Silicone breast implants (SBI) for breast reconstruction became covered by Japanese medical insurance in 2013. Reports suggest that the 10-year risk of SBI rupture is around 10%. This study examined the rate of SBI rupture and associated risk factors in Japan. A total of 2071 patients who received SBI reconstruction underwent SBI ultrasonography at our institution. The results revealed that 95% exhibited no rupture, while 5% showed evidence of rupture, with rupture rates of 1.1 and 11.8% at 5 and 10 years, respectively. Multivariate analysis identified prolonged implantation duration, multiple insertions, and capsular contracture as independent risk factors for rupture. Therefore, careful monitoring is essential when these factors are present. As the use of SBI in breast reconstruction continues to increase, further research is needed, particularly focusing on late complications, including rupture.

Fat grafting comprises of three key steps：liposuction, purification, and lipoinjection. After transplantation, complications such as oil cysts formation, fibrosis, and calcification due to fat necrosis may occur. To achieve stable and successful engraftment, it is essential that surgeons understand the mechanism of engraftment, carefully perform the procedure and select the appropriate instruments. This article discusses the devices utilized in each of the three steps of fat grafting to the breast.

In breast reconstruction, achieving symmetry with implants alone can be challenging. Fat grafting is an effective adjunct to address issues such as implant contour irregularities, rippling, and depressions in the upper chest and axillary areas. Our previous studies suggest that combining fat grafting with implant-based reconstruction results in patient satisfaction levels between those achieved with implant-only and autologous tissue reconstruction, contributing to improved aesthetic outcomes. This technique is simple and suitable even for beginners in fat grafting. In the long term, considering the potential transition from implants to autologous reconstruction, the appropriate selection of fat donor sites should be carefully examined.