Implants vs Fat: ‘Reverse Liposuction’ Changes the Game

When liposuction was first introduced in the US nearly three decades ago, no could have imagined a scenario in which we’d want to put the fat back in. But with innovative uses for fat and technique advancements, “reverse liposuction” is being reported as an alternative to breast implant replacement, with the added viability of future applications.


Aesthetic applications that involve fat have continuously improved in recent years. As a result, Daniel Del Vecchio, MD, a board-certified plastic surgeon practicing in Boston, Mass, believes his reverse liposuction technique can give plastic surgeons a useful new option for breast augmentation in those women who opt to remove breast implants.


According to Dr. Del Vecchio, fat can be uses in lieu of implants for both volume and shaping of the breast, as reported in a recent article published in the December issue of Plastic and Reconstructive Surgery.


According to the American Society of Plastic Surgeons (ASPS) 2011 Plastic Surgery Statistics, the most popular cosmetic surgical procedure is breast augmentation with implants. And breast implants don’t necessarily last forever. Whether it’s due to implant-related issues or changes in preference, many women opt to remove and/or replace their implants over time.


In the article, Dr. Del Vecchio describes a 42-year-old woman who was not satisfied with the overly full and rounded results of the breast augmentation with implants she had seven years earlier. Because of the unnatural-looking appearance of her breasts, she no longer wanted implants, but was also worried about how her breasts would appear after the implants were removed. Dr. Del Vecchio’s solution? A procedure that removed the implants and used autologous fat in their place, which he calls simultaneous implant exchange with fat (SIEF).


Fat offers the benefit of being more malleable than the predetermined shape and size of saline- or silicone-filled implants. Dr. Del Vecchio’s approach with fat allows him to refill the breasts after removing implants while giving him the flexibility to shape the breast itself for a more natural looking result. As part of the procedure, the patient in this reported case study underwent tissue expansion with the Brava system for three weeks prior to the SIEF procedure. On the day of the procedure, Dr. Del Vecchio first harvested the fat he would inject over and around the implants via liposuction from the thighs and tummy to create a smoother, more natural looking breast contour. Next, he removed the implants, which made room for additional fat to be added for volume, and used the space under the skin the Brava system created.


One procedure, performed in one day, with excellent results reported one year later—Dr. Del Vecchio patient achieved approximately the same breast volume as that of her previous implant size.


What’s next? Dr. DelVecchio believes this is a step in direction of using fat post-liposuction for breast reconstruction and/or augmentation. "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," writes Dr. Del Vecchio.


Plastic and Reconstructive Surgery is the journal of the American Society of Plastic Surgeons and is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.