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Aesthetic Breast Augmentation: Fat Transfer VS Implants

According to Fat Graft in Composite Breast Augmentation with Round Implants: A New Concept for Breast Reshaping by Luca Maione, Fabio Caviggioli, Valeriano Vinci, Andrea Lisa, Federico Barbera, Mattia Siliprandi, Andrea Battistini, Francesco Klinger, Marco Klinger (2018) Breast augmentation surgery with implants is one of the most common aesthetic surgical procedures. Round and anatomical textured implants are employed very often, and fat grafting has proven to be a very useful complementary procedure in breast augmentation.


BREAST AUGMENTATION


Sometimes referred to as a "breast aug" or "boob job" by patients, involves using breast implants or fat transfer to increase the size of breasts. This procedure can also restore breast volume lost after weight reduction or pregnancy, achieve a more rounded breast shape or improve natural breast size asymmetry.



It is also referred to as augmentation mammoplasty. When fat from another part of the patient's body is used to create the improved breast volume, the procedure is referred to as fat transfer breast augmentation.


BREAST IMPLANTS


Implant manufacturers occasionally introduce new styles and types of breast implants, so there may be additional options available.




Further modifications such as power liposuction and ultrasonic liposuction have been introduced with variable results. Despite these advances, the tumescent technique remains the worldwide standard of care for liposuction.


Saline breast implants

Saline breast implants are filled with sterile salt water. Should the implant shell leak, a saline implant will collapse and the saline will be absorbed and naturally expelled by the body.

Saline breast implants provide a uniform shape, firmness and feel, and are FDA-approved for augmentation in women age 18 or older.


Structured saline breast implants

Structured implants are filled with sterile salt water, and contain an inner structure which aims to make the implant feel more natural.


Silicone breast implants

Silicone breast implants are filled with silicone gel. The gel feels a bit more like natural breast tissue. If the implant leaks, the gel may remain within the implant shell, or may escape into the breast implant pocket. A leaking implant filled with silicone gel will not collapse.


If you choose silicone implants, you may need to visit your plastic surgeon regularly to make sure the implants are functioning properly. An ultrasound or MRI screening can assess the condition of breast implants. Silicone breast implants are FDA-approved for augmentation in women age 22 or older.


Gummy bear breast implants

Form-stable implants are sometimes referred to as gummy bear breast implants because they maintain their shape even when the implant shell is broken.


The consistency of the silicone gel inside the implant is thicker than traditional silicone gel implants. These implants are also firmer than traditional implants.


Shaped gummy bear breast implants have more projection at the bottom and are tapered towards the top. If a shaped implant rotates, it may lead to an unusual appearance of the breast that requires a separate procedure to correct. Placement of gummy bear implants requires a slightly longer incision in the skin.


Round breast implants

Round breast implants have a tendency to make breasts appear fuller than form-stable implants. Higher profile options can achieve even more projection. Because round implants are the same shape all over, there is less concern about them rotating out of place.


Smooth breast implants

Smooth breast implants are the softest feeling. They can move with the breast implant pocket, which may give more natural movement. Smooth implants may have some palpable or visible rippling under the skin.


Textured breast implants

Textured breast implants develop scar tissue to stick to the implant, making them less likely to move around inside of the breast and become repositioned. Texturing offers some advantage in diminishing the risk of a tight scar capsule.


FAT TRANSFER


Fat transfer breast augmentation essentially uses liposuction to take fat from other parts of your body and inject it into your breasts. This is a breast augmentation option for women who are looking for a relatively small increase in breast size and would prefer natural results.




Preoperative expansion of the breast followed by injection of the patient's own fat provides a safe and effective alternative to implant surgery for breast augmentation.


In autologous fat transfer, fat cells obtained by liposuction from one part of the patient's body-for example, the thighs-are transferred for use in enlarging and reshaping the breasts. There's growing interest in fat transfer as a less-invasive alternative to techniques using breast implants.


PREOPERATIVE EXPANSION


The technique-which includes using a special suction-pump bra device for a few weeks before surgery to "pre-expand" the breasts-provides greater augmentation than fat transfer alone, according to the new report. The lead author was ASPS Member Surgeon Roger K. Khouri, MD of Florida International University and Miami Breast Center, Key Biscayne, Fla.


A bra-like device that uses gentle negative pressure (a vacuum) to gradually expand the breast. Brava pre-expansion provides extra room in the breast, along with a "fibrovascular scaffold" that the transplanted fat cells can occupy. The patient also wears Brava for a week or so after fat cell injection.


The difference was explained by increased survival of transplanted fat cells after pre-expansion: about 80 percent, as measured by MRI scans before and after surgery. This compared to about 55 percent fat cell survival without pre-expansion.


While the idea of breast fat transfer is not new, it has seen a resurgence in recent years, with several groups of plastic surgery researchers reporting successful results. However, relatively low survival of the transplanted fat cells has been a limiting factor. Without pre-expansion, there is simply not enough room within the breast for the transplanted fat cells to survive and thrive.


IMPLANTS VS FAT TRANSFER


Fat or implants are both good methods for breast enlargement.

Fat grafting to the breast is the most natural way of enhancing your breast shape and size, with minimal scars. There is no chance of rejecting your own fat and the risk of infection is much lower compared to breast implants. The main drawback of fat grafting is the limited amount that can be injected in each sitting.


Breast augmentation with implants is faster and can be performed in a single stage, but carries a higher risk of infection, scars, and capsular contracture. They also do not feel as natural as your own fat. Additionally, there is also the option of a hybrid breast augmentation, where both methods are used.


Each method has its pros and cons, and the right method should be decided in a thorough consultation with our plastic surgeon who is experienced in both. Through close discussion, you and your plastic surgeon can determine the best procedure for you.


CONCLUSION


Breast augmentation surgery can increase fullness and projection of your breasts, improve balance of breast and hip contours & Enhance your self-image and self-confidence. But does not correct severely drooping breasts. A breast lift may be required along with a breast augmentation for sagging breasts to look fuller and lifted.


Breast lifting can often be done at the same time as your augmentation or may require a separate operation. The plastic surgeon should practice cautious & assist the patient in making this decision.


REFERENCE

Fat Graft in Composite Breast Augmentation with Round Implants: A New Concept for Breast Reshaping by Luca Maione, Fabio Caviggioli, Valeriano Vinci, Andrea Lisa, Federico Barbera, Mattia Siliprandi, Andrea Battistini, Francesco Klinger, Marco Klinger (2018)

Breast Augmentation Augmentation Mammaplasty by Plastic Surgery ASPS (2023)

Fat Transfer Provides Alternative to Breast Implants by Plastic Surgery ASPS (2012)

Aesthetic Procedures: Breast by Plastic & Reconstructive Surgery (2021)

Placement of Breast Implants by Mayo Clinic (2023)


 


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IFAAS Mini Fellowship (Observation)

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Aesthetic Breast Augmentation & Breast Lifting


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