A variety of suboptimal results arise in breast augmentation, not from failure of the implant per se, but from failure of the overlying soft tissue to adequately cover the implant. The purpose of the present communication is to describe a new concept of composite breast augmentation surgery combining the core volume projection of breast implants with the natural look and feel of overlying fat, utilizing traditional tissue-based implant planning combined with autologous fat grafting.
Methods/Technique:
197 patients were treated over a three year period. This approach was employed in a spectrum of breast implant procedures when the overlying soft tissue was thin or insufficient to adequately cover the underlying prosthesis, and was employed in both breast implant revision and in primary breast augmentation. In a subset of the cases, quantitative 3D imaging of the breast preoperatively and one year postoperatively evaluated the persistence of transplanted fat volume in the subcutaneous, or “third space” of the breast. In primary cosmetic augmentation cases, pre-expansion of the breast was not performed. In revision cases, pre-expansion was performed because the capacity of the recipient site was insufficient to support the desired volume of fat required to achieve the aesthetic result. In a second subset of patients, mammograms taken one year after surgery were compared to preoperative mammograms and were independently evaluated by breast radiologists.
Results/Complications: Complications included one case of capsular contracture and two cases of palpable cysts requiring drainage in the early postoperative period. On a percent volume maintenance basis, 57% of the volume of graft injected persisted at one year. Because fat provided soft tissue coverage over the implants there was less need to place the prosthesis beneath the muscle; many of the procedures were performed placing implants in the sub-fascial plane. Mammographic evaluation revealed no cysts, masses or fat necrosis, presumably because the capacity of the recipient site was not overloaded with fat.
Conclusion:
Performing breast augmentation with simultaneous implants and fat in the same patient affords a more powerful and versatile approach, as both modalities can work together to achieve a synergistic outcome. Composite breast augmentation should be added to the list of applications where fat grafting to the breasts may have clinical utility beyond simple core volume enhancement.