Mammary Lipofilling

This procedure is a means of breast augmentation, i.e., increasing the volume and improving the profile of the breast. It is performed without the use of breast implants, and in certain cases may be used to reconstruct the breast after tumour removal.

The operation

Lipofilling is performed in an operating theatre that conforms to the highest sterility and patient safety standards. If a large amount of fat is required for the procedure, the patient is given a general anaesthetic; otherwise the operation can be performed under local/regional anaesthesia and sedation.

The fatty tissue is harvested by inserting a small cannula, connected to an aspirating syringe (liposuction) into a donor region of compact adipose tissue rich in stromal vascular fraction, an excellent source of adult stem cells (ADSCs). Donor sites are usually the abdomen, flanks (the so-called “love handles”) or thighs. Once harvested, the fat is treated to remove excess fluid, and loaded into small 3cc syringes.

Using micro-cannulas, it is then injected into the breast at various depths along micro-channels under the mammary gland, between the breast and the underlying pectoral muscle, and between the mammary gland and the skin. This procedure can be repeated several times until the desired effect is achieved, and up to a maximum of 250–300 cc can be injected into each breast at each lipofilling operation.

When a large increase in breast volume is required, the fat is generally harvested in association with a technique called liposculpture, which not only enables the breast to be augmented considerably, but also improves the profile of the flanks and thighs by removing a large amount of adipose tissue.

During the operation, the harvested fat must be centrifuged, and half of the material collected is lost during this process, meaning that candidates for this type of surgery must be suitable for liposuction, so that the required amount of tissue can be taken. For these patients the operation will have a dual benefit, removing excess adipose tissue from fatty areas, and, at the same time, increasing the size of the breasts.

Following the operation there will be a small scar at the donor site of roughly 3 mm (from the incision needed to insert the suction needle) but the recipient breast will remain unscarred, as the needles used for the graft are too fine to leave a mark. Thanks to its low invasiveness, this operation is considered very safe.

What kind of anaesthesia is used?

Local anaesthesia + sedation, or general anaesthetic

How long does operation take the?

2 – 4 hours

How long will I have to stay in hospital?

1 day or day surgery

When can I resume my normal social activities?

After 1 week

Lipofilling After Breast Reconstruction.

Lipofilling is a surgical technique that consists of three main phases: harvesting fat, its purification via centrifugation or another suitable method, and its injection into the area to be treated. The sites most often used to harvest the fat are the lower abdomen, flanks (“love handles”), thighs, and the inner side of the knee. First an anaesthetic and vasoconstrictor solution is injected into the donor site (wet technique), and then the adipose tissue is harvested through small incisions using suitable aspiration cannulas. The fatty tissue is then processed, and subsequently injected in small quantities so that it survives uniformly and stably. Only small quantities of fat are injected to promote integration with the surrounding tissues of the recipient site, and for the same reason it is preferable to inject the adipose tissue into different layers at different levels (multiple deposition planes using the same infiltration cannula) and over a wide area. This will improve survival and the generation of new blood supply to the grafted tissue, thereby allowing it to “settle in” correctly. In other words, the fat is injected through a small-bore needle connected to a syringe in very small quantities, and into many different channels at several different levels, to create a three-dimensional network of transplanted fat, which promotes both revascularization (the development of new blood vessels) and long-term stability.

The potential of this treatment has recently been further enhanced by technological advances such as water-assisted harvesting systems, as well as stem cell enrichment systems.

Indications:

Correcting complications of breast implant surgery: Lipofilling is particularly useful in implant surgery, and can be performed during the various phases of reconstruction to increase the thickness of the tissue under the skin and over the implant. In this way it can reduce the risk of skin rippling and implant exposure, as well as the risk of capsular contracture syndrome. The use of fat grafts is especially indicated when the tissues overlying the implant are thin, for example in cases where a breast tissue expander has been used, radiotherapy damage is an issue, or where the patient cannot be offered autologous reconstruction.

In implant surgery, complications affecting the soft tissues that cover the implant may leave visible irregularities in the surface layers of the breast. In such cases, and if visible wrinkling of the silicone implant walls occurs, fat can be harvested and injected into regions around the breast to thicken the tissues covering the implant and correct its unsightly appearance. In other cases, specifically those patients with scarce fatty tissue under the skin and limited muscle tropism (blood supply), the upper part of the implant may become visible and give the breast an artificial look. In these patients, the breast can be made to look more natural by transplanting adipose tissue around the entire border of the implant.

Post-mastectomy patients can also benefit from fat grafts, with or without stem cell enrichment. These can be used in association with implant surgery, but it is also possible to perform breast reconstruction using fat grafting alone. This type of lipofilling requires several treatments, and can be facilitated by means of a suction-based breast enlargement device that creates negative external pressure (the Brava System), or different harvesting and/or stem cell enrichment techniques.

Capsular contracture syndrome: This is, without doubt, the complication that causes the greatest morbidity in patients who undergo breast reconstruction via implant surgery. Implants invariably become surrounded by a layer of scar tissue (capsule), which, in the majority of cases, remains soft and pliable, and therefore has little effect on either the shape or the consistency of the breast. However, in a significant percentage of patients, the capsule can gradually increase in thickness and shrink. This is called capsular contracture, and causes deformation of the implant, compressing it into an unnaturally rigid spherical shape. Although slight capsular contracture usually requires no treatment, in more severe cases (grades III and IV), lipofilling can be used to correct the deformities in the shape and position, as well as, in certain cases, reduce the severity of the capsular contracture.

After breast-conserving surgery: Breast-conserving surgery can damage the breast skin and underlying tissue (parenchyma), leading to unsightly deformities, which may also affect the areola and nipple, usually by changing their shape or position. Nevertheless, excellent results have been reported when lipofilling has been used to correct such deformities in patients who experience breast volume reduction and/or distortion following QUART (surgery plus radiotherapy). Many QUART patients feels that it is prudent to wait for at least 1 to 2 years after the procedure, although many Centres will provide lipofilling even before this settling period has elapsed.

Scarring: Lipofilling may also be successfully used to correct and improve the appearance of scarring. In these cases the injection of adipose tissue under the skin can improve the tissues, filling dents and hollows, and smoothing out irregularities. This occurs thanks to the combined action of fat as a joint “filler” and local source of stem cells and growth factors. Fat grafting is performed to correct deficits in the layers beneath the skin, and improves both the quantity and the quality of the superficial component of the dermis.

What kind of anesthesia is used?

Local anesthesia + sedation, or general anesthetic

How long will I have to stay in hospital?

1 day or day-hospital

When can I resume my normal social activities?

After 1 week

Revision Breast Surgery

The more common reasons for seeking revision breast surgery are implant deflation, implant exchange (size or type), capsular contracture, implant malposition, double-bubble deformity, or a combination of these issues. When a breast implant is inserted, a scar forms around it as part of the natural healing process, called a capsule. The capsule may sometimes tighten and compress the implant creating a distorted breast shape. The goal of revision surgery is to help restore a more youthful contour and attractive appearance.

TO REMEMBER:

	Length:	One to two hours, depending on the condition to be treated.
	Anesthesia:	Local anesthesia and intravenous sedation may be used, although general anesthesia may be more desirable.
	Inpatient/Outpatient:	Either, depending on patient preference
	Possible Side Effects:	Discoloration and swelling may occur initially, changes in nipple or breast sensation.
	Risks:	Risks include adverse reactions to anesthesia, blood accumulation that may need to be drained surgically, and infection.
	Recovery:	The patient should be able to return to work within seven to ten days depending on the type of work. Special care must be taken to be gentle with your breasts for at least one month after surgery.
	Results:	Depends on the patient’s breast laxity or sagginess after having had children or losing weight. Generally stable. However, gravity and the effects of aging will eventually alter the size and shape of virtually every woman’s breasts.

Breast Reduction

The procedure usually requires two to four hours of operating time depending on the technique chosen and the size of the breasts.Reduces breast size and improves physical and emotional symptoms caused by very large breasts.

Procedure

Breast reduction surgery, also referred to as reduction mammoplasty, reduces the size and improves the shape of the breasts. Typically, women who are candidates for this procedure have physical symptoms related to the weight or shape of their breasts. These symptoms include back pain, neck pain, and bra strap grooves in the shoulders. The incisions vary based on the breast size before the operation and the final post-operative size.

An incision is made around the nipple and areola accompanied by a vertical incision below the areola with or without a horizontal incision made in the crease below the breast. Short scar techniques are frequently applicable in breast reduction surgery and allow excellent reduction of size with improved shape while limiting the extent of the incisions.

For reduction of very large breasts, in some cases the nipple and areola may need to be surgically removed and reapplied as a graft. Removing and reapplying the nipple/areola tissue will result in the loss of nipple sensation and the inability to breastfeed.

To Remember:

Length:

The procedure usually requires two to four hours of operating time depending on the technique chosen and the size of the breasts.

Anesthesia:

The procedure is typically performed under general anesthesia supplemented with local anesthesia. Smaller reductions can be performed under intravenous sedation without the need for general anesthesia.

Inpatient/Outpatient:

Depending on the size of the breasts, type of anesthesia selected, and length of the surgical procedure, patients may return home on the same day as their surgery or spend the night at an aftercare facility or hospital.

Possible Side Effects:

Prolonged swelling and delayed healing.

Risks:

Risks associated with breast reduction include: unfavorable scarring, loss of nipple sensation, loss of ability to breastfeed, loss of nipple and breast tissue, unsatisfactory shape, and failure to achieve aesthetic goals.

Recovery:

Typically recovery requires one to two weeks. Most patients return to normal activities within that period of time. Strenuous physical activities are discouraged for three to six weeks after the surgery.

Results:

Most patients who undergo a reduction mammoplasty are pleased with the size and the shape of their breasts and are delighted with the improvement and lessening of the symptoms of pain and discomfort that they experienced due to the weight of their breasts. 

Breast Asymmetry Correction

Most women notice a degree of variation in the size and shape of their breasts, and in most cases, this is completely normal and natural. This condition is called breast asymmetry. Genetic and developmental factors can play a role, sometimes resulting in breasts that are not disproportionately out of balance. This noticeable difference in a woman’s breasts can cause embarrassment, affect what activities she’s comfortable with and decrease her self-esteem on a daily basis.

WHAT CAUSES BREAST ASYMMETRY?

Common causes of breast asymmetry include:

• Hormonal changes: normal changes in a woman’s hormone levels will naturally affect the size of her breasts, and these changes may have a different impact on each breast and can also be permanent in nature.
• Atypical ductal hyperplasia: women experience this condition when milk-duct tissues grow rapidly in one or both breasts, and the comparative rate of growth in each breast could also lead to asymmetry.
• Juvenile hypertrophy: women with this condition experience rapid breast growth in one breast but not the other during puberty as a result of completely natural causes. Later breast growth and changes to the breast never correct the original asymmetry once it occurs, however.
• Hypoplasia: this condition refers to breasts which never develop fully during puberty, resulting in small breasts which may be widely spaced or very uneven in appearance. The areolae may also be overly large and of differing sizes, as well.
• Breastfeeding: Often a newborn may prefer one breast over another during breastfeeding, causing the favored side to produce more milk, thus increasing its size. The condition will often return to normal, but sometimes, stretched skin can persist, leaving lasting asymmetry.
• Trauma: accidents or severe trauma to a woman’s chest can permanently alter the size of one or both breasts unless corrective surgery is sought.

WHEN DOES BREAST ASYMMETRY BECOME A PROBLEM?

• Uneven breast size
• Uneven breast shape
• Different nipple size or shape
• Uneven nipple position

BREAST ASYMMETRY SURGERY OPTIONS

Possible procedures include:

• Breast augmentation: a breast augmentation procedure will enlarge the breasts, through the use of implants, to a satisfying and attractive fullness based on your overall physique and goals. Different sized implants can be used in each breast.
• Breast reduction: a breast reduction will reduce the size of one or both breasts by removing excess skin and fat to produce a pleasing breast appearance that may also reduce pain and discomfort in women who have very large breasts.
• Breast lift: a breast lift will improve the position of the breasts on the chest wall and may be performed in conjunction with a breast augmentation or breast reduction or on its own.
• Fat transfer augmentation: a fat transfer augmentation can improve the size of the breasts, without implants, by using fat from your own body to restore breast fullness.
• Nipple repositioning: nipple repositioning restores the nipples to their original position on the breast, correcting mal-positioning due to stretched skin, drooping breasts and other factors.

ARE THERE ANY RISKS INVOLVED IN BREAST ASYMMETRY SURGERY?

Breast surgeries share the same risks as general surgery but may also include capsular contracture, or internal scarring, as a result of placing the implant and also the possibility that the implant may later rupture. Like the risks from general surgeries, the risks from breast surgeries are extremely low when performed by a qualified and experienced plastic surgeon.

Breast surgeries, including surgeries for breast asymmetry, remain extremely popular and common worldwide, and patients not only have overwhelmingly problem-free surgeries but also enjoy the highly satisfying and long-lasting results that these procedures produce.

WHAT IS RECOVERY FROM BREAST ASYMMETRY LIKE?

If you receive implants as part of your breast asymmetry surgery, your recovery time will be around six weeks in total. Your surgeon will inform you of a suitable aftercare process that includes scheduled check-ups, wound healing methods and advice regarding your return to everyday activities. The end result, however, will be well worth your investment, as you will soon be able to enjoy two attractive breasts of similar volume and shape which will give you satisfaction and confidence every day.

Occasionally, a second procedure is recommended to make small adjustments such as raising a nipple or to transfer a little more fat into a particular area but only in unique circumstances. Dr Choy uses the best enhancement and reconstructive techniques available to deliver beautiful results for his patients in a single surgery.

Male Breast Reduction

Reduces overly developed male breasts and nipples to provide a masculine chest appearance.

Male breast reduction surgery reduces overly developed male breasts and nipples using liposuction and/or by surgically removing excess glandular tissue.

ally removed and reapplied as a graft. Removing and reapplying the nipple/areola tissue will result in the loss of nipple sensation and the inability to breastfeed.

TO REMEMBER:

	Length:	Approximately one and one-half to three hours.
	Anesthesia:	Either general anesthesia is used or intravenous sedation and local anesthesia are used.
	Inpatient/Outpatient:	This is an outpatient procedure.
	Possible Side Effects:	Temporary bruising, swelling, numbness, soreness, and/or a burning sensation are possible.
	Risks:	Infection, fluid build-up, injury to the skin, rippling or looseness of the skin, asymmetry, pigmentation changes, excessive scarring if tissue was cut away, loss of nipple sensation, contour irregularities and in some instances the need for a second procedure to remove additional tissue is required.
	Recovery:	The patient may go back to work after seven days. More strenuous activity may be resumed after two to three weeks. Most of the swelling and bruising will disappear after three to six months.
	Results:	Permanent, although subsequent weight gain may cause the breast area to once again become larger.