Composite Breast Augmentation: Soft-Tissue Planning Using Implants and Fat

Background: A variety of suboptimal results arise in breast augmentation due to failure of the overlying soft tissue to adequately cover the implant. The authors describe a new concept of composite breast augmentation surgery that combines the core volume projection of breast implants with the natural look and feel of overlying fat. Methods: A total of 197 patients were treated over a 3-year period. This new approach was used when the overlying soft tissue was thin or insufficient to adequately cover the underlying prosthesis, in both breast implant revision and primary breast augmentation. In a subset of cases, quantitative three-dimensional breast imaging evaluated transplanted fat volume in the subcutaneous space of the breast. In primary cosmetic augmentation cases, preexpansion was not performed. In revision cases, preexpansion was performed to support the desired volume of fat required to achieve the aesthetic result. In a second subset of patients, preoperative and 1-year postoperative mammograms were evaluated by breast radiologists. Results: Fifty-seven percent of the volume of graft injected persisted at 1 year. Because fat provided soft-tissue implant coverage, there was less need to place the prosthesis beneath the muscle; many implants were placed in the subfascial plane. Evaluation revealed no cysts, masses, or fat necrosis, presumably because the recipient site was not overloaded with fat. Conclusions: Breast augmentation with simultaneous implants and fat affords a more powerful and versatile approach, and achieves 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.