Fat Grafting and Breast Augmentation: A Systematic Review of Primary Composite Augmentation

Fat grafting during primary breast augmentation has the ability to address the limitations of soft tissue coverage of breast implants. The purpose of this study was to evaluate the current evidence on patient selection, surgical techniques, and assessment of outcomes with composite breast augmentation. METHODS: A systematic review of the literature was performed for studies reporting on primary composite breast augmentation. Studies were analyzed for level of evidence, surgical techniques for implant placement and fat grafting, postoperative complications, and assessment of additional outcomes. RESULTS: Five studies (4 case series and 1 retrospective cohort study) were identified for review with a pooled total of 382 patients. Implants were most commonly placed in the subfascial plane (156 patients, 54.1%) followed by dual-plane placement (51 patients, 17.6%). Round (220 patients, 57.6%) and textured (314 patients, 82.2%) implants were utilized in the majority of cases. The average amount of fat grafted among all 5 studies was 109.2 ml per breast (range 55–134 ml). The most common fat grafting location was in the subcutaneous plane and over the medial breast/cleavage (80% of studies). Overall complication rates were low. The pooled reoperation rate was 3.7% with repeat fat grafting as the most common reason for reoperation (9 cases, 2.4%). CONCLUSIONS: Primary composite breast augmentation is a safe procedure with a trend toward subfascial implant placement and low fat grafting volumes focused on the medial breast borders. Long-term studies with analysis of additional outcome measures including patient-reported outcomes will further bolster the current evidence.