The Hybrid (Composite) Breast Augmentation with Implant and Fat

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.