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Simultaneous Implant Exchange with Fat (SIEF)

Dr. Ron Somogyi


So you’re considering having your breast implants removed?

 Today’s breast implants provide natural appearing, long lasting, comfortable results. Women who want to have their implants removed, however, can be faced with a significant decrease in volume, deflated breast shape and sometimes a droopy or low nipple position. Traditionally, these patients would undergo implant removal and a simultaneous breast lift. This would provide for improved breast shape after implant removal but would not help with the decrease in size and the often depleted or flat upper pole of the breast.

Simultaneous Implant Exchange with Fat (SIEF) is a new, but well described and effective, alternative or adjunctive procedure for woman seeking removal of their breast implants. During a SIEF procedure, breast implants are removed and the breast skin is reshaped as needed. Fat is then harvested from elsewhere in the body through standard liposuction techniques. This fat is then re-injected into the breasts to replace some of the volume lost when the implants were removed. Placement of the fat can be tailored to where it is needed most. Often, this includes filling the upper part or cleavage areas of the breast.

While most patients would achieve an improvement in contour from fat grafting to the breasts after implant removal, this is not necessary in many patients and in some patients it is not possible. First, the patient must have enough fat to donate from elsewhere in the body. Favourite sites for fat harvest include the abdomen, flanks and thighs. Second, if the implant that is being removed is relatively small and the patient has enough remaining breast tissue, removal with or without a breast lift is often enough.

SIEF, performed by an experienced Plastic Surgeon is a safe procedure that can help to provide a natural restoration of breast shape and volume after implant removal. There are always limitations as to how much fat can be effectively transferred. As a result of this limitation, virtually all patients will still be somewhat smaller in volume after implant removal. In cases where a large volume of fat is required, fat transfer can or should be performed in two separate sessions, usually 4-6 months apart. There are a number of potential risks unique to the SIEF procedure.  The first are related to the areas where the liposuction is performed. Contour abnormalities, bleeding, infection and pain are rare but possible risks.  When the fat is transferred to the breast, most of it will stay where it is placed. Some, however, will be absorbed by the body and occasionally some fat may form into small oil cysts or hardened calcifications. This is rare and not dangerous but can affect the final volume and/or contour achieved.

If you are considering removal of your implants for any reason, visit an experienced plastic surgeon that can offer SIEF as a potential addition to implant removal.