Procedure 02
Composite augmentation, implants and fat
An implant for volume, fat transfer for shape. Both combined in the same operation, to work on the cleavage, the contours and the space between the breasts.
- Duration
- 2 h 15 min
- Anaesthesia
- General
- Stay
- 1 night or day case
- Recovery
- 7 to 10 days
Figures confirmed by the surgeon; they vary from case to case and are specified in consultation.
The essentials
The four questions that come up
- What is composite augmentation?
- The combination, in the same operation, of a breast implant and a fat transfer. The implant provides the volume, the fat shapes the contours, the cleavage and the space between the breasts.
- Why combine the two?
- Because an implant alone provides volume but does not correct the transitions: the upper edge, the gap between the breasts, the finesse of the contours. The fat does that, where the implant cannot.
- Is the implant different?
- It is chosen smaller, since the fat provides part of the volume. It can readily be placed in front of the muscle, in the subfascial space — that is, under the muscle’s fascia.
- Who is it for?
- Patients who wish for a very natural result, whose tissues are thin, or whose cleavage and space between the breasts call for work that the implant alone cannot do. The indication is established in consultation.
An implant for volume, fat for shape
Composite breast augmentation consists of combining a fat transfer, to shape and augment the cleavage, with the placement of a breast implant.
This improves the contours of the breasts, as well as the cleavage and the space between the breasts. The two procedures are carried out in the same operation and answer two different needs: the implant gives volume and projection, the fat works on the transitions.
What the combination brings
An implant, whatever its quality, remains a volume placed under the tissues. Where these are thin, its edges may show.
Fat transfer answers precisely this limitation: deposited in a thin layer, it thickens the cover, softens the upper edge of the implant and fills the hollow of the cleavage. It also makes it possible to bring the breasts visually closer by working on the space between them, which an implant does not do.
The implant works on volume. The fat works on shape and transitions. This division is what defines composite augmentation.
A smaller implant, placed in front of the muscle
In this case the implant chosen is smaller, since part of the volume is provided by the fat.
It can then readily be placed in front of the muscle, in the subfascial space — that is, under the muscle’s fascia. This plane avoids detaching the pectoral muscle and the consequences this has on the dynamics of the breast.
The choice of shape — round or anatomical — and of incision follows the same rules as for a classic augmentation: they are decided in consultation, from your measurements and the quality of your tissues.
In practice, Dr Azencot most often chooses a 300 cc implant, combined with a transfer of about 200 cc of fat per breast. These orders of magnitude are adjusted in consultation, from your measurements and the volume of fat available for harvesting.
The role of the fat
The fat is harvested from the patient herself, then reinjected after preparation.
It has two advantages of its own: it is autologous tissue, therefore perfectly tolerated, and it shapes itself where it is deposited — which makes it possible to work on areas an implant cannot reach, such as the upper pole or the space between the breasts.
The donor areas are chosen according to the patient’s figure: abdomen, hips, outer thighs, inner thighs. Dr Azencot quotes a take rate of around 70% — some of the transferred fat is resorbed over the first few months, and it is the remaining volume that makes the result.
A single session is enough, since the implant already provides the volume required.
Composite augmentation requires mastering both techniques and knowing how to balance them. It is a longer operation than a simple augmentation, and the result depends as much on the choice of implant as on the quality of the fat transfer.
Frequently asked questions
What patients ask
These answers reflect the content written and validated by the surgeon. Each one is written to stand alone, question by question.
How does it differ from a classic augmentation?
Why is the implant smaller?
What is the subfascial plane?
Where does the fat come from?
Is the result more natural?
Glossary
The words on this page
The terms used here, each defined in a sentence in the site’s glossary.
Gallery
Composite augmentation, before and after
Cases operated on by Dr Azencot, photographed before and after surgery, in front and three-quarter views. Drag to compare. The captions are the surgeon’s own.
Photographs for information only — neither a commitment nor a guarantee of result. Every situation is unique and assessed in consultation.
Meet us
Consultation
A first consultation is there to understand your request and tell you what is possible — including when the answer is that it is better to do nothing.
Clinique Esthétique Ferrère
16 ter rue Ferrère
33000 Bordeaux
Write to the practice
A question before booking a consultation?
Your message goes directly to Dr Azencot’s office.
In cosmetic surgery, French law requires a detailed written quote and a cooling-off period of at least fifteen days between the consultation and the operation. No deposit may be requested during that period. Two consultations are required before any operation.