Breast volume can be created without an implant. BiVol designs the shape and volume of the breast using ADM — acellular dermal matrix — a biological material instead of a silicone implant. The first thing to understand is that "no implant" does not mean "nothing goes in": a biological matrix is used, and that changes what the procedure can and cannot do.
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How can volume be created without an implant?
BiVol creates shape and volume with ADM rather than a silicone implant. Conventional augmentation inserts a silicone implant of a fixed size and shape; BiVol instead uses a biological matrix, planned around the breast tissue and body frame.
The approach is therefore different from choosing an implant's width and projection. But not using an implant does not mean any size can be reached: existing breast tissue volume, skin condition, chest wall structure and the desired degree of enlargement all determine the real range.
Read alsoThe basic concept of BiVol is covered in “BiVol, the fourth-generation implant-free breast surgery” (Korean).
Does ADM turn into my own tissue over time?
ADM is a biological material made by removing cellular components from human dermis and leaving the extracellular matrix that forms the tissue scaffold.
It was not created for breast surgery alone; it has been used in breast reconstruction and soft-tissue supplementation across several fields. Once placed, surrounding cells and vessels move in, and the matrix can integrate and remodel. But the common assumption that ADM fully becomes your own tissue or normal breast tissue after a certain time is not accurate: integration happens, and how far it goes depends on the material, the surgical method and individual tissue condition.
ADM has been used in breast surgery for capsular contracture and reconstruction, and a meta-analysis of nine therapeutic studies found lower recurrence. Evidence for it as a volume-building method over the long term is still limited.[1]
How does it differ from implants and fat grafting?
All three create breast volume, but the material differs.
| Aspect | Implant | Fat grafting | BiVol |
|---|---|---|---|
| Main material | Silicone implant | Your own fat | ADM |
| Volume creation | Fixed implant size | Grafted fat | Shape and volume designed with ADM |
| Fat harvest | Not needed | Needed | Not needed |
| Key consideration | Tissue thickness, implant size | Harvestable fat, take rate | Tissue condition, desired enlargement |
Fat grafting requires harvesting fat from the abdomen or thigh, which is difficult when body fat is low. BiVol does not use your own fat, so it is a different method from fat grafting even though both avoid a silicone implant.
Fat grafting, the comparison point here, showed a mean retention of 62.4% in a systematic review of 22 studies covering 3,565 patients.[2]
When can BiVol be considered?
If a silicone implant itself is a concern, or you are looking for a method other than implants and fat, BiVol can be compared as one option. Common reasons patients ask:
- Discomfort with the idea of an implant
- Worry about implant edges or a foreign-body feel
- Too little fat to harvest for grafting
- Wanting volume planned differently from fixed implant sizes
It is not automatically the better choice for everyone. Where breast tissue is very sparse, where a large enlargement is desired, or where there is skin laxity or a chest wall shape that calls for something else, other methods may be considered together. The decision should not rest on "no implant" alone but on tissue volume, desired size and skin condition together.
BiVol breast surgery: common myths and facts
| You may think… | In practice |
|---|---|
| "BiVol is a type of implant." | It is ADM-based, not a silicone implant. |
| "No implant means no complications." | Any surgery carries risk, and long-term evidence is limited. |
| "BiVol is enough for large volume." | For large volume, implants or hybrid may be more realistic. |
In BiVol consultations I look at the desired volume and the size of the concern about implants side by side. If there is a real reason to avoid an implant and the change wanted is realistic, it is a reasonable option to review.
BiVol creates breast shape and volume with ADM instead of a silicone implant, so the planning question is not which implant width and projection but what the existing tissue can support. Integration with surrounding tissue occurs, but describing ADM as fully turning into your own breast tissue is inaccurate. A nine-study meta-analysis supports ADM in capsular contracture treatment with lower recurrence, while long-term evidence for it as a volume-building method remains limited — and fat grafting, the other implant-free route, retained a mean 62.4% in 22 studies. It is one option among implant, fat and hybrid, not a universal upgrade.
🔬 The research behind this article
These are the international journal papers that support the content above. Select a title to open the abstract on PubMed.
- Aesthetic Surgery Journal 2023 — meta-analysis of 9 studies, 481 breasts, ADM in capsular contractureSamuels K, Millet E, Wong L. Efficacy of Acellular Dermal Matrix Type in Treatment of Capsular Contracture in Breast Augmentation: A Systematic Review and Meta-Analysis. Aesthet Surg J. 2023;44(1):26-35.Key: lower recurrence; volume-building evidence still limitedText [1] · PMID 37595294 · DOI
- Aesthetic Surgery Journal 2016 — systematic review of 22 studies, 3,565 patients, cosmetic fat graftingGroen JW, Negenborn VL, Twisk JW, Ket JC, Mullender MG, Smit JM. Autologous Fat Grafting in Cosmetic Breast Augmentation: A Systematic Review on Radiological Safety, Complications, Volume Retention, and Patient/Surgeon Satisfaction. Aesthet Surg J. 2016;36(9):993-1007.Key: mean volume retention 62.4%Text [2] · PMID 27329661 · DOI
🎬 Watch: Dr. Park Seong-Soo on video
Korean-language videos from BongBong Plastic Surgery's official channel and Dr. Park's channel, “Seongsu-ro Doctor”. Titles are translated for reference; selecting one opens YouTube.
- BiVol breast surgery without an implant, explained by Dr. Park Seong-SooSeongsu-ro Doctor · 2025.07.02
- Which material is used in BiVol breast surgery?Seongsu-ro Doctor · 2026.01.02
- BiVol breast surgery: what aftercare involvesSeongsu-ro Doctor · 2025.11.16
Frequently asked questions
Does BiVol put nothing inside the breast?
A. No. It means no silicone implant; an ADM biological matrix is used. It is not a method of enlarging the breast with your own tissue alone.
Can BiVol make the breast significantly larger?
A. It aims to create volume, but the achievable degree depends on existing breast tissue, skin condition and chest wall structure. It does not work by selecting a specific cc as an implant does.
Is BiVol the same as fat grafting?
A. No. Fat grafting harvests and transfers your own fat, while BiVol uses ADM, an acellular dermal matrix.
If I dislike implants, is BiVol the better choice?
A. It is one option to compare, but not automatically more suitable. Desired size, existing tissue and skin thickness should be reviewed before choosing between implant, fat and ADM.
📖 References
Select a [number] in the text to jump to the source, and ↩ to return. Only papers whose title, journal and year were verified on PubMed are included.
- Samuels K, Millet E, Wong L. Efficacy of Acellular Dermal Matrix Type in Treatment of Capsular Contracture in Breast Augmentation: A Systematic Review and Meta-Analysis. Aesthet Surg J. 2023;44(1):26-35. — Aesthetic Surgery Journal 2023 — meta-analysis of 9 studies, 481 breasts, ADM in capsular contracture. ↩
- Groen JW, Negenborn VL, Twisk JW, Ket JC, Mullender MG, Smit JM. Autologous Fat Grafting in Cosmetic Breast Augmentation: A Systematic Review on Radiological Safety, Complications, Volume Retention, and Patient/Surgeon Satisfaction. Aesthet Surg J. 2016;36(9):993-1007. — Aesthetic Surgery Journal 2016 — systematic review of 22 studies, 3,565 patients, cosmetic fat grafting. ↩
BongBong Plastic Surgery · Dr. Park Seong-Soo, Medical Director
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