Vladimir Stojiljkovic, M.D., Ph.D.
Braničevska 13 (kod Hrama), 11000 Beograd – Serbia
dr.stojiljkovic(at)yahoo.com

 

A technique of implant exchange is reported using recipient-site preexpansion followed by autologous fat transplantation to the breast in two patients with breast implants who desired implant removal. First patient sought cosmetic improvement in the appearance of her breasts; seven years earlier, she had undergone subglandular breast augmentation, with silicone implants placed through inframammary fold. Second patient, otherwise, six years earlier had correction of Poland’s syndrome using silicone implants through inframammary approach. She was satisfied with result, but just desired implant removal.

Recipient-site preexpansion, used 2 weeks before fat grafting, may have both practical and theoretical benefits in increasing the breast subcutaneous space and stimulating the recipient-site microcellular environment overlying the prosthetic implant, allowing the subcutaneous insertion of a sufficient core volume of donor graft at the time of prosthetic explantation. In the cases described, the postexplantation breast volume at 6 months to 1 year postoperatively by MRI imaging was equal to or greater than the preexplantation composite volume of breast and implant. Preexpansion before implant exchange with fat affords amore abundant space, completely independent from the subglandular or submuscular planes. In this new space, the “third space” of the breast, it is possible to technically place graft into the breast subcutaneous tissue and alleviate breast asymmetry resulting from pocket distortions caused by capsular contracture or by implant pocket drift. Observing breast augmentation with implants and with fat grafting in the same patient affords a unique opportunity to analyze some of the key differences between the two techniques. Recipient-site preexpansion and simultaneous implant exchange with fat (SIEF) should be added to the list of applications where fat grafting to the breasts may have early clinical utility and portends the use of fat used in conjunction with breast implants to achieve better patient outcomes.