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“SIEF”—Simultaneous Implant Exchange with Fat: A New Option in Revision Breast Implant Surgery

Del Vecchio, Daniel A. M.D., M.B.A.

Plastic and Reconstructive Surgery: December 2012 - Volume 130 - Issue 6 - p 1187–1196
doi: 10.1097/PRS.0b013e31826d9c3c
Breast: Special Topic
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Summary: A technique of implant exchange is reported using recipient-site preexpansion followed by autologous fat transplantation to the breast in 12 consecutive patients with breast implants who desired implant removal. Recipient-site preexpansion, used 2 weeks before fat grafting, may have both practical and theoretical benefits in increasing the breast subcutaneous space and stimulating the recipient-site microcellular environment overlying the prosthetic implant, allowing the subcutaneous insertion of a sufficient core volume of donor graft at the time of prosthetic explantation. In the cases described, the postexplantation breast volume at 9 months to 1 year postoperatively by quantitative three-dimensional imaging was equal to or greater than the preexplantation composite volume of breast and implant. Preexpansion before implant exchange with fat affords a more abundant space, completely independent from the subglandular or submuscular planes. In this new space, the “third space” of the breast, it is possible to technically place graft into the breast subcutaneous tissue and alleviate breast asymmetry resulting from pocket distortions caused by capsular contracture or by implant pocket drift. Observing breast augmentation with implants and with fat grafting in the same patient affords a unique opportunity to analyze some of the key differences between the two techniques. Recipient-site preexpansion and simultaneous implant exchange with fat (SIEF) should be added to the list of applications where fat grafting to the breasts may have early clinical utility and portends the use of fat used in conjunction with breast implants to achieve better patient outcomes.


Boston, Mass.

From the Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School.

Received for publication January 8, 2012; accepted June 7, 2012.

All matters related to the clinical care of patients and preparation of the article conform to the Declaration of Helsinki.

Disclosure:The author has no financial interest to declare in relation to the content of this article.

Daniel A. Del Vecchio, M.D., M.B.A.; Back Bay Plastic Surgery, 38 Newbury Street, Boston, Mass. 02116,

©2012American Society of Plastic Surgeons