Hybrid Breast Enlargement - Breast Implant and fat grafting

Some women experience a disturbance in the development of the breasts which leads to underdeveloped and/or asymmetrical shapes of the breasts. Others have experienced a loss of fat and sagging breasts after pregnancy and/or weight reduction. This can be experienced as both cosmetic and intimately embarrassing for some. These groups are common candidates for breast augmentation with breast implants and/or fat injections.

A growing trend is to combine the insertion of implants in combination with fat for those who want volume increase in the breasts with the natural feeling of fat. The procedure is suitable for those who do not have enough fat to move/use and for those who want to shape other areas of the body. The natural look can be seen especially at the cleavage and the peripheral part of the breast, i.e. the upper part, the outside and under the breast.

Since 2008, Oslo Plastic Surgery has performed breast augmentation with our own fat tissue, and we have operated on over 250 women. We created this offer as an alternative to breast augmentation with implants. Oslo Plastic Surgery therefore has a long follow-up period for these operation patients, who have proven to be very satisfied with their operation, and that the fat volume in the breasts has remained stable.

See separate information sheet on Breast augmentation with implants. And breast augmentation with fat and fig.shaping.

Implant insertion methods

The first method; a pocket is prepared under the mammary gland, another method is under the pectoral muscle, and a third and often better alternative is to place the implant under the membrane of the pectoral muscle. We then protect the implant with the fascia itself (the strong membrane around the muscle) and at the same time avoid using the muscle itself. A silicone prosthesis is inserted into the pocket of a size and type that has been chosen in collaboration with the patient before the operation. The scar is placed either under the breast (most commonly) so called sub mammary fold, around the nipple or at the armpit. Ripples (wrinkles) of the skin could be avoided if the implant is placed under the muscle or under the fascia. The choice is based on what suits the patient’s anatomy and will give the best aesthetic result.

The ability to breastfeed is not normally destroyed by the operation or the possibility of a mammography examination. Breast augmentation does not increase the incidence of breast cancer either. (See more under FAQ)

The surgery does not give right to a sick leave. You should restrain with physical training for at least 4 weeks after surgery. In the beginning the scar will be red, itchy, and hard. In time it will lighten and soften. The scar can be hidden under a bra or a bathing-suit and will not be visible when wearing low neck clothes. We recommend you tape the scars for a couple of months after surgery.

About our implants

Oslo Plastikkirurgi clinic uses the renowned Mentor Memory Gel prostheses. They are available with smooth or textured surface and with moderate to ultra-high profile. You will, in consultation with the surgeon, decide which implant is right for you.

Mentor Memory Gel breast implants feel like natural breast tissue without compromising on reliability or safety.

Mentor has been one of the world’s leading manufacturers of quality implants for over 30 years and has been a trusted choice for millions of women worldwide. Founded in 1969, Mentor Worldwide LLC is a leading manufacturer and supplier of medical products for over 100 countries. Mentor’s activities include research, development, and production at several plants in Europe and the USA.

The prosthesis usually consists of silicone, but there are also other types of prostheses consisting of saline, or a combination with saline and silicone. The exterior of the prosthesis contains silicone. Regarding the shape, the prostheses may be round or drop-shaped, the latter giving in some women a more natural form of breast enlargement.

The implant consists of silicone, but it is also possible to use other type of implants such as saline and a combination of saline and silicone, when the outer part of the implant consists of saline. Your surgeon will explain all the options available to you in detail.

You can read more about Mentor implants here: http://www.breastimplantsbymentor.net/en-EMEA/

You also have choices about shape. You can select a round or anatomical shaped implant, which look more natural. Sometimes we can combine a breast enlargement with a breast-uplift (Mastopexy), if the breast tissue has sagged. See more information about this procedure here.

How to perform breast augmentation with your own fat

For breast augmentation with own fat tissue, small tunnels are prepared under the mammary gland, alternatively in the pectoral muscle where the fat is built in layers without pressure. The fat is taken out and treated in a special way before it is injected with a special cannula in the chest area, the so-called Coleman’s technique; a vibration technique with the MicroAire machine that creates more space for fat in the breast and stimulates healing, which leads to better retention of the fat and thus better results. The amount of fat needed for the procedure depends on the desired volume of the breasts. With a standard fat injection, small scars of approx. 3 mm where the needles are inserted.

Resorption of the fat and long-term result

The result of this type of surgical technique depends on resorption of the injected fat, i.e. the extent to which the body itself absorbs the fat. Usually, the fat is incorporated (grows) well in the recipient area. You must expect that the body absorbs up to 40% of the amount of fat in the first months, therefore you fill a little more than you need (overcorrect) to compensate for this loss. There is also no guarantee that someone will absorb more than 40%.

Handling the fat is crucial for it to grow firmly. There are several conflicting techniques for processing the fat that is removed so that only pure fat is injected. The fat must be treated carefully without major damage to the fat cells. A centrifugation process in which a simple machine separates the fat is considered to meet these requirements. But here the last word has not been said. We use a low degree of centrifugation to separate the fat but retain the intimate fat fluid that supplies the fat cells with, among other things, the natural growth factors, and stem cells that we think give the best possible result.

It is not uncommon for a new injection to be needed, and in case of resorption of more than 40%, a new fat injection is offered within the warranty period; this on the condition that there is sufficient fat for injection for any volume increase or in cases where asymmetry occurs. If the fatty tissue is not sucked away from the body, so that the volume is not satisfactory, this remains a natural and long-lasting result.

We close the wound with stitches that dissolve by themselves. In very few cases, a drain (tube) is inserted to remove blood and fluid from the wound area under the breast. These are usually removed the day after the breast augmentation. In principle, breast augmentation does not give grounds for sick leave. Physical training and hard physical work should be delayed for approx. 4 weeks. The scars are often red, itchy, and hard at first, but with time they fade and soften. However, the scars are hidden by bras or bathing suits and will not be visible in low-cut dresses. In rare cases, the scars become wide and clearly visible because this depends on the woman’s own inherited characteristics. We therefore recommend that you tape the scars for a couple of months after a breast augmentation.

Pick-up and accommodation

If you live some distance from the clinic, we recommend that you spend one night in or near Oslo Plastic Surgery Clinic so that our caring staff are on hand to reassure you should any issue arise, that will cause you concern.

You must agree in advance with a person to pick you up at the clinic approx. 1 hour after the end of the operation, as you cannot drive, take public transport or taxi alone. You should also have someone with you the same day and the first night.

If you live far from the clinic, we recommend that you spend the night in Oslo, either with family / friends or at a hotel.

Hotels near Oslo Plastic Surgery:

-Frogner House Apartments, Bygdøy Allé 53. Website: https://frognerhouse.no
(We have an agreement with Frogner House Apartments).

-Hotel Gabel’s Hus in Gabel gate 16. Website; www.nordicchoicehotels.no

Pre-Operation preparations

To get optimal results and avoid complications

Avoid stress, stay out of the sun, eat healthily, keep your weight within a normal BMI range, exercise regularly, and refrain from alcohol for 2 days prior to surgery and 2 weeks after surgery. Please refrain from smoking/snoozing for at least 2 weeks before surgery and a minimum of 2 weeks after surgery as smoking can interfere with the result.

Before surgery

You must ensure your personal health on the day of surgery. Please contact us as soon as possible if you are in doubt, as we may have to postpone your surgery therefore saving you a journey to our clinic.

Prior to surgery you will have received a prescription for antibiotics, pain killers and Hibiscrub 40 mg/ml which are all available from your local pharmacy. The day before surgery you must shower using the Hibiscrub and again on the day of the procedure immediately

before surgery. Use a clean towel for drying and put on clean clothes when you leave home and change the sheets on your bed.

YOU MUST NOT EAT ANYTHING 6 HOURS BEFORE SURGERY, but you may drink water and light juice (not milk) and chew gum up to 4 hours prior to your surgery. You may take necessary medication/s with a sip of water on the morning of the operation.

Please decide for an adult friend to pick you up after surgery, as you will not be able to drive or take a cab alone. We also advise you to have a responsible adult person staying with you during the first 24 hours.

Taking medications prior to surgery:

It is very important that you stop using the following medications 2 weeks before surgery: Acetylsalisyre, Albyl, Albyl-E and other medications that cause extended bleeding as Ibux, Alka-Seltzer, Antineuralgica, Asacol, Artrizin Alka, Brufen, Butazolidin Alka, Codacetyl, Confortid, Dispril, Dispril med kodein, Doloxene Forte, Denobid, Felden, Fenylbutazon, Gamaquil Comp, Globentyl, Globoid, Indocin, Kodein-Magnyl, Kodifen, Licyl, Magnyl, Magnyl-Koffein, Mundisal, Napren, Naprosyn, Novid, Novid with koffein, Paraflex Comp., Tanderil, Vitamin E, and Selen, Tricycliske antidepressiva.

We also recommend you omit Garlic, evening primrose oil, Gingko Bilabo, Aspirin and any drug containing blood thinners.

The above products are known blood thinners therefore not beneficial when you are having surgery. For Marivan we have individual arrangement. Please request this information on your consultation.

Day of Surgery

After a final discussion with your surgeon the planning process will begin. You will be photographed, and markings will be made on your surgical areas. At this stage you will have time and the opportunity to ask any questions that you may have forgotten so that your surgeon can reassure you that he fully understands your goals and expectations.

You will be introduced to your anesthetist (who will be happy to discuss any fears or issues you have regarding your anesthetization). You will also meet your theatre nurse.

The sedation which you are given in your arm is a quick and painless procedure and you will fall asleep very quickly.

You should be ready to go home within 1 hour following surgery and remember to arrange for someone to pick you up. You should have adult company with you for the next 24 hours to assist you with general tasks, so that you can relax and take it relatively easy.

We will provide you with the cell phone numbers to call us should you feel the need, but this is very rare. We just need to reassure you that we are there for you 24 hours a day.

After Surgery

We will require you to come to the clinic for a follow up check. WITH ALL SURGERY THIS IS IMPORTANT AS YOUR SURGEON NEEDS TO SEE HOW YOU ARE SETTLING.

We do not recommend you fly for 48 hours post-surgery. You may feel nauseous and tired in the hours following surgery. It is important to take your painkillers and drink enough fluids.

We close the wound with stitches that dissolve on their own. We do not usually insert the drain (tube), only in very few cases is it inserted to remove blood and fluid from the wound area under the chest. These are usually removed at the clinic 1-2 days after the operation.

You may experience dizziness if you get up quickly from a chair or perhaps when you are lying in bed, so be sensible, take it easy and move slowly. This is quite normal following surgery and should pass within a couple of days.

The first 2-5 days following your breast surgery you may feel stiff and sore in the chest region. You should be calm and lie as still as possible, with your upper body raised. For the next five days, you can move gently. If you have an active job, it is a good idea to stay home.

After the operation, you get a special bandage that is removed after 2 days, the tape is kept on for 2 weeks. You will be required to wear a sports bra for approximately 6 weeks after surgery day and night and 6 more week at daytime. Your breasts may feel tight and sensitive to the touch and your skin may feel warm or itchy.

After the tape is removed (after 2 weeks) you can shower the area and put on new tape. It is recommended that you tape the scars with skin-friendly tape for at least 2 months. Surgical tape such as Micropore or Steri-Strip can be bought at the pharmacy, alternatively silicone tape.

 Follow ups will be carried out at the clinic/alternatively through phone or video consultation:

1 day after surgery, after 1-2 weeks, after 3-6 months and finally after 1 year when our guarantee to you is completed.

Bleeding and infection are unusual and if they do occur, they may need to be treated with a small operation and/or an antibiotic.  Asymmetry, incorrectly placed implants, or the formation of hard capsules” capsular contracture” can also occur. If corrections are needed, they will be scheduled free of charge within one year after your surgery. Anesthesia allergy is extremely rare.

If correction is necessary due to complications or unsatisfactory results, this is done free of charge within one year if there is a medical indication and a clear potential for improvement. This is our warranty period.

Heavy physical exercise and strenuous body movement or lifting must not be undertaken for a minimum of 4 weeks following the surgery.

The results will emerge between 3 to 6 months following surgery.

Contact form

If you want to know more or have questions, use the form and we will reply to you within a short time.

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Dr. Amin Kalaaji

Dr. Amin Kalaaji, MD, PhD is a board-certified plastic surgeon and head of the clinic at Oslo Plastic Surgery, and president of the Norwegian Association for Aesthetic Plastic Surgery (NFEP) 2018-2020.

Dr. Kalaaji has established the Oslo plastic surgery clinic in the Frogner district, central Oslo, in 2002. In 2022, the clinic will celebrate its 20th anniversary.

Dr Kalaaji participates in many meetings and holds lectures and trainings around the world. This benefits all our patients as he is always up to date on the latest and most advanced treatments and surgical techniques. Patient safety, high quality and individual treatment always weigh the most at Oslo Plastic Surgery.

Dr. Kalaaji is trained in plastic surgery in France (Paris) and Sweden, with a doctorate in plastic surgery from Sweden, in bone transplantation for cleft lip and palate. He was previously chief physician at the plastic surgery department at Telemark Central Hospital, and chief physician and acting head of department at the plastic surgery department Ullevål, Oslo University Hospital. He now works at Oslo Plastic Surgery in Oslo and has had clinic responsibility there for over 20 years.

In recent years, his focus has been on aesthetic procedures including breast surgery, fat transplantation to all parts of the body, especially the face, eye, chin, chest, BBL buttock augmentation with own fat and intimate surgery. In addition, correction of inverted nipples is carried out (where he has developed a very special technique that preserves the function of breastfeeding), rhinoplasty and the usual face operations such as facelifts, eyelid surgery and ear surgery. He has also researched the quality of life of patients who have undergone breast surgery such as breast implants, breast lifts with implants, intimate surgery, and rhinoplasty.

Dr. Kalaaji has published several scientific articles and has given over 400 presentations and courses on plastic and aesthetic surgery in the Nordics, Europe, and the world.

Among other things at ASAPS, ISAPS, ISPRES, IMCAS, and at many national and international aesthetic surgery meetings and participates as Faculty in global aesthetic courses for the «International Society for Aesthetic Plastic Surgery» (ISAPS), in ASAPS (The American Society for Aesthetic Plastic Surgery) at a congress in Boston in 2011, which deals with the quality of life of women with breast implants and in New York 2018 with courses in Mommy Makeover in aesthetic surgery and other widespread combined operations, and the importance of choosing combinations. Many works have been published in the Norwegian journal «Kirurgen» in April 2012 and in the prestigious Aesthetic Surgery Journal and PRS (Plastic and Reconstructive Surgery) from 2013 to now.

He has also given lectures and been a guest lecturer in London, Manchester, Berlin, Rome, Paris, Marseille, Tours (France), Helsinki, Linköping, Stockholm, Gothenburg, Karlstad, Uppsala, Tromsø, Lofoten, Oslo, Copenhagen, Marrakech, among others. , Tunis, Aleppo, St. Petersburg, Cape Town, Rio de Janeiro, Miami, Cairo, Beirut, Kota Bharu (Malaysia), Dubrovnik, Coventry, Belgrade, Sarajevo and Kyiv, about breast augmentation with fat transplantation, buttock augmentation with own fat, the clinic’s own operating method regarding inverted nipples that preserve breastfeeding function, rhinoplasty, intimate surgery, and breast lift with implants at high-quality international conferences.

Dr. Kalaaji currently sits on the editorial board of the Journal of Plastic surgery and Hand Surgery, and of the prestigious Aesthetic Surgery Journal in addition to the Acta Chirurgiae Plasticae Editorial board.

Dr. Kalaaji is an active member of the international organization International Society for Aesthetic Plastic Surgery (ISAPS) and was a member of the membership committee of the same organization. ISAPS is a leading organization for experts in cosmetic plastic surgery.

He has also been an active member of the American Society for Aesthetic Plastic Surgery (ASAPS) since 2007 and has since attended this prestigious annual meeting in the USA.

Dr. Kalaaji serves as a member of the International Committee of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2009-2023.
“The time and dedication offered by Dr. Kalaaji to the Society is truly appreciated by the members and by the Board of Directors of the American Society of Aesthetic Plastic Surgery (ASAPS),” stated ASAPS President, Dr. Jack Fisher, MD. 2017.

Dr. Kalaaji is also included on the International and Education/Program Committees of the American Society for Aesthetic Plastic Surgery (ASAPS).

In October 2015 and 2017, 2019, 2021, Dr. Kalaaji chaired the Norwegian American Aesthetic Meeting (NAAM 1,2,3,4) in Oslo. Link: www.naam.no

Dr. Kalaaji was chairman of the board of the Norwegian Association for Aesthetic Plastic Surgery (NEFP) 2018-2020, before this he was a board member of the Norwegian Association of Plastic Surgery from 1999-2001 and was elected as a board member of the Norwegian Association of Aesthetic Plastic Surgery (NFEP) 2014-2018. In addition, Dr. Kalaaji is an active member of the Nordic Plastic Surgery Association and the International Society of Plastic Regenerative Surgery.

In July 2017 and 2021, Dr. Kalaaji was elected as National Secretary of ISAPS in Norway for a period of 8 years, and in October 2018, Dr. Kalaaji was unanimously elected to the board of the International Society of Plastic Regenerative Surgery (ISPRES) 2018-2020 and is acting chairman of the membership committee in ISPRES (2020-2022)

Dr. Kalaaji was recently elected in June 2022 as the Assistant Chair of National Secretaries for all ISAPS National Secretaries, 2022-2024.

He has just published as editor-in-chief a book in two volumes: Plastic and aesthetic regenerative surgery and fat transplantation. Clinical application and operative techniques. This book—with its 117 chapters, approximately 2,000 pages, 1,625 educational figures, and 131 video clips—proudly represents the knowledge and expertise of 242 authors, including 72 female colleagues, from 31 countries and 5 continents.

These engagements and the roles Dr Kalaaji participate in mean that we are always up to date in the latest treatments, patient safety and surgical techniques.

FAQ

Oslo Plastikkirurgi answers here frequently asked questions, and we hope that this will give you good information. We want to be helpful in the process before an operation. If you have more questions, just write or call us.

When you want bigger breasts and/or change shape.

When you want more natural breasts in texture and shape.

When you have underdeveloped or tubular breasts.

In case of volume difference on the breasts/breast asymmetry

During the operation, a pocket is prepared under the mammary gland, alternatively under the pectoral muscle. A third and even better alternative for most people is to place the implant under the membrane of the pectoral muscle, then you will also achieve protection of the prosthesis with the fascia itself (the membrane around the muscle) and at the same time avoid using the muscle itself.

The reports of possible short- or long-term damaging effects of silicone inserts have not been scientifically confirmed. Inserting breast implants is today considered a safe procedure in accordance with strict EU / EEA rules.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare type of lymphoma associated with textured implants that are largely unused today. Characteristic of breast implants with BIA-ALCL is that malignant cells are found either in the fluid (swelling) around the prosthesis or as an infiltrate in the prosthesis capsule that has been added no earlier than one year after surgery. The risk of developing or dying from BIA-ALCL is minimal, but it is always important to take risks and findings seriously. There is also curative treatment in the detection of the disease in good time. We offer our patients via the prosthesis company lifelong advice if they have questions about their implants from us.

Oslo Plastikkirurgi clinic uses the renowned Mentor Memory Gel prostheses. They are available with a smooth or textured surface and with a moderate to ultra-high profile. You will, in consultation with the surgeon, decide which implant is right for you.

You can get the implants with different types of gel. Mentor implants are available in sizes 100cc. Mentor is CE and FDA approved implants. The implants have a lifetime warranty in the event of a leak (ie they replace the implant itself), and they also provide a subsidy for the operation in the event of a leak within 10 years.

You must meet the following requirements to be a candidate for breast augmentation with your own fat: a desire not to insert foreign bodies, have existing fat for correction, have a realistic expectation of volume increase, normal ultrasound/MR of the breast, no family history of breast cancer.

Fat is usually harvested from the abdomen, thighs, and sides, but can also be harvested from other places on the body. Your wish will be important here.

Liposuction in conjunction with breast augmentation with your own fat is not a slimming method and we recommend that you be at your ideal weight at the time of the procedure so that the result is the best possible. Unwanted fat from the selected areas will be gone.

Nothing has been documented to show that fat injections into the breast are harmful in any way, nor that it induces breast cancer. This method has even been used on patients who have undergone breast cancer surgery to build up their breasts with good results. *

* Kaoutzanis C1, Xin M, Ballard TN, Welch KB, Momoh AO, Kozlow JH, Brown DL, Cederna PS, Wilkins EG. Autologous Fat Grafting After Breast Reconstruction in Postmastectomy Patients: Complications, Biopsy Rates, and Locoregional Cancer Recurrence Rates. Ann Plastic Surg. 2016 Mar;76(3):270-5. doi: 10.1097/SAP.0000000000000561.

It should not be difficult to detect cancer after fat grafting as we always refer to ultrasound before the operation to confirm the starting point so that it is easier to detect cancer.

We have a one-year guarantee on the operation and if, up to one year after the operation, there is a medical indication for an unsatisfactory result, a new operation/correction can be calculated free of charge.

For the first two days after the operation, you must rest. You will experience some pain, and occasionally nausea. It is important that you take painkillers as prescribed and make sure you drink plenty of water for the first 24 hours. The pain will be individual, but basically you should be able to move freely the next day.

You can have children and breastfeed after such an operation.

After 5-6 days, you can take off the bodysuit and, if necessary, shower the areas that have been liposuction, apply new tape and then put the bodysuit back on. The body must be worn day and night for the first 6 weeks, and then during the day for 6 weeks. You must wear a sports bra for 6 weeks after the operation (not a sports bra)

After two weeks, you can shower and put on new tape (same place as you received after the operation). You can remove the tape when the wounds have healed. You must wait until four weeks after the operation to use a normal bra.

Vigorous physical training and hard physical work are not recommended for approx. two weeks after surgery, but you are completely mobile and can resume daily activities already the day after surgery.

All patients must have a consultation before the operation. The consultation is conducted by our experienced plastic surgeon who will confer with you and your medical condition and motivation for surgery. An examination is then performed, and the surgeon assesses a possible operation.

If you are suitable for the procedure, you will receive information about the procedure, precautions for the time before and after the procedure, and you will receive answers to your questions. We then photograph the breasts and take important distance measurements to assess the need for an implant. You then get to test a special bra prosthesis, both sizes and shapes. We show several before and after pictures and if desired we can make 3D animation of the result. Feel free to tell us about this before the consultation so that we can calculate well in time.

In a consultation you get a prescription for antibiotics, possibly painkillers and Hibiscrub solution 40 mg / ml which you can buy at the pharmacy.

You must be healthy on the day of surgery. If you are in doubt about whether you have a cold or the like, you must contact us. The operation is not performed when you have the flu and / or fever or cough or other infection in the body. Our staff will receive you and together complete you for the operation, the surgeon looks at you before the procedure and draws up the planned procedure, as well as answers your questions. Anesthesia staff also come to greet you and answer your questions. After the operation, you will be served food and plenty of drinks in the form of bread, yoghurt, and juice (tell us if you want another diet / have allergies).

In Norway, it is not allowed to show before and after pictures from cosmetic procedures during marketing or on the clinic’s website. However, we can show great pictures from previous patients when you come for a consultation with the surgeon. This can be very helpful when choosing the shape and size of the implant, and it can make it easier for you to imagine a result. We do not send photos.

We have a 1-year warranty. If correction is necessary due to complications or unsatisfactory results, this is done free of charge within one year if there is a medical indication and a clear potential for improvement. This is our one-year warranty agreement.

Vedlegg:

1 – IPRAS Journal, Issue 8, 2012

2 – Kirurgen tidsskrift 2016, (25. Januar 2016)