What is a composite breast augmentation?
It is the combination of breast augmentation with prostheses and breast lipofilling. This treatment is interesting in cases where the patient is relatively thin and her ribs very visible. If a breast augmentation is considered, despite all current modern techniques, the neckline may appear artificial with an excessive and brutal cleavage between the very thin part of the thorax with visible ribs and the beginning of the curve of the breast. In those cases where the patient has a little fat to collect via liposuction it can be interesting to use this fat to camouflage the edges or contours of the implant. The whole problem though lies in the possibility of actually finding any fat to use as most often those breast augmentation patients who are so thin that their ribs are visible simply do not have any fat to be taken via liposuction, or else so little that that it will be useless for the realization of a lipofilling.
What is the procedure for composite breast augmentation?
As usual, before any plastic surgery breast operation, it is necessary to have one or two consultations with the plastic surgeon, have a blood test, a mammography, buy a post-operative support/compression bra and see the anesthetist. If you smoke you have to stop a month before the operation. The operation takes place on an outpatient basis or, more often, with an overnight stay for supervision at the Blomet or Eiffel clinic. It lasts on average 2h30.
How is it done on a technical level?
First of all, micro incisions are made hidden in small folds and other discreet areas and the fat is removed with the power-assisted (PAL) liposuction technique with a gentle and tumescent suction. The following areas are preferred: the inner side of the knees, the inner side of the thighs, the sides (love handles), the hips and the belly. The fat has to be deep and the skin must be of a good quality. The whole problem with liposuction is that the fat that is taken can very well return if the patient gains weight, it can sometimes be put on elsewhere and also the skin is likely to wrinkle if it is not of sufficient quality (orange peel effect or cellulite).
Once the fat has been extracted (at least a liter is needed), it is centrifuged to remove everything that is unnecessary (blood, tissue debris, oil, etc.) and then injected into the neckline to hide the edges of the breast prosthesis. Often 60 to 120 cc of fat is needed per breast.
The breast prosthesis is placed according to the usual technique, via a very short underarm incision or sometimes by the areola if it is wide enough. A pocket is created both in front and behind the muscle to obtain a natural breast augmentation effect (dual plane). From time to time it is possible that if the implant is small, the breast very glandular, and the skin very firm to place the breast prosthesis in front of the muscle prepectorally. The prosthesis (Dr. Masson often uses Eurosilicone, Nagor or Motiva Ergonomix) is round, smooth, with a flexible cohesive silicone gel. Often the profile is moderate for a nice natural breast augmentation result and the average volume is 250 to 330 ml to obtain a gain of 1 to 2 cups. Most often the patient goes from an A or B to a C or small D cup. A drain is almost never placed today.
Dr. Masson’s office is the very first in Paris to be equipped with 4D Eve 4.0 scanner technology.
When you come for a composite breast augmentation consultation you will be able to use augmented reality to discover how your new breasts will look.
What are the advantages and disadvantages of this technique?
The big advantage of this mixed technique of breast augmentation with both a breast prosthesis and fat is the very natural result obtained in skinny patients in whom breast augmentation without an implant would not be possible (not enough fat) and where an implant would give quite false results.
On the other hand, it’s important to know that the post-operative effects and pain last longer because there are two interventions combined in one. I recommend 7 to 10 days of recovery time after the operation.
The complications are always the same. For lipofilling: excessive absorption of fat, folds at the point of the liposuction, and infection. For implants: shells, ruptures, and future change is essential.
The price of composite breast augmentation with a good cosmetic surgeon in Paris costs at least 7500 euros, in practice often a little more because there are multiple liposuction sampling areas.