Objectives: To present simple ways of using fat for primary breast augmentation, mastopexy and implant removal.
Introduction: Fat grafting should be considered a primary option in both aesthetic breast augmentation with implants, mastopexy with or without implants and a variety of congenital and secondary aesthetic breast deformities.
Materials / method: A closed system with Power Assisted Liposuction (PAL) techniques is preferred. Tumescent is delivered using a vibration for better dispersion and hemostasis as shown by Del Vecchio. Harvest is done with cannulas whose hole size is compatible with the diameter of the delivery cannula. Implant sizers are placed either submuscularly or subfascial, followed by lipoharvest, cleaning of the lipoaspirate with Ringer’s lactate and grafting with an automatic, vibratory cannula in an extracorporeal loop.
Results: Indications for fat grafting included women with thin tissue covering, anatomic variations such as a wide cleavage or asymmetry. Patients requesting mastopexy are more likely to benefit from fat grafting alone. Patients with specific deformities such as Poland’s syndrome or tubular breast deformities are excellent candidates for combinations of fat grafting with implants or fat grafting alone. With the resurgence in fear about textured implants and BIA-ALCL, more woman are having total capsulectomies and volume replacement with fat.
Conclusion: Fat grafting for primary and secondary aesthetic concerns should be considered as part of your approach. The procedure is simple when done as a closed loop and will continue to yield better results as new agents such as P188 are introduced on the market.
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