Evaluation of the efficacy and safety of breast augmentation using implants combined with autologous fat grafting: a retrospective study of 219 cases.

Background: Hybrid breast augmentation-silicone gel implant placement combined with autologous fat grafting-is increasingly used in women with a thin soft-tissue envelope, yet large series from centers outside the groups that first described the technique remain limited. We evaluated the volumetric efficacy, safety, and aesthetic outcomes of hybrid augmentation, and examined whether the size gain explained patient-reported satisfaction. Methods: We retrospectively reviewed 219 women who underwent primary hybrid breast augmentation, with complete 12-month follow-up. Outcomes were the change in breast circumference, patient-reported satisfaction (BREAST-Q Augmentation module, version 2.0; Satisfaction with Breasts domain, scored 0-100), a surgeon-rated aesthetic score, and postoperative complications. Data were analyzed in SPSS version 26.0 using paired t-tests, Fisher's exact test, univariate logistic regression, and Pearson correlation. Results: Breast circumference increased by a mean of 12.6±1.3 cm at 6 months and remained augmented at 12 months (mean gain 10.3±2.5 cm; both P<0.001). BREAST-Q satisfaction rose from a preoperative baseline of 54.4±5.9 to 80.9±5.7 at 6 months and 82.2±5.4 at 12 months (mean improvement +27.8 at 12 months; 95% confidence interval: 26.9-28.8; P<0.001), and surgeon aesthetic scores were consistently high. The overall complication rate was low (5.9%; 13/219); all events were minor, and no Baker grade IV capsular contracture occurred. Patient satisfaction was not explained by the magnitude of the size gain: BREAST-Q was not associated with the increase in circumference at either time point (r=0.05 at 6 months and r=0.06 at 12 months; both P>0.3). No complication occurred among the 33 patients with a smoking history (P=0.23), and body mass index (BMI) was not associated with complications (odds ratio 1.02; P=0.92). Conclusions: Hybrid breast augmentation provided substantial and durable enlargement with a low, exclusively minor complication profile in thin-tissue patients. Because satisfaction was largely independent of the degree of size increase, these findings support prioritizing soft-tissue quality and natural contour over volume alone. In the absence of an implant-only comparison group, these findings characterize outcomes after hybrid augmentation rather than establishing its superiority or the independent contribution of fat grafting.