Breast Augmentation With Fat Transfer

For breast augmentation results that look and feel the most natural, plastic surgeons typically place the breast implant behind the existing breast tissue and under the chest muscle (called a submuscular placement), so the implant is not easily seen or felt. This common technique is not without drawbacks, including a recovery that is longer and more difficult than it needs to be. Dr. Robert Shenker is one of the only surgeons in Canada who offers his patients an alternative called "composite breast augmentation" at his Kitchener-Waterloo clinic. This approach is often a better choice for women from London, Guelph, Windsor, and Cambridge who want to enhance the size and shape of their breasts and get back to their busy lives as quickly as possible.

What are the drawbacks of placing the implant under the muscle?

In order to place the implant under the chest muscle during breast augmentation, the surgeon creates a pocket for it by partially detaching the pectoralis major muscle from the ribs and chest bone. After surgery, the muscle must stretch to accommodate the volume of the underlying implant. All of this usually causes bleeding, prolonged pain, and swelling in the upper chest. In addition, the chest muscle loses strength–and worse–distorts the shape of the breast with certain arm movements (called animation deformity).

Why not just place the implant on top of the muscle?

While recovery from the traditional subglandular approach (placing the implant on top of the chest muscle) is easier than with submuscular implant placement, results usually do not look natural. Because the implant is not covered by the chest muscle, the upper edge of the implant is usually noticeable, especially in women without much fat and breast tissue of their own.

What is composite breast augmentation?

This technique combines the use of a highly cohesive silicone gel breast implant with fat transfer. Using liposuction, fat is collected from areas where it's not wanted–such as the abdomen, flanks, or thighs–and purified. The breast implant is placed behind the natural breast tissue, but on top of the intact chest muscle. The purified fat is then carefully injected into the breast around the implant. The transferred fat conceals the upper portion of the implant while enhancing the shape of the upper breast and cleavage. Most patients require just 50 to 150 cc of purified fat per breast.

implant placement diagram implant placement diagram

What are the advantages of breast augmentation with fat transfer?

Dr. Shenker prefers the composite technique for a variety of reasons, including:

  • The chest muscle is left alone, so there is less trauma to tissues and faster recovery.
  • A slightly smaller implant is needed, which reduces stress on supporting tissues.
  • The upper breast and cleavage can be enhanced without complications, such as symmastia. In fact, the cleavage area can be specifically targeted for enhancement.
  • Breast shape can be fine-tuned with mindful placement of fat grafts.
  • The transferred fat responds to the patient's weight fluctuations to keep the breasts proportional with the rest of the body.
  • Areas of unwanted fat are sculpted as part of the procedure.

Review the table for a side-by-side comparison of the 3 techniques

Comparison of Breast Augmentation Techniques

Results Under the Muscle Under the Breast Tissue Composite
Breast size increased Yes Yes Yes
Chest muscle impacted Yes No No
Top of implant covered Yes No Yes
Implant distortion Yes No No
Upper breast enhanced Not always Not always Yes
Cleavage enhanced Not always Not always Yes
Breast size adjusts with weight change No No Yes
Under the muscle
Breast size increased Yes
Chest muscle impacted Yes
Top of implant covered Yes
Implant distortion Yes
Upper breast enhanced Not always
Cleavage enhanced Not always
Breast size adjusts with weight changes No
Under the breast tissue
Breast size increased Yes
Chest muscle impacted No
Top of implant covered No
Implant distortion No
Upper breast enhanced Not always
Cleavage enhanced Not always
Breast size adjusts with weight changes No
Breast size increased No
Chest muscle impacted No
Top of implant covered Yes
Implant distortion No
Upper breast enhanced Yes
Cleavage enhanced Yes
Breast size adjusts with weight change Yes

What is recovery like after breast augmentation with fat grafting?

Recovery after the fat grafting approach is faster and less painful than after breast augmentation with the submuscular technique. Composite breast augmentation patients are typically ready to return to work and daily activities within just a few days, although experiences vary. Depending on the amount and location of fat taken, you may need to wear compression garments on donor areas for approximately 2 weeks to minimize swelling and promote smooth results.

Because approximately 80 to 85% of the transferred fat will survive, Dr. Shenker "overfills" the breasts to achieve the desired size and shape.

What happens if I lose or gain weight?

The transferred fat cells respond to weight changes like other fat in the body; they expand with weight gain and shrink with weight loss. These size fluctuations keep the breasts looking natural and in proportion with the body as it changes.

Women travel to The Cosmetic Surgery Clinic for composite breast augmentation from London, Guelph, and throughout Southwestern Ontario. To learn more, request a consultation using our online form or call our office at (519) 746-1132 to schedule an appointment. Review this blog post for additional information about this exciting technique.

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Dr. Robert Shenker Dr. Stephanie Ma

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