'Reverse Liposuction' Allows Plastic Surgeons to Replace Breast Implants with Fat
Exchange Procedure Offers New Option for Breast Augmentation after Implant Removal, Says Report in Plastic and Reconstructive Surgery

Arlington Heights, Ill. - A "reverse liposuction" approach-replacing breast implants with the patient's own fat cells-provides a new alternative for women undergoing removal of implants used for breast augmentation, according to a report in the December issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

The technique, called simultaneous implant exchange with fat (SIEF), represents a "conceptual paradigm shift of using natural fat for volumetric augmentation and breast reshaping," writes ASPS Member Surgeon Dr. Daniel Del Vecchio, Boston. He believes that SIEF is a useful new option to replace breast implants, and illustrates the expanding possibilities for using fat obtained from liposuction for breast augmentation and reconstruction.

SIEF Replaces Implants with Woman's Own Fat

Dr. Del Vecchio used the SIEF technique in a 42-year-old woman who had undergone breast augmentation with implants. Seven years later, she was dissatisfied with the results. She felt her breasts were too full and rounded, especially at the top, and looked unnatural for her age. She wanted the implants removed, but was concerned about the appearance of her breasts afterward.

Dr. Del Vecchio designed the SIEF approach as a way of maintaining the volume of the breasts while creating a more natural shape after implant removal. Before surgery, the patient completed three weeks of "pre-expansion" using a bra-like device (Brava®), which uses gentle negative pressure (a vacuum) to gradually expand the breast.

On the day of surgery, liposuction was performed to harvest fat cells from the patient's thighs and abdomen. This "reverse liposuction" technique provided fat to inject into the space over the implants. Using the patient's own fat cells, the surgeon was able to sculpt and reshape the breast, allowing a smoother transition at the top.

The implants were then removed, eliminating the "pocket" they had formerly occupied. This reduced pressure within the breasts, thus allowing injection of additional fat. This fat was directed into the subcutaneous space (under the skin), which had been created by Brava pre-expansion.

More Natural Appearance in a Single Procedure

Thus in a single procedure, Dr. Del Vecchio was able to remove the implants and replace them with the patient's own fat cells, while creating a more natural appearance. On follow-up one year later, the breasts were about the same volume as they were with implants, with a more satisfactory cosmetic result.

Breast augmentation using implants is the most common cosmetic surgical procedure. But some patients eventually have the implants removed-not for problems related to the implants themselves, but because of soft tissue problems at the implant site or because they are dissatisfied with their results. In these cases, strategies have generally focused on replacing the implant with one that will be better tolerated or produce a better appearance.

Dr. Del Vecchio believes SIEF with "reverse liposuction" provides plastic surgeons with a useful new option for women undergoing removal of implants for breast augmentation. Renewed interest in techniques using the patient's own (autologous) fat for cosmetic and reconstructive plastic surgery has been observed in recent years. Dr. Del Vecchio coauthored a recent article discussing the versatility of clinical fat grafting-highlighting the need to match the right technique to the right clinical situation.

The SIEF procedure further illustrates the versatility and clinical value of autologous fat grafting for specific plastic surgery applications. Noting that implants and fat both have inherent advantages and disadvantages, Dr. Del Vecchio concludes, "If the current debate is 'implants vs. fat', the versatility of fat and the core volume reliability of implants may, in the future, evolve to a place where implants and fat can work together, serving essential functions in the same patient."

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.