On April 11, 2013, I attended the first Composite Breast Workshop in New York City. What is a “composite breast”? A composite is a combination of two or more distinct substances, each with different physical characteristics, in which each substance retains its properties while contributing to the whole. In this case, implants and fat are used to create a more aesthetic shape and size of the breast, in a way in which just one of these items alone cannot do. For most cosmetic breast augmentation patients, implants alone can provide an excellent result. In these cases, the patient already has a good shape to the breast, and needs only the volume which an implant can predictably provide. In some cases, as in breast reconstruction, both shape and volume are lacking. Therefore, an implant can provide volume, while additional fat can soften the apparent edges to improve the shape of the breast.
Composite treatment of the breast is an excellent option for patients with the tuberous breast deformity. In these cases, the inferior pole of the breast has failed to completely develop secondary to intrinsic constriction. While the ideal breast is round with breast tissue spread out across the chest, in a tuberous breast, the breast tissue is concentrated directly below the nipple. As a result, the breast may appear long and narrow. Traditionally for a tuberous breast, the constricted breast tissue is released, an implant is placed, and the nipple-areolar complex is reduced in size. In severe cases, there is a tendency for the constricted tissue to recur at the base of the breast, distorting the shape of the reconstructed breast. In these cases, adding fat to the constricted region not only improves the shape of the lower pole of the breast, but it also appears to help soften the constricted tissue. With the use of the recently approved anatomic silicone gel implants, the options available for reconstruction of the tuberous breast are now excellent.
The use of fat in the breast has nonetheless been controversial in the past. Although there is some concern that grafting fat to the breast can result in nodules and calcifications on mammography, there is no data at this time which shows any interference with the detection of breast cancer. Some of the other known complications associated with fat grafting include infection, cyst formation, fat necrosis, and fat resorption. The method that each surgeon uses for harvesting the fat, preparing it, and injecting it also varies widely. However, each of these items also determines how successful the graft will be.
With the advent of newer and better breast implant technology, and refinements in fat harvesting and grafting to the breast, the options for aesthetic and reconstructive surgery in the breast have never been more exciting.