of the fat cells transferred will survive and get a new blood supply within weeks from the procedure. The patient’s own fat is the only filler I recommend to be used for breast augmentation as the technique has been tested and performed for many years now. It implies minimal risks and potential complications, the results are completely natural, and the plastic surgeon only uses natural fillers.