Yes, it is possible to combine a traditional breast augmentation with a fat transfer procedure. This specialized approach, formally known as Composite Breast Augmentation, utilizes the strengths of both techniques to achieve a more refined and natural-looking result than either method alone. The composite method maximizes volume increase while optimizing the soft tissue contour of the breast.
Defining Composite Breast Augmentation
Composite breast augmentation is a dual-method procedure that combines the volume-enhancing capability of a breast implant with the contouring qualities of autologous fat grafting. The primary function of the breast implant is to provide the main projection and volume increase, which is a larger effect than fat transfer alone can safely achieve. The fat component is used for shaping and blending the implant into the surrounding tissues, not primarily for volume.
The process begins with harvesting fat cells from a donor area, such as the abdomen, flanks, or thighs, using liposuction. The extracted fat is then processed to separate viable fat cells from fluids or damaged cells. The purified fat is strategically injected into the breast tissue around the newly placed implant.
The implant is placed first to establish the desired size and shape, often under the muscle or fascia for better coverage. The purified fat is then injected in small, precise aliquots into the breast tissue, especially around the implant edges and the cleavage area. This dual approach gives the surgeon control over both the foundational volume and the final contouring achieved by the fat. Using the patient’s own tissue for this final layer results in a softer transition than an implant-only procedure.
The Aesthetic Function of Fat Grafting
The fat used in composite augmentation serves the distinct purpose of aesthetic refinement. Its most important role is to soften the transition between the implant’s edge and the chest wall, especially along the lower and outer borders. This blending creates a gradual slope, helping the augmented breast look and feel more like natural tissue.
For patients with minimal natural breast tissue or a thin skin envelope, the fat acts as a biological buffer to disguise potential signs of the implant. It is effective at camouflaging visible rippling or palpability, which can occur when the implant is close to the skin’s surface. By increasing the thickness of the overlying soft tissue, the fat layer makes the result appear smoother and more seamless.
Fat grafting is also used to address minor pre-existing or post-operative asymmetries between the breasts. Strategic placement of the fat allows for fine-tuning the breast shape that the fixed form of the implant cannot achieve alone, such as enhancing upper pole fullness or improving the cleavage contour. Furthermore, the transferred fat is thought to improve the quality of the overlying skin by introducing regenerative cells.
Ideal Candidates for the Combination Procedure
Patients who benefit most from composite breast augmentation generally desire a significant volume increase but seek the most natural aesthetic possible. A primary candidate is a patient with a naturally thin body type who has low native breast tissue and a thin skin envelope. For these individuals, an implant alone might be too visible or palpable, making the added fat necessary for coverage and a smooth contour.
Another ideal candidate has a slight degree of breast asymmetry, where the fat can be used as a targeted filler to equalize minor volume differences. The patient must also possess a sufficient amount of harvestable fat in other areas, such as the abdomen or thighs, to provide the necessary volume for grafting. While the fat volume needed for contouring is not as large as for a fat-only augmentation, a viable donor site is still a prerequisite.
This combined method is also considered for revision cases, where a patient seeks to correct contour irregularities or address implant visibility from a previous surgery. Patients with tuberous breast deformity, which involves constricted tissue at the base of the breast, are excellent candidates. The fat can be placed strategically to soften the constricted areas and provide a more rounded lower pole contour.
Expected Results and Long-Term Viability
The short-term aesthetic result of composite breast augmentation is a breast that feels soft and displays smooth, natural contours without the sharp edges sometimes associated with implants. The fat layer provides a cushioned effect over the implant, contributing to a more realistic feel. Immediately after the procedure, the transferred fat volume will be slightly larger than the final result, as not all injected fat is expected to survive.
A percentage of the transferred fat cells will not establish a new blood supply and will be naturally absorbed by the body in the initial months after surgery. Studies indicate that the volume retention rate typically stabilizes between 50% and 80%, with the final volume becoming permanent after about six to eight months. Once the surviving fat cells integrate into the breast tissue, they behave like any other fat cell and last indefinitely.
The long-term viability of the fat is directly tied to the patient’s weight stability; the transferred fat will fluctuate in size with future weight gain or loss, just like the fat in the donor area. The recovery period for a composite procedure is slightly more involved than an implant-only surgery because it includes two separate surgical sites: the breast and the liposuction donor area. Patients must manage post-operative care for both areas, with the liposuction sites requiring compression garments and healing time.