First, let me start by saying I see many women come in for breast implant removal. There are a host of issues for the “why”- they are over it, they want to be smaller, they worry their implants are making them sick (BII- breast implant illness). Many of them ask, “Can’t you just put my fat in there instead?”
This is a study out of Belgium where they are attempting to do just that.
This is an article out of the July 2021 Aesthetic Surgery Journal, “Composite Breast Remodeling After Implant Removal by Tissue Recruitment and Loops Fixation with Power Assisted Liposuction and Lipofilling.” They even have a catchy name for it “PALLL.”
Study:
They proposed a new technique to remodel the breast after removing the implant by using an internal suture to loop the breast to help it narrow and have more projection. The researchers claim it also helps recruit tissue from the upper abdomen and axilla (armpit) area, which gives more tissue to fill with fat.
- They did 52 consecutive patients, average age 55, and BMI 24.
- 41% were smokers
- Reason for removal – 28% for rupture, 58% for capsular contracture and 14% for pain or migration.
- Average implant volume removed 292cc
- Average lipofilling was 223cc
- Average breast volume by the suture loop 82cc
Technical issues: They did not remove the breast capsule unless it was thickened with severe capsular contracture. To create the double loop, they tunnel using a cannula in the subcutaneous plane lower, going deeper as they go cephalad. They do this loop twice. They use a nonabsorbable Filapeau 2 suture. Then, they do fat transfer where they can, rinsing out any fat that ends up in the old breast implant cavity. Patients wear loose non compressible bras for 2 months after surgery.
They do the fat grafting using power assisted handpiece, which they think the vibration and grafting together helps the fat transfer by preventing coalescence of fat lobules.
They discuss issues with fat grafting to the breast. 1. Fat resorption. 2. Unpredictable movement of injected fat, and you are limited to grafting into the native breast tissue only. 3. It can’t reverse breast droop. 4. It does not give good projection to the breast.
Discussion
Others have tried to improve fat grafting survival in the breast by increasing the space to graft into by BRAVA domes and other expanders. (BRAVA domes are no longer available on the market) They also discuss those who do serial surgeries, grafting more each time .
My thoughts?
Wow. I think I need to address this as a separate blog as I have many thoughts. I think doing a suture loop to lift the breast or shape the breast is fraught with tons of issues. Dr. Khouri did it when I studied with him in Miami. I am a HUGE Dr. Khouri fan, but just like I don’t like threadlifts in the face to do facelifts (and even our literature doesn’t support them), and I feel “threadlifts” for the breast are the same. For true change, you can’t treat tissue like a marionette string.
As for fat grafting to the breast, there are uses for it, but it is tricky. Where the implant used to be is a space with no blood supply. To put fat into that space doesn’t work- it would be like planting a tree into a concrete swimming pool.