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Secondary Composite Breast Augmentation: Concept and Outcomes, Introduction to a Layered Approach.

BACKGROUND
Secondary procedures following breast augmentation are often more difficult than primary cases, because the soft-tissue envelope changes over time.


OBJECTIVES
This study was conducted to confirm the utility of a composite technique in breast revisional surgery.


METHODS
This was a 9-year retrospective chart and photographic data study of one surgeon's experience with the combined use of fat and implants in revisional cases. The 148 patients had a follow-up at least one year after surgery. Our approach consists of a detailed analysis of the different layers covering the implant and yields a treatment plan addressing all issues involving the secondary breast.


RESULTS
On average, revisional surgery was performed 8.66 years after the first augmentation. The mean age of the patients at surgery was 42 years (range, 22.2-70.7 years). The mean fat harvest was 600 mL (range, 100-3000 mL) and the mean volume of fat reinjected was 153 mL (range, 60-400 mL). The mean volume before and after revision was the same (288 vs 289 mL). Preoperatively, the breast implants were located in a subpectoral pocket in 78.7% of the patients and, postoperatively, in a subglandular pocket in 74.8% of the patients. Within the first 2 years, 13 patients (8.7%) underwent reoperation for additional fat grafting. Among 45 preoperative breast capsular contractures, there were eight recurrences in the first 3 years and four reoperations.


CONCLUSIONS
Secondary breast augmentation cannot rely solely on implant exchange. Because the soft-tissue envelope also ages over time, fat grafting is mandatory in the vast majority of secondary cases. A rigorous preoperative analysis enables breast defects to be treated appropriately.