Breast augmentation with lipofilling is indicated to add small volumes. For larger volumes (more than 1 cup size) and better projection of the breast implants are needed. The ratio implant volume versus fat volume is determined by the presence of sufficient donor tissue (fat). At the outpatient clinic the procedure is discussed and your expectations are evaluated. If the patient has enough donor tissue, the procedure will aim at using a maximum of fat tissue with the addition of a small implant. In general, the final volume is 1/3 of fat and 2/3 of implant.
For example, if a volume increase of 300 cc is wanted we will aim to add 100 cc of fat and will add the residual volume with an implant of 200 cc. To have an increase of 100 cc we need to inject 200 cc of fat (based on our experience). Instead of adding an implant of 300 cc, an implant of 200 cc is chosen (1/3 less foreign material).
The hybrid breast augmentation consists of choosing the right implant volume with additional fat grafting. It is clear we want as much fat tissue as possible and this depends on the donor sites. In patients with sufficient donor tissue the surgeon will be able to add more autologous (own tissue) tissue compare to lean patients. Your specific situation and clinical presentation will be discussed at the outpatient clinic and a 3D scan of both breast will be performed to measure the final volume.
It is important to mention any previous history of breast cancer or genetic predisposition. A mammogram will be taken from the age of 35 and at an earlier age in patients with genetic predisposition. Smoking is absolutely forbidden.
A standard breast augmentation with implant insertion through an inframammary incision is performed. In most cases, we will be able to position the implant in a prepectoral position (before the muscle). This approach causes less discomfort at the short and long term compared to a position behind the muscle (retropectoral implant). Because lipofilling is added to the procedure the surgeon is able to thicken the subcutaneous tissue layers of the breast. Doing so the implant will become less visible and palpable. In other words, the injected fat acts as an additional coverage.
The steps in the procedure are:
- liposuction of donor areas to evaluate the amount of “harvested” fat
- based on the volume of the removed fat, sizers (test implants) are inserted to assess the final implant volume
- final implant is inserted
- additional lipofilling is performed
Our clinical experience shows that injection of 100 cc of fat results in a volume increase of approximately 50 to 60 cc. These findings are based on MRI studies performed in patients who underwent fat grafting procedures.
- part of the volume is your own volume
- less foreign material (implant)
- result more natural
- less visible or palpable implant
- specific areas can be treated
- incision to insert implant
- longer procedure
- discomfort from liposuction
- need for donor tissue