Preservation of the Peri-prosthetic Capsule Allows Larger Volumes of Fat Transfer After Explantation
Background:
•Autologous Fat Grafting (AFG) offers a promising solution for preserving breast contour and volume, especially after explanation1.
•A common concern with breast AFG is volume retention, with smaller volume AFG potentially requiring multiple fat grafting sessions. However, larger volume AFG can have unpredictable graft survival2.
•Implant removal may necessitate capsulectomy, which further depletes breast volume and eliminates a potential fat grafting plane, which may be an important consideration for volume retention3.
Objective:
The purpose of this study is to investigate the role of capsular preservation and postoperative outcomes of large-volume AFG for breast reaugmentation after explantation.
Methods:
•A retrospective review was conducted on all consecutive cosmetic augmentation patients who underwent explantation with large-volume AFG (>200 mL) performed by the senior author between January 2021 and July 2024.
Surgical Technique:
Implants were approached through a limited inframammary or circumvertical approach. In cases of calcified or abnormally thickened capsules, capsulectomy was performed. Fat grafts were deposited in separate 2 mm ribbons into the soft tissues of the breasts. Subcapsular fat deposition was conducted when the capsule was present.
Results:
Fifteen patients (30 breasts) were included
•Average BMI was 26.25±4.64.
•Indications for explantation included breast implant illness (n=1), ruptured implants (n=3), capsular contracture (n=5), pain (n=2), and aesthetic dissatisfaction (n=4).
•Implants were pre-pectoral in 33% of cases.
•Capsulectomy was performed in 47% of breasts, and mastopexy in 87%.
•Average implant size removed was 357±71 mL and average AFG volume was 555±225 (range: 210–1000) mL.
Capsulectomy, pocket location, and BMI on AFG volume
•AFG volume was 28% greater in the no-capsulectomy group compared to the capsulectomy group (460.71±139.25 vs. 637±256, p<0.03).
•BMI and pocket location (pre-pectoral vs. sub-pectoral) did not have an impact on the amount of fat injected (p=NS).
Complications
•Two breasts in one patient developed dehiscence and superficial infection within 30 days
•Fat necrosis occurs in 4 breasts and was not associated with initial AFG volume (p=NS)
•No other early complications (donor-site complications, seroma, hematoma, deep vein thrombosis (DVT), fat necrosis, or reoperations) occurred.
Additional AFG
•Two patients required additional fat grafting of 366±199 mL
•Breasts requiring additional fat grafting had lower initial AFG (290 mL vs. 595 mL, p<0.001).
Conclusions:
•Large-volume autologous fat grafting after cosmetic explantation is an effective option for maintaining aesthetic goals with minimal complications.
•Preserving the periprosthetic capsule during explantation facilitates larger fat volume transfers.
•Lower initial graft volumes may increase the likelihood of requiring additional fat grafting.
References:
1.Turner A, Abu-Ghname A, Davis MJ, Winocour SJ, Hanson SE, Chu CK. Fat Grafting in Breast Reconstruction. Semin Plast Surg. 2020 Feb;34(1):17-23. doi: 10.1055/s-0039-1700959. Epub 2020 Feb 15. PMID: 32071575; PMCID: PMC7023975.
2.Seth I, Bulloch G, Gibson D, Chow O, Seth N, Mann GB, Hunter-Smith DJ, Rozen WM. Autologous Fat Grafting in Breast Augmentation: A Systematic Review Highlighting the Need for Clinical Caution. Plast Reconstr Surg. 2024 Mar 1;153(3):527e-538e. doi: 10.1097/PRS.0000000000010614. Epub 2023 May 2. PMID: 37166041.
3.Maurice Y Nahabedian, Large-Volume Autologous Fat Grafting to the Breast, Aesthetic Surgery Journal, Volume 41, Issue Supplement_1, June 2021, Pages S16–S24, https://doi.org/10.1093/asj/sjaa426
