Fat Injections to Reconstruct Breasts or Increase Breast Size

Please tweet and retweet Tweet

As described in my previous blog Free Fat Grafting grafts of small pieces of fat removed from one area of the body and placed in another area was first attempted in the late 1800s and early 1900s. In 1893, German physician Franz Neuber grafted a piece of upper arm fat to a patient’s cheek. Two years later, in 1895, another German physician, Dr. Karl Czerny, performed the first documented breast augmentation when he grafted a fatty tumor from a patient’s lower back to repair a breast defect. With the introduction of liposuction in the 1980s the available donor source for fat injections rapidly increased. Although a minority of plastic surgeons currently inject fat into the breast to enlarge them for cosmetic reasons the tide is changing. In 1987 the American Society of Plastic Surgeons advised against fat injections into the breast due to concerns that it affected breast cancer detection and the survival rate of injected fat was unreliable. That opinion was reversed in 2008 in the face of increasing evidence that cancer detection and cancer rates themselves were not affected by the procedure. Now the flood gates have opened and everyone even non-plastic surgeons want to inject fat into the breasts.

Breast Reconstruction with Aeroform Tissue Expander

Please tweet and retweet Tweet

It seems like all the latest breast reconstruction techniques like Neopec come from Australia. Now the Australians have come up with a rapid way to expand chest skin after breast cancer mastectomy to allow placement of a breast implant and thereby reconstruct the breast (see my blog Reconstruction After Breast Cancer Surgery). Usually a saline balloon or expander is surgically placed and the surgeon then progressively fills it with salt water that is injected on a weekly basis to stretch the skin. This can take up to 6 months. Now they have devised an expander that contains a cylinder of compressed carbon dioxide gas. The patient controls the release of the gas into the expander with a handheld remote control and slowly expands on a daily basis.

Preliminary data reveal that using the Aeroform Tissue Expander the expansion can be completed in 17 days instead of 6 months. Enrollment in FDA clinical trials have begun in the US and the manufacturer is predicting a 2014 FDA clearance for general use.


Aaron Stone MD - Plastic Surgeon Los Angeles
Dr. Stone's Twitter
       

New Type of Breast Implant - The Ideal Breast Implant

Please tweet and retweet Tweet

The 2 main types of breast implants available for decades have been the saline filled an silicone gel filled breast implants. Each has its pros and cons. Silicone gel implants have a more natural feel and look. Unlike silicone gel, implants containing only saline do not blend well with surrounding tissues at the edges of the implants. This is due to the chemical properties of salt water which is chemically charged as positive and negative charges that attract each other as opposed to silicone gel which does not carry a charge. Thus saline is more cohesive than silicone. What this means in clinical terms is that saline implant margins are more visible than silicone gel implant margins, especially when the soft tissue (breast gland and fat) between the outside world and the implant is thinner. Thus, in those patients with smaller breasts (less glandular tissue and/or fat) it is preferable to place saline implants under the chest muscle.

Systemic Lupus Erythematosus (SLE) and Cosmetic Surgery

Please tweet and retweet Tweet

Lupus is a rheumatic condition which affects the muscles, joints, and connective tissue. About 1.5 million people in the US have lupus which includes as many as 10,000 children. Nearly 90% of those diagnosed with lupus are female. It's an autoimmune disease. A healthy immune system produces special proteins or antibodies and these normally protect the body against bacteria and viruses that cause infections. In the case of lupus, the immune system confuses the body's healthy cells and sees them instead as if they were a bacteria or a virus, and the result is that our antibodies then attack some of our own body's healthy cells. You become allergic to yourself.

Breast Implants and Bodybuilding

Please tweet and retweet Tweet

Female body builders in general have little body fat and the process can also melt away breast tissue. Refilling the breast skin envelope is then challenging in this situation because there is so too little fat or breast tissue to cover the edges of a breast implant placed on top of the muscle. So saline implants above the muscle are out of the question. Implants placed under the muscle are even more problematic because the pressures or forces applied to them during weight lifting can rupture the implant or more commonly shift them out of position. I saw one patient who while bench pressing squeezed her implant out of position so it formed an unsightly U-shape around the lower border of the pectoralis major chest muscle.

The only answer although not optimal is a cohesive gel breast implant placed on top of the chest muscle and in selective cases the addition of acellular dermal matrix to ensure the edges of the implant and rippling are not visible, although that is costly and is not be the right choice for all such patients.

Breast Implants Augmentation and a Natural Look
Aaron Stone MD - Plastic Surgeon Los Angeles
Aaron Stone MD - twitter

Breast Implants and Lymphoma Cancer

Please tweet and retweet Tweet

Patients with either saline- or silicone gel–filled breast implants may have a very small but significant risk for a rare cancer called anaplastic large-cell lymphoma (ALCL), a cancer of the immune system, adjacent to the implant. This is currently under investigation and its existence should be considered if there is a build up or collection around the implant (seroma) years after the original surgery. Because the risk is very small the current policy is one of data collection only and no changes have been recommended for the use of breast implants or the frequency of follow up after breast implant surgery. The FDA continues to state that breast implants are "safe and effective when used as labeled."

New Discovery Could Make Breast Implants Obsolete

Please tweet and retweet Tweet

Earth shattering news out of Australia this week could have monumental effects on breast surgery, both reconstruction after breast cancer and enlargement for cosmetic reasons. The technique discovered in Australia is called Neopec. So far the process has only been performed in pigs and was so successful that human trials are scheduled too begin in early 2010. The pigs grew new breasts in 6 weeks. The surgeon places a scaffold or shell of biodegradable material in the breast, redirects a small blood vessel from the arm into the shell, places a small amount of the patient's own fat inside the shell, and a dissolvable gel called Myogel is also placed in the shell. The Myogel and blood flow from the transferred artery stimulate the fat to grow until it fills the shell and therefore takes the shape of the shell. This is a direct finding from stem cell research. After that the biodegradable shell is dissolved by the body. In the future the shell may come with its own artificial blood vessel.

Free Fat Grafting

Please tweet and retweet Tweet

Grafts of small pieces of fat removed from one area of the body and placed in another area was first attempted in the late 1800s and early 1900s. These were used as padding between 2 surfaces in the body, plugs to stop bleeding, to fill out indented areas for cosmetic reasons, etc. The main difficulty was getting the fat to survive as larger blobs of fat would die before any blood vessels could grow into them. More than half of the implanted fat would disappear so early proponents of this would put more fat in place than they needed. That way they would end up with the right amount of fat after blood vessels finished growing into the fat and no more fat would die. In order to make the fat easier to work with (structurally more durable) and add some bulk to the graft a thin layer of deep skin layers were left attached to the fat grafts. These are called dermal fat grafts. Unfortunately this does not make more of the graft survive. Also those grafted tissues that do not survive tend to turn into scar tissue that may be seen and/or felt leading to a poor cosmetic result.