Fat Grafting for Implant Failure
Breast augmentation using breast implant is accepted treatment that works well in the majority of patients & today considered a reliable operation with well-defined parameters and predictable outcome but, its complications include medical ones; capsular contracture, Late onset seroma, Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) & infection plus improper aesthetic outcome like; inadequate soft tissue coverage of the implant, asymmetry, excessive fullness of the upper pole, rippling, bottoming out, , palpable implants, visible implants and an unsatisfactory shape and size compare to patient body shape and size.
For this reason, breast implantation is associated with considerable revision rates, approaching 24% at 4 years postoperative & 36% at 10 years postoperative. Complications necessitating revision include capsular contracture, pain, inadequate soft tissue coverage of the implant, asymmetry, recurrent late seroma, and excessive fullness of the upper pole. Some of the complications are more frequently than others and some of it, its incidence is increasing with increase the age of the implant in the body like capsule contracture. Revisional surgery to treat these conditions may involve changing the implant or changing the style of the implant, placing an acellular dermal matrix, performing a pocket reassignment, or performing a permanent explantation or adding fat transfer to hide the visible rippling of the implant. Most of these complications can be corrected surgically with or without breast implant exchange. Repeated the complications with a patient may end up with a decision to remove the breast implant whether the decision come up from the surgeon side or by the patient.
Fat grafting is an ideal technique for accomplishing the exchange of breast implants with autologous fat. Autologous fat transfer to the breast, consider today a novel approach that immediately follows explantation and utilizes the pliancy of the stretched skin, soft tissue, and expanded subcutaneous space of the breast as a scaffold that tolerate even large-volume fat injection. Several investigators have advocated for breast augmentation by autologous fat transfer as an alternative or adjunct to implantation.
For patients with long time saline filled implants, and she does want to remove and not use any more breast implant and has the fat transfer donor areas, in these cases the saline implants are deflated under local anaesthesia 2 weeks before the planed surgery to give the tissue time to contract. The amount of tissue retraction and improvement is impressive.