Is the hybrid technique where an implant is placed under the breast tissue (subfascial) for augmentation, and simultaneously fat graft is injected in the breast tissue envelope to create a more reliable and concealable layer over the implant.
Breast augmentation is the most common cosmetic plastic surgery procedure performed. Patient satisfaction after this procedure is high and long-term complication rates have been acceptably low. However, certain challenges in breast augmentation remain, despite advances in implant technology and operative techniques. Achieving adequate soft tissue coverage of the implant has been a persistent challenge in breast augmentation, particularly in thin patients. A paucity of breast tissue and subcutaneous fat can portend a poor cosmetic result despite excellent enhancement of volume and projection, due to the inability to hide the presence of the prosthesis under the patient’s native tissue. This mismatch between size and soft tissue coverage results in implant palpability, edge visibility, and often rippling, all of which are disconcerting to both the patient and surgeon.
Primary fat grafting at the time of breast augmentation has emerged as another tool to better maintain natural breast shape and conceal the underlying prosthesis while augmenting breast size. Composite breast augmentation refers to the principle of combining prosthetic implants and autologous fat to manage the core volume and overlying soft tissue of the breast, respectively. The use of both implants and autologous fat allows the surgeon to have independent control over breast volume using implants, and breast shape using autologous fat. In this regard, composite augmentation circumvents some of the limitations of implant-only augmentation in patients with a deficient soft tissue envelope, manages breast asymmetries more precisely, and obtains the desired breast shape in a more refined manner.
Many patients who undergone breast implant surgery in the past might choose to remove their implants for a variety of reasons. Unfortunately, removal of the implants often is not easy as placing it. Over time, the breast tissue experience changes due to the implant reaction as the body recognizes it as being a foreign body and creates a wall called the implant capsule. Commonly, the capsule is thin and pliable, however, in some instance the wall can be thick and firm causing pain, breast distortion and other relevant symptoms. Additionally, breast tissue may sag and deflate over time due to continuous exerted pressure of the breast implant on the surrounding tissue. As result, when implants are removed, unless a patient has gained weight, they are often left with less breast tissue than they had prior to the augmentation procedure.
Implant removal can be performed through the same inscion where the implant was introduced. If the implant is intact, it is removed. If the implant is ruptured, the implant casing as well as the implant material is completely removed and the tissues thoroughly cleansed. If the implant scar (capsule) is problematic, it is also partially or fully removed with a surgical procedure called a capsulectomy. A breast lift or implant exchange (usually with a bigger size) with up lift can then be performed depending on the patients’ dynamics and desires.
Patients choose to have implants removed due to implant deflation, implant malposition, waterfall deformity, implant visibility or rippling, pain from implants, capsular contracture or scarring around the breast implant, weight gain, back pain, breast asymmetry or simply because the implants have been in place for a long period of time and the patient would like them removed or exchanged.
Some patients who have had implants for a long period of time and have some sagginess of their natural breast tissue and some stretching of their overlying breast skin. In this case, you may want a procedure to lift the breast into a more aesthetic position, called a mastopexy or breast lift.
After your procedure, you will be fitted with a special post-surgical bra or wrap. You will have a light dressing covering the incisions. Swelling is typical after surgery. You may shower 24 hours after the procedure. Dr. Karaaltın uses a multimodal pain management approach to reduce or eliminate your need for narcotic pain medication, which helps patients recover quickly and feel more like themselves soon after their cosmetic surgery. Most of our patients are ready to return to work within 1-2 weeks. Initially, Dr. Karaaltın and the medical staff will see you or communicate with you to ensure proper healing. Most of the swelling begins to subside within the first week or two and typically resolves by 4-6 weeks. We advise you to avoid heavy lifting or strenuous activities greater than 5 kgs for 4-6 weeks during the healing process.