How does SIEF (Simultaneous Implant Exchange with Fat) compared to staging explant and healing before lipo/injection of fat?

Question

One PS brought up a point that implant removal without addressing subsequent cavity can result in scar tissue formation, which can cause contraction that may pull the nipples/areola in unpredictable directions and cause other deformities that will be difficult to correct later, and so recommended that explant/graft be done together. Assuming I have enough fat to harvest, what is the best sequence to replace 300cc IMP with fat? PreIMP A/AA, PostIMP B/small B, Post-Fat ideal B/B over 1-2 tx.

Dallas Buchanan, MD · Answer

Thank you for this very good question. I think Dr. Sowder gives and excellent response. There is no specific study that shows one method superior to the other so this answer is a matter of theory, opinion, and conjecture. The issue with fat grafting that many patients do not understand is that you cannot just remove an implant and replace the empty space with fat....the majority of that fat (that which is not in contact with living viable tissue) will die. So in my opinion, fat grafting at the time of implant removal is less successful and leads to less fat viability. True there is some scarring after removal but a lift may help prevent some of these issues and scarring can be repaired at the time of fat grafting. I usually have patients wait 3-6 months after implant removal to proceed with fat transfer.Hope this helps!

Roger Khouri, MD · Answer

You have a great question. After performing hundreds of these surgeries, we found that immediately replacing the implant with fat is the best option. The reason is that the implants have stretched out the breast tissue in front of the implant resulting in loose breast tissue that is in an ideal state to fill up with fat. If you let the breast heal, the breast tissue returns to normal and the scaffold created by the stretch is gone. Injecting fat meticulously into the loose breast tissue immediately after removing the implant increases the fat survival percentage because there is blood flow in the area.
 Of course, only so much fat can be transferred into the loose breast tissue at one time. Also, the fat grafts are not placed in the implant cavity because it cannot survive there. Instead, the grafts are diffusely weaved, one micro-droplet at a time, into the breast tissue to fill it again. The initial procedure will leave you with approximately half the volume of the original implant. The results will be permanent. Depending on the final desired size, you may choose to have an additional procedure to increase the breast size. The results will be a permanent and more natural looking and feeling breast.

Connie Hiers, MD, FACS · Answer

The fat is not placed in the cavity left from the implant removal, but in the actual breast tissue. If you have enough breast tissue to support the fat, the transfer could be done at the same time. Some transfers do need to be done at a later time for safety to the fat. I would suggest meeting with a board certified plastic surgeon who can examine you and tell you your best options.

Lisa Lynn Sowder, MD (retired) - Account Suspended · Answer

Thanks for the great question.  Fat transfer is still a procedure that is evolving and I don't think anyone actually has the experience or data to answer your question.  It is true than implant removal can result in some scar tissue formation in the area of the former pocket and capsule and the skin and breast tissue does contract.  I don't really think that fat grafting would prevent the former since the fat is not placed into the former pocket but rather into the overlying breast tissue.  Fat grafting may prevent the latter but the contraction of breast tissue and skin is usually a desired thing after implant removal.  It helps prevent sagging.  To really answer your question, many women in your position would need to sign up for a study where immediate fat transfer was done on one side and delayed on the other side.  I can assure you that this study would never make it through a review board and nobody would sign up for it!I require my implant removal patients to wait a minimum of three months prior to fat transfer.  By three months the skin and breast tissue is usually done contracting and the layers of the breast and chest wall are usually solidly healed.  Fat transfer is done into all layers of the chest wall and it's very important for everything to be healed down.  The other procedure that can be very helpful after implant removal is a breast lift.  I often do these at the time of implant removal if I am certain the patient will have a lot of sagging once the implants are out.

How does SIEF (Simultaneous Implant Exchange with Fat) compared to staging explant and healing before lipo/injection of fat?

Answers (4)

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