Breast Implants or Lipofilling in Augmentation Mammoplasty? A Randomized, Open-Label, Controlled Trial

Background: The author presents his own experience using breast implants (BIs) or fat grafting, commonly called lipofilling (LPF), to correct breast hypoplasia. Objectives: Compare the aesthetic results obtained in a study group (SG) using BIs in breast hypoplasia correction with those of a control group (CG) treated with LPF, analyzing the influence of breast and chest deformities (tuberous breast, breast volume differences/asymmetries, nipple–areola complex asymmetry, pectus excavatum, and carinatum) in the outcomes. Methods: A randomized, open-label controlled study was performed. A total of 95 patients affected by breast hypoplasia (SG) were treated with BI, comparing results with the CG (n = 90) treated with LPF. The pre-operative analysis was conducted through anamnesis (considering also the patient’s expectations), clinical and photographic assessment, and an instrumental evaluation based on magnetic resonance imaging, mammography, and ultrasound. Post-operative follow-up occurred at 1, 2, 4 weeks, 3, 6, 12 months, and then annually until the fourth year. Results: 87,5% (n = 83) of SG patients treated with BI showed excellent aesthetic outcomes after 12 months compared with the CG patients treated with LPF, who showed the same results in 70% (n = 63) of cases. Breast augmentation maintenance in the SG was significantly higher than in the CG (p <.0001). However, more natural results were reported in the CG than in the SG (p <.0001). Conclusions: BI and LPF were safe and effective in this controlled trial. CG's patients displayed more natural results, obtaining a better pectus excavatum correction, while SG’s patients showed more evident and lasting results. Level of Evidence I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.