Zones for Fat Grafting in Hybrid Breast Augmentation: Standardization for Planning of Fat Grafting Based on Breast Cleavage Units

Abstract

Background: Autologous fat grafting is a procedure indicated for breast augmentation to improve coverage of silicone implants and redesign breast shape. Different techniques are based on parameters that have not been systematically standardized. The authors present a method using breast zone standardization based on breast anatomy to achieve an anatomical composite breast. Methods: The authors performed this zone standardization in 76 breasts (38 patients) undergoing primary/secondary augmentation. The area between the implant and the clavicle and parasternal area was marked to receive fat grafting and divided into three zones. A mathematical formula [volume of autologous fat graft = (π × r2 × p)/4.8] was used to estimate the fat graft volume according to implant volume in the respective zones. Results: Implant volumes ranged from 205 to 375 cc (mean, 265 cc), and patients received an average fat graft volume of 105.3 cc per breast (range, 36 to 135 cc); the average fat volume in zones I/II and III was 78.28 cc (range, 0 to 100 cc) and 27.03 cc (range, 15 to 60 cc), respectively. Three minor complications were observed (5.2 percent) during a mean follow-up of 12.8 months. A high correlation was observed between the fat grafting performed in the cohort and predictions obtained from the formula (p < 0.001). Conclusions: Recognizing risky cleavage breast zones between the implant pocket and the upper and medial quadrants remains essential to attain satisfactory outcomes. Although experience and proper judgment are still important in the fat grafting technique, the data presented here offer plastic surgeons an additional standardized framework to help deliver predictable hybrid breast augmentation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Hybrid Augmentation Mastopexy with New Generation of Smooth Surface Implants: Combining the Benefits of Fat Grafting, Inferior Muscle Support, and an L-Shaped Scar

“…In our experience, some surgeons tend to address the wide cleavage deformity with larger volume implants. 37,40,41 In patients with lower pinch test results undergoing AM, the implant may be very close to the skin in Volume 152, Number 1 • Hybrid Augmentation Mastopexy 37e the medial quadrants, leading to implant tips and rippling. For this reason, applying fat grafting in zone III is a valuable technique that can provide a smoother transition in the medial region.…”

“…Approaches such as glandular flaps, 15,16 suspension sutures, 17 and muscular slings [18][19][20][21][22][23][24] and meshes [25][26][27][28] have been described, and associated techniques such as fat grafting have been suggested in patients with poor soft-tissue coverage to better cover implants. [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] Initially defined as composite surgery, [29][30][31][32] the main advantage of what is now described as hybrid breast augmentation is the ability to reshape the upper/ medial breast poles. [29][30][31][32][33][34][35][36] A recent technique involving soft-tissue support from a composite reverse inferior muscle sling has been shown as an alternative for breast/implant stabilization.…”

Subfascial Axillary Hybrid Breast Augmentation: Technical Highlights and Step-by-Step Video Guide

“…Autologous fat grafting has become more common in breast augmentation. [16][17][18][19][20][21][22][23][24][25] Concurrent fat grafting, defined as composite [17][18][19]21 or hybrid breast augmentation, 7,13,[23][24][25] has recently been evaluated as a beneficial technique; associating these two procedures provides camouflage for the implant edges and a natural cleavage. 7,13,[17][18][19][20][21][22][23] Although breast augmentation is welldescribed, previous studies concerning the subfascial technique are limited, and most involve the inframammary approach.…”

Hybrid breast augmentation: a surgical approach and formula for preoperative assessment of fat graft volume

“…For studies using HBA mean body mass index (BMI) can be relatively normal, and oftentimes underweight. For example, the mean BMI for 1 summarizes the basic characteristics of HBA studies from a focused search of PubMed, Web of Science, Cochrane Library, and Google Scholar databases (5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

“…Their study found 100% of patients were very satisfied after one year of follow-up, however the anthropometrics of his patients also allowed for larger fat volume injections (BMI: 26 kg/m 2 ). On the other hand, those with underweight BMI such as Maximiliano et al, Munhoz et al [2021], and Munhoz et al [2022] conferred less satisfaction (96.6%, 95.2%, and 94.5% very satisfied or satisfied, respectively), while 3.3%, 4.7%, and 5.4%, were partially disappointed (8,9,11). For physicians, HBA is also a satisfying procedure, with Sforza et al (10) concluding 84.5% of surgeons reported high levels of satisfaction, while 13.3% reported good levels and 4.2% reported fair levels.…”