Para-Sternal Infiltration (PSI) Composite Breast Augmentation
Francisco G. Bravo, MD, PhD.
Doce de Octubre University Hospital, MADRID, Spain.
PURPOSE - The simultaneous combination of both fat grafting to the breast and mammary implants has been recently proposed as a useful technique in breast augmentation surgery, especially in secondary procedures and in order to avoid the sub-muscular plane. The purpose of this study is to evaluate the aesthetic benefits of para-sternal infiltration (PSI) of fat at the time of primary implant breast augmentation.
METHODS - 59 consecutive primary breast augmentation patients were studied retrospectively. Patients were divided into two groups: group 1 patients (n=38) were treated only with breast implants, while group 2 patients (n=21) received PSI of 60 to 140 cc of treated fat simultaneously to their breast implant placement. Patients were followed for a minimum of one year. The length between the medial borders of the breasts, defined as the para-sternal Vertical Aesthetic Lines (VAL) was measured through digital imaging software pre- and post-operatively on both groups. A Student´s t test for independent samples was employed to statistically compare the results between groups and a Student´s t test for paired variables was used to compare pre- and post-operative results on each group.
RESULTS - The mean length between the para-sternal VALin group 1 before surgery was 1.31 cm (± 0,51), which was not significantly different (p=0.4) from the same measurement taken in group 2: 1.43 cm (± 0,61). The mean length between the para-sternal VAL in group 1 post-operatively was significantly higher: 2.26 cm (± 1.24) (p < 0.0001), while this length for group 2 was significantly lower after surgery: 0.60 cm (± 0,32) (p < 0.0001). No cysts or fat necrosis were observed in group 2, presumably due to the low volume of fat employed.
CONCLUSIONS - Para-Sternal Infiltration of fat performed simultaneously to breast augmentation is a safe procedure, which seems to provide a considerable cosmetic advantage by improving the medial transition zone of the breast implant with the sternum. It seems to avoid a “separated-breasts” deformity, which may produce unnatural results in implant-based breast augmentations, especially in thin patients.
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