This article presents an overview of the subfascial approach to primary and secondary breast augmentation with form-stable implants associated with autologous fat grafting. Although breast augmentation is a well-studied procedure, there are few previous reports concerning the subfascial technique and, especially, this technique associated with lipofilling. Consequently, the authors present their experience with a form-stable, anatomically shaped silicone gel breast implant, which has recently been approved in the United States following FDA clinical trials. Primary and secondary breast augmentations using form-stable implants resulted in satisfactory outcomes.
The latest generations of silicone implants and the introduction of surgical techniques such as the subfascial approach have improved esthetic outcomes following breast augmentation.
The advantages of the subfascial pocket are soft tissue coverage and avoidance of the limitations of the submuscular position. In the upper breast pole, this technique is useful in minimizing the appearance of the edges of the implant and provides an adequate supporting system.
Autologous fat grafting has been performed more frequently. Based on various clinical studies, fat grafting may be considered to treat breast defects secondary to oncological diseases and esthetic deformities.
Most candidates for primary and secondary breast augmentation can be successfully treated with this present technique. Ideal primary candidates are those with significant hypomastia/amastia with less soft tissue to adequately cover the implant. Ideal secondary candidates are those with partial/total soft tissue deficiency with visible implant contours and rippling, and patients with stretched breast tissue and irregularities of the implant surface.