Fat grafting versus implant-based treatment of breast asymmetry, a single surgeon experience over 13 years: a paradigm shift?

Background Breast asymmetry can result from congenital or traumatic aetiologies. Breast implants, autologous fat grafting, or a combination of both of these techniques are commonly used to achieve symmetry. This study adds critical evaluation of long-term patient outcomes in a large study group, to evaluate pearls and pitfalls of these treatment modalities. Methods A prospectively maintained database of a single surgeon experience in breast asymmetry treatment over a 13-year period (2006-2018) was retrospectively analysed. Breast implant surgery and fat grafting to treat asymmetry were compared in terms of number of operations to achieve symmetry, complications, and overall patient satisfaction. Results Thirty-five patients underwent breast implant surgery, requiring an average 2.1±1.6 operations to achieve symmetry, with a major complication rate (requiring secondary procedures) of 26% (n=9). Again, 26% (n=9) were converted to lipofilling due to either implant removal or unsatisfactory results. Thirty (86%) patients underwent fat transfer monotherapy to achieve symmetry and no major complications were recorded. Nine percent (n=3) of these patients preceded to have additional implant surgery. Conclusions Although implant-based reconstruction seemingly offers a quick single stage procedure, it is associated with significantly more revision procedures as a result of complications including capsular contracture, implant rupture and breast distortion. Fat grafting, despite requiring sequential operations to achieve initial symmetry, ultimately offers a more durable result and is associated with significantly fewer and more minor complications, while not increasing the total number of procedures required to achieve symmetry in the long term.