Breast

Fat Grafting of the Breasts

Tuesday, January 27th, 2015

While it may sound crazy, fat grafting of the breasts is the real deal. Suctioning out unwanted fat from one area of the body and adding it to specific areas in a breast helps create a more refined, sculpted look. Initially used for breast cancer reconstruction, techniques continue to evolve and the technique is now being used more and more in cosmetic breast surgery as well.

Fat grafting of the breasts is not new. In 1895, a German physician named Vincenz Czerny described breast reconstruction of a 41 year-old singer. She was concerned about how she would appear on stage after having to have a breast removed. She had a large lipoma (fatty tumor) in her lower back, so this was taken and placed in the mastectomy defect. In 1919 another German doctor, Erich Lexer, published "Free Transplantations", a 2 volume text about grafting. In this text he described some clinical applications of fat graft breast augmentation and reconstruction. Melvyn Bircoll, a Los Angeles surgeon, published his experience with breast augmentation using liposuctioned fat in 1987. Emmanuel Delay in Lyons, France began using fat grafting for breast reconstruction in 2000. Gino Rigotti, in Verona, Italy, presented a large series at a 2007 European aesthetic plastic surgery meeting. Over the last 10 to 15 years fat grafting has been championed in the United States by Sydney Coleman in New York, Daniel Del Vecchio in Boston, Roger Khouri in Miami, and Kamran Khoobehi in New Orleans.

Methods for obtaining the fat, processing it, and placing the fat into the breasts are changing all the time, allowing for ever-improving shapes and contours with enhanced safety and predictability. One of the early concerns about fat grafting was that it may make mammograms more difficult to interpret. Clinically this has not been found to be the case. Del Vecchio and others have published their experiences, with a very low incidence of oil cysts and calcifications seen after fat grafting. Peter Rubin in Pittsburgh also reported a study showing that mammograms of women who have undergone breast reduction surgery are actually more difficult to interpret than mammograms of women who underwent fat grafting.

Many women come to the office with a desire to have more shapely breasts. An area that almost all want to have addressed is the flattened area at the top of the breasts, where the chest transitions to the breast. Breast implants help fill that area and may be all that's needed. Sometimes, however, adding a little fat to the upper breast may create an even more subtle transition and more filling in that area. Fat may also be added in other areas as well, depending on the specific findings and desires. A woman who is thinking about breast augmentation who also happens to have fullness in her thighs or abdomen may be an ideal candidate for fat grafting of her breasts. Using slightly modified liposuction techniques, the fat is removed from the areas where contour improvement is desired. The fat is collected and cleansed of oils and blood cells. The cleaned fat is then injected into the desired areas of the breasts.

The surgery may take two or three hours to accomplish. Recovery is similar to that of a typical liposuction operation. For a few days there is some soreness at the sites from which the fat was taken, and the breasts feel fairly tight. Swelling begins to subside after five or six days but the final shape of the breasts and the suctioned areas won't be seen for a few months.

Fat grafting of the breasts is an exciting, evolving technique. Women now ask about it frequently when they visit the office. If you have been thinking about changing the shape and appearance of your breasts, fat grafting is something you should at least know about. Call the office and come learn about this intriguing procedure!

24 Hour Saline Breast Enlargement

Wednesday, September 10th, 2014

It seems to be all the rage in New York these days. Saline injected directly into the breast tissue. Wow!

So, why on earth would a woman have something like that done? There are a few reasons. Some women who are considering breast augmentation want to have a good idea of what they'll look like with breast implants. Rather than trying on implants in their bras, they can have a doctor inject saline into their breasts. Seeing what 350 cc's of saline in the breast looks like may provide some indication of the look a 350 cc implant may create. Some women have no desire to actually get breast implants, they just want to have larger breasts for about 24 hours. The injections can certainly provide an amazing look for parties, weddings, and red carpet type events. The effect, however, only lasts about 18 to 24 hours. In New York City these procedures go for $2500 to $3500. That's quite a bit to pay for a 24 hour pick-me-up.

I understand the thoughts behind saline injection into the breasts. On some level it makes sense. On the other hand, in our office we use the Vectra XT three dimensional imaging system to help women understand about how they may look with specific breast implants. Rather than do multiple needle sticks (some of which invariably will pass through milk ducts, potentially introducing contaminants into the breast tissue), the Vectra system lets the computer do the work to help show potential results. A study published just last month found that this system has about a 90% accuracy rate. Saline that is injected directly into the breast will not give a reliable representation of what a breast implant will do. Saline that is injected into the breast is placed in the breast tissue itself; an implant is placed behind all of the breast tissue and in most cases partly behind the pectoral muscle. Saline injected into the breast tissue will expand the skin and breast tissue in all directions. An implant placed behind the tissue pushes the tissue forward. The look really is different.

There may be some risks to the saline injections. As mentioned above, they may push contaminants into the otherwise sterile breast tissue. This could lead to infection, even if the procedure is done as sterilely as possible. Also, if you've ever been given a shot, you know that some bruising may occur. Injecting saline deeply into breast tissue requires fairly large needles to pass through a lot of tissue, including some blood vessels. That's likely to create some bruising and soreness. Finally, if the procedure were to be done multiple times to the same woman, it's possible that her skin would stretch and become droopy. That's not likely to happen with one or two injections, but it's conceivable that it would happen after multiple procedures.

I have not yet had a woman come into my office asking for saline breast injections. If she wanted to do it for some special event and understood the effect would only last about 18-24 hours, I would probably consider it. On the other hand, if her thought is that she'd like to see how she would look with that volume implant, I would have her try three-dimensional imaging with the Vectra system. I think it's likely that the Vectra system will provide a more accurate representation of the potential outcome, and do it with no real risk.

Come by and see the Vectra XT three dimensional imaging system. We use it with almost every patient we see in the office. It's cool, it's powerful, and it makes the consultation process so much more meaningful.

Breast augmentation: Now's the time!

Tuesday, February 11th, 2014

This unusually cold North Texas winter will soon be a memory. Spring is just around the corner! Temperatures warm, heavy coats are put away, and warm weather clothing makes its way to the display racks. It's a perfect time for breast augmentation! Contrary to what a lot of people think, most women who come to see me for breast augmentation surgery don't want really big breasts; they just want to wear great tops. Most of these women have never felt comfortable in cute tops or bathing suits and they want to feel confident wearing sleeveless and strapless clothing.

One of the best things about breast augmentation is that there are so many shapes and sizes of breast implants available. We can help you choose an implant that enhances your figure without making you look disproportionate. In our office the Vectra 3-dimensional imaging system is used as part of the consultation to help you find the look you want. The Vectra system takes photographs of your torso with 6 cameras, and the computer blends these photographs into one three-dimensional image. We can choose any implants available in the US today, click a mouse, and like magic the software creates a simulated image of your breasts with those exact implants in place. Rather than seeing before-and-after pictures of other women who have undergone breast augmentation, this system lets you see what you may look like after an augmentation. The software even includes bikini tops and sleeveless tops that may be superimposed on the image to show you how you might look in those.

Spring is a fantastic time for breast augmentation. Be ready for the summer! Come visit with us and see what you might look like after an augmentation. The Vectra technology is way cool. Check it out!

A new product for breast implant surgery

Sunday, October 27th, 2013

I just returned from an educational event in Miami. About 200 plastic surgeons were invited by Allergan (a large company producing many aesthetics products including breast implants) to learn about a new product they will be launching in January 2014. The product is a sophisticated silk mesh that may be used for, among other things, revising certain types of reconstructive and cosmetic breast problems. We were taken to a lab, the Miami Anatomical Research Center, and provided with a "hands-on" learning experience in a very high-tech environment. The product, called SERI, looks like it may be very helpful for women whose breast implants have "bottomed out" or end up too far apart or too close together. This was a great experience and an opportunity to remain at the forefront of providing innovative products and services in breast surgery. All of us in the office are dedicated to providing our patients with current, comprehensive, and compassionate care. Come check us out!

Vectra 3-dimensional imaging in Fort Worth

Thursday, September 5th, 2013

We are the first medical practice in Tarrant County offering the Vectra XT imaging system. This is truly a "Wow" device! Six cameras take pictures of you, then a computer takes those six pictures and reconstructs one 3-dimensional image. We can then do some amazing things with this 3-D image. The image can be rotated and twisted, allowing us to show you parts of you that are hard to see in a mirror. As part of the educational process, we can draw on the image to show you, for instance, where incisions may be required or to point out specific findings to make sure that we are talking about the things that are most important to you. For our breast augmentation patients it's even better. Information about every breast implant currently available in the US is stored on the computer. We can take the 3-dimensional image of the woman's chest and pick a specific size, shape, and volume implant. Click a button and voila! The computer creates an image of what the result of those specific implants might look like in that specific person. Want to see what a different set of implants might look like? Click, done. We have also found this to be very useful in our breast cancer patients. In those women it helps us tailor the final result to more closely match the size and look of the reconstructed breast to the breast without cancer. While this imaging system does not tell us exactly what someone's final result will be, we have found it to be a wonderful tool in helping our patients understand possibilities. Vectra has been, for our practice, an incredible enhancement to the entire educational process for our patients. Come see it for yourself! We're the first in the area to have it!

Breast Reconstruction: It Takes a Team

Wednesday, September 28th, 2011

One of my passions is breast reconstruction surgery.  In the Fort Worth area we have many talented surgeons performing mastectomies for breast cancer patients, and I have worked with 13 of those surgeons this year.   Fort Worth surgeons are knowledgable about breast reconstruction and frequently present it as an option to their patients who are planning to undergo mastectomies.  Nationwide, however, that is not always the case.  Studies from the University of Michigan found that minorities had previously not been offered reconstruction in a disproporionately high percentage of cases.  Because of this, the state of New York last year made it mandatory that women undergoing treatment for breast cancer be offered the option of breast reconstruction.  This article is a nice summary of that:  http://www.psnextra.org/articles/breast-recon-law.html . 

I am involved with a team of physicians who treat breast cancer patients.  We have conferences on Wednesdays where individual cases are presented.  The team includes medical oncologists, radiation oncologists, surgical oncologists, pathologists, breast-imaging specialists, clinical breast nurse navigators, genetics specialists, and plastic surgeons.  All aspects of the cases are discussed, from the specifics of the tumor cells to the living situation of the patient.  This provides a balanced, well-thought-out plan of treatment uniquely suited to the patients.   Because of my dedication to treat these cancer patients in a timely manner, we sometimes have to alter my clinic schedule so I can work with the mastectomy surgeon to eradicate the cancer and provide immediate breast reconstruction.  My office staff does amazing work in managing all of this.  We find that this team-oriented approach makes the entire process a little less scary, a bit more comforting, and a lot more thorough in providing optimal treatment for our breast cancer patients.

Blame It On the Baby

Tuesday, August 30th, 2011

It's okay.  Really.  Having a baby wreaks havoc on a body.  The hormonal changes alone are enough to make you a little crazy.  And then there's the stretching followed by the shrinking followed by the, "OMG, what happened to my breasts/abdomen/buttocks/thighs (take your pick)?!"  We have designated our office as a safe haven for mothers who have had it with the untoward physical changes wrought by pregnancy.  You want to come in and get it off your chest, literally and figuratively?  Feel free.  Wanna let it all hang out?  We won't tell anyone.  We're here to help.  We'll listen, sympathize, and provide a warm, comfortable place.  On top of that, we can show you how to get even, how to make a few changes and build a better birthday suit.  Mommy makeover?  That's so 2000.  Come in and see what's new in body contour surgery.  A visit with us can be so uplifting!

To Smush or Not To Smush...are Mammograms Necessary?

Sunday, August 28th, 2011

As we approach Breast Cancer Awareness month (October), I think it's informative to assess mammogram issues.  In 2009 a government-sponsored study was reported by the US Preventive Services Task Force.  The outcome of this report was that mammograms are overused and really almost never needed until a woman reaches age 50.  The recommendation was that women not receive mammograms until they reach age 50, then they should decide whether they want to have them or not.  At most, according to this report, women should have mammograms every two years beginning at age 50.

That report was, and is, in stark contrast to recommendations by The American College of Obstetricians and Gynecologists, The American College of Radiology, and the American Cancer Society.  All of these groups recommend that women begin receiving mammograms at age 40, and that they continue having mammograms yearly after that.    For women in their 20's and 30's, clinical breast examinations should be performed every three years. (Here is an interesting link: ob-gyn-group-recommends-annual-mammograms-in-40s).

I work with a lot of breast cancer patients.  Many of them are in their 20's. I am not a statistician but rather just a practical practicing plastic surgeon.  Whether the government or a government-sponsored agency reports data, or whether a medical group reports data, there will probably be some hidden (or maybe not so hidden) bias.  To me it gets down to, who do you trust more, your government or your doctor?  Use common sense, be aware and be vigilant, and be your own strongest advocate.  Keep "abreast" of your health!

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