The most advanced breast augmentation technique today is the combined technique, that is to say, in which prostheses and the patient’s own fat are used. Augmentation mammoplasty continues to be the most demanded cosmetic surgery in Spain and, although most of them are still performed using prostheses, the use of the patient’s own fat is spreading, as has already been shown in recent international congresses. It is the best way to correct the asymmetry between both breasts, reach those points where the prosthesis does not reach and smooth the edges of the breast implants … In short, it is about modeling the breast getting better shape and a very natural look. In addition, the use of fat is ideal to increase the cleavage and give the sensation of breasts closer together.
The tendency is to put 50% of the volume provided by the prosthesis and the other 50% provided by fat. Once injected, the fat acts in a similar way to a mountain of sand: there comes a time when the projection stops increasing with respect to the volume added and, for that reason, the use of a small prosthesis is needed to give the desired projection.
The combined breast augmentation technique is also ideal for cases of prosthesis replacement, since it avoids putting a larger prosthesis than the previous one, in order to compensate for scar tissue. With successive prosthesis replacements the amount of breast tissue is reduced and, generally, to end up with a similar volume of the breast it is necessary to increase the volume of the prostheses. The addition of fat improves the quality and thickness of the patient’s own tissue, with a more natural feel, leaving the prosthesis more covered, as well as allowing smaller prostheses with similar volume. Fat is also placed in cases where the skin is so thinned that the folds of the prostheses can be seen, a problem known as “rippling” and which occurs most frequently on the lateral edge of the breast.
Can anyone undergo the combined breast augmentation technique?
Most women can undergo this technique, with the exception of excessively thin patients who do not have fat accumulation in any area of the body, or those who are heavy smokers.
If the patient is very thin, sometimes it is not possible to add as much fat as desired, and the available fat is used to prioritize the area where to put it, for example, in the neckline, to make the breasts closer together, or on the sides, to reduce the risk of rippling.
In cases of patients who smoke, a period of at least one or two months before and approximately 2 months after surgery without smoking is recommended. Smoking affects the fat attachment, so in smokers the amount of fat that remains is less than in non-smokers.
Before performing this technique, imaging studies are always done to rule out that the patient does not have breast problems.
The fat is obtained from areas where it is aesthetically beneficial to remove it. These are usually the abdomen, back or thighs, so that the aesthetic benefit is double. Once infiltrated in the breasts, the fat will behave there as it did in the donor area, that is to say, if the patient gains weight then she will gain more weight in that area in proportion to the rest of the body.
How to choose the size in a breast augmentation surgery?
Each patient is different and, in order to achieve the best results, it is essential to take into account three aspects: the physical characteristics of the patient, her preferences and medical criteria. Patients must be listened to in order to meet their expectations but, of course, the specialist in Plastic, Aesthetic and Reconstructive Surgery must always advise the best option based on his knowledge and experience.
Treatments must always be personalized and the patient must be well informed about the different aspects of the intervention. When only prostheses are used, it is easy to know the final size, since the existing volume is from the prosthesis. On the other hand, when fat is used there is always an important variation in volume, since at the beginning there will be a great increase in size due to the swelling, and then part of that volume will be lost during the first month. The final amount of fat that remains varies depending on several factors, such as the fat injection technique and patient characteristics, among others.
What exactly does the combined breast augmentation technique consist of?
This technique combines the traditional breast augmentation by introducing a prosthesis through the areola, armpit or breast fold, with what we know as lipofilling or lipotransfer. Lipofilling consists of extracting by liposuction the fat accumulated in a certain area of the body to use it as a filling material in another area where we are looking for a greater volume. In this sense, water-assisted liposuction (Aqualipo, also known as Bodyjet or WAL) plays a fundamental role, since with this system there is less damage to the adipose tissue when extracting it, so the quality and durability is greater. Scientific publications describe a survival rate of 80-90% compared to 50-70% with the traditional liposuction technique.
Can there be complications with the combined breast augmentation technique? Which ones?
In principle it is not a technique that presents much risk of complications and, knowing how to manage the technique, these are minimized. There is a limit to the amount of fat that can be placed in a tissue and, from that point on, the risk of complications increases and the amount of fat that remains in the tissue decreases. When this happens, small indurated areas may appear due to fat necrosis, or oily cysts due to fat destruction, which are solved with massage and small punctures to empty them.
In some cases, rather than complications, it is more a matter of the fat being less than desired, and this is not 100% predictable, so the surgeon must know how to clarify the patient’s own expectations prior to surgery. Another fat filling session may be necessary three months after the intervention, until the desired volume is achieved, always on an outpatient basis, with local anesthesia and minimal discomfort.
To avoid complications it is essential to choose a surgeon specialized and experienced in the technique. The patient must check the surgeon’s qualifications and professional trajectory… when it comes to health, safety must come first. It is also important to work with the best suppliers. In Dr. Carballeira’s case, high-end prostheses are used, very safe and resistant, from the largest international manufacturers. And finally, the hospital environment: the procedure must always be performed in an operating room equipped with advanced technology and equipped with the necessary resources.
Is it a painful technique and how will the recovery be?
It is not a particularly painful technique. The patient may suffer some discomfort after the operation, which subsides with the usual anti-inflammatory drugs for about five days. It is not necessary to remove stitches, as they remain inside and the scar is minimal and hidden.
It is generally not recommended to wear tight clothing for a month to allow the fat to remain in a high percentage. It is also recommended to avoid taking weights of more than 5 kg during the first month in cases where prostheses have been placed. The patient can incorporate to her daily activity with moderation and, after one month, a totally normal life can be carried out.