Hybrid breast augmentation

This is a holistic approach to breast augmentation, aiming to increase your breast size and improve shape with the help of BOTH breast implants and your own fat.

Who could benefit from a hybrid breast augmentation?

To undergo surgery is a very personal issue; make sure this is what YOU want and not what someone else wants you to have done!! You could benefit from a hybrid breast augmentation if you are unhappy with the size or the shape of your breasts. This may be due to them not having ever fully developed or perhaps not having developed symmetrically. You may also consider this procedure if you feel your breast are not of an adequate volume or that you have lost volume/shape due to aging, weight loss or pregnancy. A hybrid breast augmentation offers the best of both world, adding substantial volume centrally with the help of an implant, as well as super sculpting the breast to the desired shape using fat grafting / lipo filling.

Please be advised that even hybrid breast augmentation alone cannot address a markedly sagging breast. Such presentations are often best corrected with a combination of breast augmentation as well as a breast lift.

Evaluation for a hybrid breast Augmentation!

Apart from a detailed medical history, during a breast augmentation consultation your breast size, shape and the size and position of your nipples will be evaluated and discussed. Your skin quality will also be taken into account. Family history of breast cancer, previous or planned pregnancies will also be taken into consideration. It is not advisable to consider breast augmentation soon after childbirth or completion of breast-feeding.

Your surgeon will also be keen to identify a fat donor site best suited to your needs. Make sure you point out which part of your body you find the fat hard to shift. This could be your tummy, sides or your thighs. Depending on the amount of available fat a number of sites may be earmarked for liposuction as suitable fat donors for lipo filling.

During the consultation types of breast implants and their placement in relation to your breast tissue and muscle will be discussed. It is important that you understand all aspects of your planned breast augmentation and if unsure make sure to ask questions.

Characteristics of breast implants

There are many reputable manufacturers in the market and numerous breast implants are available for consideration. Several features can distinguish a breast implant:

  1. Implant shape

    Round implants give a better breast projection and better improve upper breast fullness. One advantage of these implants is that because they are round there is no concern about them rotating once inserted unlike anatomical shaped implants.

    Anatomical Implants also known as tear-shaped implants tend to give a more natural look. They offer less upper breast fullness but can improve the nipple positioning and are therefore useful when one aim of the breast augmentation is to somewhat improve the vertical positioning of the nipples. This does not mean that their use would alleviate a severely drooping breast. One concern regarding their use is that once inserted if they later rotate you may need to undergo further surgery to realign them unto the desired position.

  2. Implant fill

    Saline-filled implants as the name implies are filled with normal saline- water. The advantage of this is that if the implant outer shell leaks for any reason then basically the released saline is simply reabsorbed by the body. The disadvantage is that they are less natural to touch and once leaking collapse completely. They are more popular in North Americas and less so in Europe and the rest of the world. A more form-stable version of saline-filled implants is nowadays also available in the market.

    Silicone-filled implants are filled with cohesive silicone gel. This gives the implant a more natural feel hence they are more popular worldwide. However if the outer shell of these implants starts leaking, silicone is eventually released within the implant cavity. Unlike saline implants these implants will not collapse but your body cannot break down silicone, therefore you must replace the implant as soon as possible. What all this means is that it is advisable to carry out annual ultrasound or MRI scan to ensure the implant integrity is maintained and present to your plastic surgeon for annual check ups.

  3. Implant surface

    Smooth-surfaced breast implants: This type of surface offers a softer feeling on palpation and a slightly more natural look during animation –body movement. The draw back is that in thin individuals it is prone to rippling.

    Textured surfaced breast implants: can be divided in macro-textured and micro-textured. Macro-textured implants are out of favour due to increased risk of BIA-ALCL – please see below. Micro-textured implants offer a better tissue grip and as such are less prone to mal-positioning. Studies have shown that particularly if placed below the muscle they have a lower tendency of capsular contracture- please see below.

How is hybrid breast Augmentation done?

Prior to hybrid breast augmentation surgery you have to make sure you have had a full blood test, as directed by your surgeon as well as either a breast ultrasound or mammogram. The choice of suitable implant, it’s positioning in relation to your chest muscle and placement of the incision will have been discussed during consultation. The procedure is carried out under general anaesthesia. The incision is placed strategically to ensure it is not too visible. The preferred option is placing the incision along your breast fold -inframammary fold. Alternatively it can be placed along your areolar -periareolar incision. The size of the incision varies depending on the type and size of implant. Following the incision a pocket is created either above the pectoral muscle -subglandular placement, or below the muscle – submuscular/dual plane placement.  This decision is made based on your presentation, the type of implant and the desired end result. Prior to implant insertion, fat is harvested from a previously determined part of your body, using a special harvesting cannula from the earlier identified donor site. The accumulated fat is then processed and strategically infiltrated into your breast soft tissue by means of a blunt tip cannula. This could be along the medial, superior or lateral aspects of your breast. The aim is to address inadequacies in your breast contour not otherwise amended by solitary implant insertion. Following fat grafting the implant is inserted and the incision is closed. A support bra and compression garments are then applied over your dressings.

Over time some variable loss of transferred fat is expected. This may be any where between 20-40%.

Risks associated with a body lift

A body lift is essentially an extended version of a tummy tuck and similar to any major surgery does carry some additional risks. Aside from probable risks associated with general anaesthesia, as with most surgeries, there is always a risk of bleeding, poor wound healing, irregular scars as well as infection. More particular risks include the risk of haematoma, seroma formation and wound breakdown. Other conceivable complications include DVT or pulmonary embolism and fat or skin necrosis–loss-.Any of the above may lead to future reversional surgery or hospitalisation.

Risks associated with hybrid breast augmentation!

Apart from possible risks associated with general anaesthesia, as with any surgery there is always a risk of bleeding, haematoma, poor wound healing as well as infection. More specific risks related to implant insertion include rippling, changes in your nipple sensation, intractable pain and seroma formation – fluid collection.  Late complications of breast augmentation include implant mal-positioning, implant leakage, implant rupture and capsular contracture. This is thickening of the capsule enveloping the implant, which eventually leads to hardening and deformation, requiring removal. Late seroma formation may also be a sign of another serious complication namely Breast Implant Associated-Anaplastic Large Cell Lymphoma – please see below.


As this is a hybrid procedure one has to contemplate risks in relation to fat grafting. This includes liposuction associated risks –DVT, fat embolism, pulmonary embolism- as well as possibility of breast cysts and micro calcification formation due to lipofilling.


Please be advised that breast implants are prone to wear and tear. Regardless of type and manufacturer it is prudent that you carry out annual check up as well as consider changing the implants after 10-12 years.


Breast implant associated-anaplastic large cell lymphoma (BIA-ALCL)

Breast Implant Associated-ALCL is a serious adverse complication associated largely with macro-textured and to a much lesser degree micro-textured breast implants. It is not known to be associated with smooth-surfaced implants. Most reported cases of BIA-ALCL were attributed to a particular manufacturer that has since been withdrawn from the market. However it is a development requiring urgent medical referral and as such one that you should be well aware of before deciding to go through with breast augmentation. For more comprehensive information please refer to a number of online sites including any of the followings:




Recovery following hybrid breast augmentation

You will stay overnight following surgery. There will be a drain –plastic tube- coming out of each side, which will collect excess fluid/blood. These are typically removed the next morning before discharge. Your breast will be swollen and will remain so for the first 2-3 weeks, the swelling subsiding gradually. Pain and discomfort typically does not last more than 5-7 days. Also the fat donor site will be tender and swollen for a good few weeks. Your surgeon will prescribe painkillers and any other medication deemed necessary for you. The support bra and compression garment provided will have to be worn for 8 weeks. During the first two weeks you should avoid driving, lifting heavy objects or any sudden movements. Sutures are absorbable but the knots may need removing after two weeks. Exercise should be avoided for the first 6-8 weeks depending on your recovery. Following surgery you are expected to return to us for follow up visits after a week and then again at 2 weeks, 3 months and 12 months from then on annually.