Lipoaugmentation following Implant Removal Preferred by Plastic Surgeons and the General Public

BACKGROUND: Breast implant removal followed by fat transfer to the breast (lipoaugmentation) is a newer procedure and as such there is a need for empirical aesthetic comparisons between breast augmentation with implants versus fat transfer. Fat transfer to the breast is becoming an important option for women seeking reoperation of breast augmentation. METHODS: A survey was created using standardized before and after photographs of 12 patients who underwent implant removal and lipoaugmentation. Four photographs of breasts that had no surgery were used as controls, with identical before/after photographs. The survey was administered to 96 respondents from the general population and 10 plastic surgeons. Respondents were asked to rate the breasts using a 5-point Likert scale without procedural knowledge. The responses were evaluated using parametric statistical t tests to compare responses to implants versus fat transfer in terms of their respective attractiveness, naturalness, size, symmetry, and femininity. RESULTS: Fat transfer was significantly preferred to implants on all 5 measures; attractiveness, naturalness, size, symmetry, and femininity. Fat transfer was significantly preferred to implants by a margin of +0.36 average on 1–5 scale, which is approximately 1/3 of a Likert interval on all measures. Plastic surgeons took significantly longer than the general population to complete the survey and preferred fat transfer over implants to a higher degree. CONCLUSIONS: Lipoaugmentation can provide a favorable aesthetic outcome in women seeking implant removal. The general public can be conveniently surveyed via crowd sourcing, and their aesthetic judgments largely mirror those of trained and experienced plastic surgeons. Patients weighing breast implant removal or breast implant revision could consider this study in their decision making.