News that breasts can be augmented by grafting one’s own body fat was like the ultimate ‘dream come true’ kind of solution for women looking to enhance their figure while also worrying about having something foreign inserted into their bodies. Soon however, it was realized that only modest albeit permanent gains are possible with this method and it did not satisfy what many out there were looking for.
Breast Augmentation with silicone implants has been around for over 5 decades and the modern techniques and implants have reached a high degree of perfection and predictability. The satisfaction with this technique is indeed very high. Yet there are those in whom the result looks just a bit fake or the shape is not right or they have issues with cleavage, upper pole fullness or wide separation of breasts. These are difficult to solve using implants alone.
Combine the two above-mentioned techniques and one could have a winning combination. This is the new trend in breast augmentation and it goes by the name of composite breast augmentation. This allows the doctor to use a smaller implant as the ‘core’ of the breast mound and to use body fat as a natural material to fill out and enhance different areas of the breast to give a better shape in addition to volume. Augmentation using fat graft can be customized as it is built up part-by-part, layer by layer, unlike an implant which goes in all at once and sits at the core of the breast mound.
Composite BA gives softness to the augmented breast, improves tissue coverage over the implant, addresses the need for fullness in the upper pole and can specifically address issues like poor cleavage, separation of the breasts on the chest, a very ‘bony’ midriff, or asymmetries. There is some preliminary observation that it may even reduce the last unsolved problems of breast implants namely the capsule contraction and implant pocket drift. There is also the bonus of shape improvement in the areas where fat was in excess.
However, it takes longer to do, there must be sufficient body fat available and the surgeon must have experience in this technique. A significant part of the transplanted fat fails to survive but the rest survives permanently. The non surviving fat may be converted to oil cysts visible on an ultrasound or MRI, there can also be small calcific dots visible on later mammograms. These are not harmful to the body however. In a recent study of 197 cases followed for 3 years, the authors reached the following conclusions: “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.”
Fat can be harvested from many body areas; common ones being arms, abdomen, hips, thighs and back. Fat grafting can also be repeated after 4-6 months for another round of enhancement. However, the limits of fat grafting should be respected. Pushing too much fat into a tight space and not properly distributing the fat leads to large amounts of fat not surviving and then this leads to larger cysts, nodules and problems. As always, the technique has to be sound and the doctor experienced and trained well.
Composite BA seems to be an exciting new addition to the field of breast aesthetics and one likely to find greater acceptance soon. The author has already started using this method and the experience so far is very encouraging.