Zones for Fat Grafting in Hybrid Breast Augmentation: Standardization for Planning of Fat Grafting Based on Breast Cleavage Units

• Published in: Plastic and reconstructive surgery (1963) Vol. 150; no. 4; pp. 782 - 795
• Main Authors: Munhoz, Alexandre Mendonça, Maximiliano, João, Neto, Ary de Azevedo Marques, Duarte, Daniele Walter, de Oliveira, Antonio Carlos Pinto, Portinho, Ciro Paz, Zanin, Eduardo, Collares, Marcos Vinicius Martins
• Format: Journal Article
• Language: English
• Published: Lippincott Williams & Wilkins 01-10-2022
• ISSN: 0032-1052; 1529-4242
• DOI: 10.1097/PRS.0000000000009605

Background:
Autologous fat grafting is a procedure indicated for breast augmentation to improve coverage of silicone implants and redesign breast shape. Different techniques are based on parameters that have not been systematically standardized. The authors present a method using breast zone standardization based on breast anatomy to achieve an anatomical composite breast.
Methods:
The authors performed this zone standardization in 76 breasts (38 patients) undergoing primary/secondary augmentation. The area between the implant and the clavicle and parasternal area was marked to receive fat grafting and divided into three zones. A mathematical formula [
volume of autologous fat graft
= (π × r
2
× p)/4.8] was used to estimate the fat graft volume according to implant volume in the respective zones.
Results:
Implant volumes ranged from 205 to 375 cc (mean, 265 cc), and patients received an average fat graft volume of 105.3 cc per breast (range, 36 to 135 cc); the average fat volume in zones I/II and III was 78.28 cc (range, 0 to 100 cc) and 27.03 cc (range, 15 to 60 cc), respectively. Three minor complications were observed (5.2 percent) during a mean follow-up of 12.8 months. A high correlation was observed between the fat grafting performed in the cohort and predictions obtained from the formula (
p
< 0.001).
Conclusions:
Recognizing risky cleavage breast zones between the implant pocket and the upper and medial quadrants remains essential to attain satisfactory outcomes. Although experience and proper judgment are still important in the fat grafting technique, the data presented here offer plastic surgeons an additional standardized framework to help deliver predictable hybrid breast augmentation. 
CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.