Breast implants with fat transfer can be a powerful tool in breast reconstruction, as recently demonstrated by leading Beverly Hills plastic surgeon Dr. Tarick Smiley on his Snapchat account.
The patient shown in the video had breast implant removal two years ago due to capsular contracture, a complication in which the thin scar capsule surrounding the prosthesis becomes copious and hard, leading to pain and deformity. Some studies have linked implant contamination at the time of surgery and low-grade infection during the initial recovery to this problem.
(Note: A thin scar capsule always forms around any implanted device. In fact, this is an auspicious natural process that prevents the breast implants from migrating or causing deformity. It only becomes problematic when the scar tissue becomes too thick and thus causes pain and unnatural contour.)
However, the patient’s previous corrective surgery (i.e., the capsular contracture was removed simultaneously with the implants) left her with marked asymmetry between her breasts, with the left side having its submammary fold riding higher and its tissue looking droopier than the other side.
To improve breast symmetry, shape, and projection, Dr. Smiley performed breast implants with fat transfer. The implants would provide additional volume and improve the overall contour, while fat transfer would give extra padding to make the left submammary fold match the other side.
During breast reconstruction surgery, Dr. Smiley created a small incision right at the border of the areola (pigmented part of skin) to propel the implants into their respective pocket. This incision technique generally leads to invisible scar provided that it heals well and lies precisely at the dark-light skin junction.
In the video, Dr. Smiley said the peri-areolar incision would suit the patient because it was also the incision site during her two previous surgeries (primary breast augmentation and breast implant removal due to capsular contracture). Hence, she has avoided additional scar.
After ensuring that both implants were positioned in their most natural, symmetric placement, Dr. Smiley released the lower pole of the left breast so it could take fat grafts. He then performed fat transfer with the use of blunt cannula that released “minute droplet of fat graft one at a time,” a technique known to result in high survival rate (70 percent is expected to last a lifetime).
With the concurrent fat transfer, Dr. Smiley said the once higher submammary fold of the left breast would match the other side.
He then closed the tissue in several rows with absorbable sutures, without “picking up the skin.” By eliminating most of the tension on skin, the incision is expected to heal well and its resulting scar can fade better into the background.