Reply: Subfascial Primary Breast Augmentation with Fat Grafting
Second, even if a subfascial pocket is a good way to ensure coverage of the implant, it can be insufficient, particularly in patients with a low body mass index. The mean body mass index in our series was 18.85 kg/m2, and fat grafting offers the possibility of avoiding suboptimal results caused by failure of the overlying soft tissue while avoiding dissection of the retromuscular pocket.
As we use nearly the same amount of fat for each breast, except in asymmetric cases, we did not observe any asymmetry during follow-up. The need for a second fat injection was rare if the patient had a stable body weight.
Third, we often remove fat in the prone position to collect a sufficient amount, because of the low body mass index. We do not believe there is an increased risk for contamination of the surgical field when strict asepsis rules are followed. Furthermore, fat is injected in a subcutaneous plane at the end of the surgical procedure, and thus it is difficult to see how it could be the cause of capsular contracture or any subclinical infection, as fat placement is not close to the subglandular pocket.
We totally agree with Dr. Cucchiaro that breast augmentation produces high satisfaction rates. However, we have to collect data and go further with evidence-based medicine in cosmetic breast surgery while striving to improve cosmetic results and enhance safety.