Autologous Fat Grafting for Breast Augmentation in Patients after Implant Removal

Abstract

Introduction: Patients diagnosed with symptomatic capsular contracture or with safety concerns for the implant are often reluctant to accept the operation of implant exchange, choosing instead removal without exchange or taking other options to rebuild their breasts. These patients may benefit from augmenting the overlying soft tissue of the breasts with autologous fat grafting (AFG) after removing the prosthesis if the aesthetic appearance of their breasts is an issue. A retrospective analysis of patients receiving AFG for breast augmentation after implant removal was performed. The outcomes in these patients were compared with those of the patients receiving AFG for breast augmentation as their first breast surgery during the same period. Materials and Methods: Between March 2011 and November 2013, 27 patients receiving AFG after breast implant removal (BIR) were assigned to group A and 325 patients who underwent AFG for breast augmentation without preexisting implant by the same surgeon were assigned to group B. Objective evaluation was made by measuring the change in the difference of breast circumference (BCD) and breast thickness measured by ultrasonography taken before and after the treatment. Aesthetic evaluation was performed using a 5-point Likert-type scale for patient satisfaction and comparing preoperative and postoperative digital photographs for physician satisfaction. Results: Relative to group B, patients in group A were older and had higher complication rates, including infection, fat necrosis, indurations, and calcifications (P < .05). The changes in BCD and breast thickness between the 2 groups were of no clinical significance. The reoperation rate in group A was significantly higher (P < .05). Conclusions: The number of postoperative complications of AFG for breast augmentation was found to be higher in patients after BIR. The optimal timing of AFG in the patients after BIR should be further studied if 2-stage augmentation with fat grafting is to be performed. Reoperation with fat grafting to the breasts should be considered if patients expect to have the original volume of their breasts restored.