Hybrid breast augmentation recovery: how does it differ from implant alone?

There is one additional point to monitor during recovery. In reports of breast reconstruction using fat grafting in combination with implants, complications occurred in 7.9%, which was comparable to implant-only reconstruction.[1]However, these are figures from reconstruction surgery, so they cannot be directly applied to aesthetic surgery.[2].

Do complications become "double"?

There is a report indicating they do not simply add up. Complications from breast reconstruction using fat grafting in combination with implants are 7.9%, which is comparable to implant-only reconstruction.[1]However, these are figures from surgery to reconstruct the breast.[1].

For aesthetic purposes, there is a study of 932 cases comparing 302 cases using both implants and fat grafting, 353 cases with implant alone, and 277 cases with fat alone.[2]At the stage where such comparisons have emerged, long-term conclusions have not yet been finalized.[2].

Can capsular contracture be reduced?

There is evidence suggesting it may be reduced, but this is not confirmed. The current understanding is that fat grafting in combination may offer the benefit of lowering the risk of capsular contracture (hardening around the implant) over the long term.[1].

In a report where fat was placed first followed by implant placement in breasts that had undergone radiation therapy, 93.7% showed favorable results at an average follow-up of 15 months, though all cases showed the mildest stage of capsular contracture.[3]Since hardness evaluation is primarily based on subjective palpation grading, research using ultrasound elastography for objective measurement is also progressing.[4].

What can happen on the fat side?

Oil cysts, fat necrosis progressing to calcification, unpredictable graft survival, infection, and palpable nodules have been reported.[5]Since these complications differ in nature from implant complications, the approach to follow-up monitoring also differs.

Care is needed in interpreting figures. A review summarizing complications from fat grafting breast augmentation notes that complication rates may be overestimated when reviews mix simple breast augmentation with reconstruction after radiation therapy or flap procedures.[6]When you see a figure stating "complications from fat grafting are X%," confirm what patient population that figure includes.[6].

What happens to the result if body weight changes?

The volume that persists long-term depends on body weight changes. In a study using MRI over a 3-year follow-up period, it was noted that avoiding intentional weight loss after surgery and weight gain may increase the percentage of fat that persists.[7].

There is one practical consideration that can be drawn from this. If there is limited fat available for harvesting, gaining weight before surgery and returning to baseline weight after surgery may actually reduce the amount of fat that persists.[7].

It may not be completed in one session.

Fat grafting may be performed in multiple sessions. In reconstruction reports, the number of injections per side averaged 1.3–3.2 times, with volumes per injection ranging from 59–313 mL.[1]If you include the possibility of additional sessions in your plan from the beginning, you are less likely to feel like the plan has changed partway through.

What to confirm at your consultation

The first is how many sessions the fat grafting is planned to be divided into.[1]The second is how capsular contracture will be managed if it occurs.[4]The third is whether you have plans for significant weight changes after surgery.[7].

Breast tissue thickness, skin elasticity, and the amount of fat available for harvesting vary from person to person. Many of the figures listed here come from breast reconstruction reports, and applying them to aesthetic surgery involves variability. At your consultation, ask about the plan for how implant and fat will be distributed in your body, and confirm through to the outlook for any additional sessions.