San Francisco, California-There are several reasons that a woman may elect to have her breast implants removed and/or replaced. The reasons vary greatly, from capsular contracture, to a rupture or deflation, double bubble, breast implant malposition caused by pregnancy, aging, or capsular contracture, dissatisfaction with size or shape, and many other reasons.
Most women understand that breast implant devices are not “lifetime devices” and most will need to have breast revision surgery possibly every ten years. When a woman decides to have her implants replaced, she then needs to make a decision as to what she will do to replace the volume, if anything. There are many options; she can replace with the same type of implants she previously had, or switch to a different type. Many women with saline implants want to change to silicone as they have a more natural feel. If a woman has been unhappy with the size, she may choose to go larger or smaller. Many want the new “gummy bear” implants that recently got FDA approval. Some will choose not to replace their implants with anything.
Today there is another option, and that is fat transfer to the breasts from another location on the patient’s body by liposuction, usually the tummy, flanks, or thighs. Fat transfers and fat injection procedures are increasing every year. Augmenting the face, due to loss of fullness from aging, is done many times in conjunction with a facelift. The Brazilian Butt lift, which is enhancing the butt with fat transfer, has become all the rage for the obtaining the now popular “hourglass figure.” The back of the hands, which are a giveaway for aging, no matter how young the face looks, are rejuvenated with fat injections.
Breast augmentation with the patient’s own fat has been around for a while, however, the technique has been improved. For most women, 80% of the transferred fat will become permanent. For women who are “done” with breast implants, the idea of re-augmenting with their own fat is very appealing.
When breast augmentation by fat transfer was a new procedure, there was a higher possibility that a lot of the fat would not survive and would go through a process called fat necrosis, which leaves lumps of calcified scar tissue that could interfere with readings of mammograms. Newer techniques of harvesting the fat give the fat a much higher chance of surviving and the incidence of fat necrosis is much less. Radiologists have gotten much better at determining calcifications associated with cancer than those of benign conditions.
When the implant is removed, the capsule that formed around the breast is not removed. The capsule is normal scar tissue, unless it becomes too thick and squeezes the implant making it distorted and feel hard, then it is referred to as capsular contracture. The fat that is removed by liposuction from the tummy or the hips is not placed into the pocket but placed in tiny micro tunnels in the layers of tissue outside the capsule. The capsule prevents the fat from migrating into the space left by the pocket. Drains are usually placed to help close the pocket.
The amount of fat that can be transferred depends on a few different factors, such as; how thick the tissue is that the fat is going into, if the implants were sub muscular there is an extra layer of muscle into which the fat can be placed. Some patients can receive enough fat to be almost the same size as they were with implants.
Disadvantages are: large enhancements cannot be done, and for a slender woman, she might not have enough donor fat available.
Dr. Delgado is a Board Certified Plastic Surgeon, who has specialized in breast surgery since 1988, serving the greater San Francisco Bay Area, San Jose and Sacramento.