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Composite Breast implant-fat graft augmentation.

Breast enlargement is one of the frequently requested cosmetic procedure. Traditionally a silicone based implant is used to enhance the breast size. Fat grafting is now establishing itself as an adjunct in cosmetic surgery and may be used as a volume enhancer on its own ( primary breast fat graft enlargement) or in combination with an implant which is the modern concept called composite breast- fat graft enlargement.

This technique is ideal for patients who are generally on the slimmer side in whom the implant may have to be placed under the muscle to avoid the risk of implant viability ( rippling) or palpability (knuckling) . However placing the implant under the muscle has its limitations such as weakening the muscle, and more importantly can result is “twitching breast syndrome”. In this conditions the implants/ breasts twitches every time the pectoral muscle is contracted and may be noticeable to others. To avoid this complication in composite implant-fat graft enlargement , the implant is inserted in front of the muscles but under the pectoral fascia and fat is grafted in the subcutaneous place in front of the implant. This gives a smoother outline to the Augmentation and minimises the risk of implant visibility as well avoiding the “twitching breast syndrome”.

The fat grafting is carried by doing liposuction harvesting of fat from abdomen or thighs and the fat cells are prepared in a special device. These fat cells are then grafted into the breast.

The procedure requires a general anaesthesia and overnight hospital stay.
Like with any surgical procedures the complications include those related to implant Augmentation and fat grafting.

Complications of implant augmentation include:

Bleeding

Infection which can lead to implant loss , this risk is less than 1%

Implant rupture, leak, bleed

Capsular contracture – <5% Migration Bottoming out Implant rippling and knuckling Shelf life - implant lasts 10 to 15years and may need to be replaced after that. BIA- ALCL - (Breast Implant Associated Anaplastic Large Cell Lymphoma )this is an unusual and rare condition that can develop within the capsule around the implant. It is basically a malignant large cell lymphomas of the capsule and seem to be associated with fully textured silicone implant and so far just under 200 cases have been diagnosed world wide. No exact cause-effect has been identified but the conditions appears to be associated with fully textured implant.

Complications relating to fat grafting include the following

Donor site complications

Complications that may occur at areas where liposuction is carried out are:

Bleeding

Bruising – this usually settles in few weeks

Numbness of skin

Grooving

Tunnelling

Fat necrosis – these are small hardened areas which should settle in few months

Breast injection site limitations and complications

Bleeding

Bruising

Implant damage needing replacement of implant

Infection

Fat necrosis and Oil cyst – fat necrosis and oil cyst tend to present as area of hardening or discreet lump in the breast and should be clinically assessed with ultrasound scan of the breast. Oil cyst requires aspiration with a needle and syringe under ultrasound guidance where as fat necrosis area usually settle down with time.

Loss of injected fat – as alluded earlier, some loss of fat is normal but in some patient there could be suboptimal or poor uptake of fat cells and may require more than session of fat grafting.



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