composite breast augmentation

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Important notice before reading this information:
I only use Motiva breast implants produced by Establishment Labs. Until now, there is not one single (scientific or non-scientific) report of ALCL with Motiva implants worldwide. This is believed to be due to the innovative nano-texture of these implants. Nevertheless, we are always vigilant for this problem.

Composite Breast Augmentation

Today's new standard in breast enlargement

Drs. Phillip Blondeel (Gent, Belgium), Eric Auclair (Paris, France) and Daniel Del Vecchio (Boston, USA) are the pioneers of this technique. They have published the scientific value and safety in the following scientific article:
Auclair E, Blondeel P, Del Vecchio DA. Composite Breast Augmentation: Soft-Tissue Planning Using Implants and Fat. Plast Reconstr Surg. 2013 Sep;132(3):558-68.

Retro-pectoral breast augmentation: the abandoned standard

The standard in breast augmentation used to be placement of a silicone implant behind the big pectoral muscle. This was done to cover the upper edge of the implant in order to create a more natural décolleté area.

But there important drawbacks of this technique:

painful procedure as the origin of the muscle is cut in its lower part
risk of creating a double bubble deformity
Animation/movement of the implant as the pectoral muscle contracts
difficult to medialize implants and to create a natural-looking cleavage

Pre-pectoral breast augmentation: works only in selective cases

To avoid the problems of pain and implant animation, the silicone implant can be placed in front of the pectoral muscle.

This technique works however only in patients that have sufficient thickness of their subcutaneous fat layer. This layer will camouflage the (upper) borders of the implant, ensuring a natural-looking result.

Breast augmentation by lipofilling only: also for selected cases

Performing a breast augmentation just by the technique of lipofilling is possible under certain conditions:

you need to have sufficient fat depots somewhere else on the body (hips, thighs, abdomen, love handles)
the breast skin needs a certain laxity: this occurs mostly after pregnancy or weight changes.

Disadvantages of this technique include:

“limited” volume augmentation: the amount of enlargement one can achieve in one session is less than one cup size. Multiple surgical sessions are possible with an interval of 3 months and can achieve larger volume augmentations
at every procedure there is a resorption of fat up to 40-60%

Advantages of this technique include:

improvement of breast volume and skin quality
specific shape adjustments are possible to perform, improving the aesthetic outcome with regards to symmetry
delivery of a permanent, natural result
avoids implant complications
no scars
limited pain, quick recovery
liposuction at the donor site will improve body contours

Composite Breast Augmentation, the new standard

To create natural looking breast augmentations that avoid the disadvantages of the other techniques, mentioned above we have been performing Composite Breast Augmentations (CBA) since 2010.

The implant is placed in front of the pectoral muscle mostly through a incision at the inframammary crease. This type of incision will allow easy revision if necessary in a later phase. It also allows perfect control of the creation of the pocket in which the implant is positioned.

Lipofilling is performed in the deeper layers just above the implant and in a superficial plane at the level of the medial and upper border of the implant, hereby camouflaging the implant border and providing a natural-looking décolleté.

Lipofilling can also be performed over the entire breast in the subcutaneous layer. This will create an even more natural result. Sufficient fat needs to be available for this variant.

This will also will allow the use of even smaller implants, favouring the balance of patient's own tissues over implant volume. This will provide better long-term results.

Advantages of Composite Breast Augmentation include:

improvement of breast volume and skin quality: in contrast to "lipofilling-only" augmentations, full cup size(s) increases can be easily achieved
specific shape adjustments are possible to perform, improving the aesthetic outcome with regards to symmetry
pre-pectoral pocket dissection is easier to perform and better to control compared to retro-pectoral pockets
minimal pain, what translates in faster rehabilitation
no implant animation with pectoral contraction
Precise control of inter-mammary distance and filling of décolleté
very natural result
liposuction at the donor site will improve body contours

The main disadvantage of this technique is that it has a prolonged operating time, what means that the procedure is often more expensive than other conventional breast augmentation techniques. On the other hand, it is a two-in-one operative procedure combining breast augmentation with body contouring.