Fat Grafting and Breast Augmentation

This year, it has been estimated that nearly half a million American women will undergo breastaugmentation either to improve their appearance or reconstruct their breasts following cancer surgery or mastectomy.

Breast augmentation is traditionally conducted by placing saline or silicone breast implants inside the “pocket.”  Meanwhile, these devices have been approved by the US Food and Drug Administration due to their “reasonable safety,” although patients should bear in mind that there is always a risk of rejection and other complications.

Fortunately, there is an alternative to breast implants.  Called fat grafting, the technique involves collecting fats from one donor site (e.g., abdomen and thighs) and then introducing them to another area of the body; and because no synthetic implant is used, patients should no longer be concerned with rejection and allergic reaction.

However, patients should always remember that fat grafting has its own limits.  For instance, the method is not applicable to those with limited amount of body fats; and it can only increase the breast one cup larger from its original size.

Another consideration to make is the result is somewhat unpredictable given the fact that some of the transferred fats will be reabsorbed by the body; and anything that remains a year after the procedure would likely be permanent.

One way to increase the survival rate of the fats is to purify them; this means the blood, connective tissue, and other impurities are removed.  With this method, about 60 to 80 percent of the transferred fats can survive in their new location.

But to further increase the survival rate of the fats, some doctors recommend using bra-like suction cones for three weeks prior to the procedure.  With this technique, they believe that the tension will create enough room for the grafted fats to flourish, although no extensive study can back up this claim.

After purifying the fats, they are carefully injected to the breasts; this process may take more than once to promote high survival rate of the fatty tissues.

Fat grafting that is used as a replacement for breast augmentation is like hitting two birds with one stone.  Not only the patients enjoy bigger and fuller bust, also the areas which have been liposuctioned such as abdomen and thighs will appear slimmer, resulting to a curvier body.

For three weeks, patients are usually required to wear a compression garment around the liposuctioned area; in this way, the skin will heal faster and closer to the body, thereby preventing sagging and improving the body’s contour.

Breast Enhancement Surgery

Nowadays, breast enhancement surgery comes in many forms including breast augmentation, mastopexy (raising the sagging bust), and reduction mammaplasty (decreasing its size).  And while each kind uses different techniques, their goal is the same: to improve the appearance of the bosom.

In 2011, breast augmentation was the most popular cosmetic surgery in the US, with about 307,000 procedures performed during the period.  Currently, the Food and Drug Administration has only approved saline and silicone breast implants for this surgery.

As its name suggests, breast augmentation is traditionally used to increase the bust, but with the introduction of new implant designs, it has become possible to use the procedure in creating a more prominent cleavage, and address certain types of breast deformity such as pigeon chest.

In some cases, breast implants are used to reconstruct the breasts after mastectomy or cancer surgery, although they can only be helpful if there is an ample amount of tissue left.  By using the devices, women can avoid unfavorable scarring associated with tissue-based breast reconstruction, and weakening of the donor site (e.g., buttocks, abdomen, back).

Another type of breast enhancement surgery is mastopexy in which the sagging breasts are raised to make them appear more appealing and youthful.  Contrary to popular belief, the procedure is not only popular among aging women but also on massive weight loss patients who often develop sagging, elongated breasts.

For some, mastopexy involves reducing the size of areola (pigmented part of skin surrounding the nipple) to complement the “perky” and youthful appearance of the breasts.  Doing this additional procedure does not necessarily mean more scars because doctors simply use the peri-areola incision.

While mastopexy can lift the sagging breasts, patients should take note that it cannot create volume especially in the upper and medial cleavage.  For this reason, many plastic surgeons suggest breast implants as a way to further enhance the appearance of the bosom, resulting to a prominent cleavage.

Brest reduction is another type of breast enhancement surgery, although women with medical problems caused by extremely large bust size will more likely see this as a reconstructive procedure.  If performed as a way to improve body function and address discomfort, insurance reimbursement is possible.

By contrast, breast reduction which is performed purely to enhance one’s appearance is not covered by insurance, as with any cosmetic surgeries.  In fact, most insurance companies require at least 300 grams of fats and tissue to be removed from each breast before the procedure is considered reconstructive. 

Are Sientra Breast Implants Better?

Just recently, the US Food and Drug Administration has approved a new brand of silicone breast implant; the device, which is made by California-based Sientra, can be used in breast reconstruction following cancer surgery, and cosmetic breast augmentation.

Dr. Tarick Smaili, one of the leading Los Angeles plastic surgeons, believes the FDA’s approval clearly shows the “reasonable safety of silicone breast implants, despite potential risks such as implant failure and hardening of the tissue or capsular contracture.”

“Any type of breast implant does not guaranty to last a lifetime, although modern designs can accommodate greater force and are quite resistant to the elements that are causing natural wear and tear,” Smaili said.

The plastic surgeon added that implant from Sientra is just like other brands already sold in the US market, thereby patients who will choose the new silicone implant are “technically choosing a technology that has been tried and tested for many years.”

“In fact, silicone breast implants have been subjected to the most rigorous, comprehensive clinical trials and surveys that would allow patients to make a good decision and understand the potential risks and limits of the devices,” he said.

Meanwhile, the plastic surgeon believes that Sientra breast implant is neither inferior nor superior to other brands manufactured by Mentor and Allergan, which used to be the only two companies allowed by the FDA to sell silicone and saline breast implants.

In 1992, silicone breast implants were banned in the US over concerns that they may increase the risk of cancer and many forms of systemic disease.  But in 2006, the FDA has lifted the moratorium based on facts that no study has proven the link between the devices and serious illnesses.

After the lifting of the 14-year ban, silicone breast implants are increasingly becoming more popular than saline implants because they provide a natural feel and look.  In addition, many doctors believe they are less likely to fail because the cohesive gel filling prevents wrinkling, a problem that can eventually lead to shell failure.

By contrast, saline implants—which are filled with a sterile mixture of salt and water—are relatively prone to “folds” that may rub each other, thereby increasing the risk of implant failure.

Over the past few years, breast augmentation via silicone and saline implants has been the most popular cosmetic surgery in the US.  In fact, about 307,180 procedures were conducted in 2011 alone. 

Botox for Faster Recovery After Breast Augmentation?

Breast augmentation surgery involves pain and discomfort during recovery.  However, plastic surgeons have come up with different techniques to shorten the healing time and reduce soreness and other postoperative symptoms.

One possible way to shorten the recovery is Botox injection; plastic surgeons use this treatment “off-label” to encourage the pec muscle to relax and allow the high-riding breast implants to settle downward quicker.

“Off-label” means using a treatment or drug beyond its real purpose.  For instance, Botox has been approved by the US Food and Drug Administration to remove certain types of facial wrinkles and address muscle spasm, although some doctors use it to encourage the implants to settle quicker into their natural position. 

After breast augmentation surgery, it is normal for the implants to appear unusually high off the chest wall.  This appearance generally lasts two months, although some women have to wait for as long as four months, as it takes time for the implants to drop and settle to a more natural place.

By relaxing the chest muscle, advocates of Botox believe the treatment can also speed up the recovery of patients.  And because the muscle is partially paralyzed, they also claim that there is less spasm and pain.

Crampy spasm following breast implants surgery commonly lasts several weeks or even months for some patients.

However, patients should realize that not all doctors recommend Botox injection to shorten the recovery after breast augmentation.  This is because other postoperative procedures have also been proven effective in minimizing pain and discomfort, and encouraging quicker healing.

For instance, some doctors recommend breast massage with compression exercise which can lead to faster recovery and encourage the implants to settle more naturally.  But when doing the procedure, patients should do this carefully and should avoid pinching the shell as it may affect the stability of the device.

Real Housewives Star Admits Plastic Surgery

While most celebrities deny having plastic surgery even if the result is too drastic and blatant, Real Housewives star Brandi Glanville has no qualms admitting going under the knife to improve her appearance.  In fact, she even said that in a town where “everyone is perfect, it is important to look good.”

In a previous interview, Glanville, 39, said she had breast augmentation surgery, a procedure necessary to regain the volume loss associated with pregnancy, in addition to increase her bust size.  And aside from breast implants, the star also admitted having regular treatments of laser to address her skin problems including “adult acne” and Melasma, a condition in which the skin produces too much pigmentation.

The TV personality also admitted to be receiving weekly spray tan to maintain her skin’s glow without damaging it, in addition to Botox injection and fillers to fight the early signs of aging.

Because she grew up modeling, she said that she is extremely aware of her physical appearance and knows the areas which need some improvements.  Another reason for her penchant for plastic surgery is the fact that she is now back in the dating scene.

To Glanville’s detractors who called her “plastic,” she said that “everyone has the right to do anything that can make her feel good.”

The good thing about Glanville is that despite having several cosmetic procedures, both surgical and non-invasive in nature, she looks naturally beautiful.  This is probably due to her belief that “less is more” which is her approach in plastic surgery.

Her breast augmentation is a clear example of Glanville’s “less is more” approach in plastic surgery.  While many celebrities have chosen large breast implants that gave them the “heavy top” look, she opted for smaller ones that perfectly fit her slender frame, thereby the result is a very natural appearance.

Leading Los Angeles plastic surgeon Dr. Tarick Smaili, who did not treat Glanville, said he is noticing a shift to a “more natural appearance.”

“Celebrities nowadays are choosing smaller breast implants that will give them a more natural, sexy look.  For example, Kate Hudson and Victoria Beckham have been rumored to have had breast augmentation using smaller implants, while Dolly Parton and Denise Richards have downsized their implants,” Smaili said.

Aside from giving a natural appearance, the renowned plastic surgeon also cited other advantages of small- to medium-sized breast implants including faster recovery, lower risk of downward displacement and sagging, and less chance of developing stretch marks.

Rebecca Linares Breast Augmentation with Dr Smaili

Breast Asymmetry and Implant Surgery

To some degree, both breasts are usually different in size although it is very minute that no one would even notice.  However, some women have pronounced asymmetry that makes it hard for them to choose clothing that would hide this aesthetic problem.

One way to address a noticeable case of asymmetry is through breast implant surgery.  In this procedure, a plastic surgeon will use either a saline- or silicone-filled implant to augment the smaller breast, which in turn leads to balance.

However, breast implant surgery is only ideal for patients who have no problem increasing their bust size; on the other hand, women who think that their asymmetrical breasts are too large can opt for reduction mammaplasty in which the tissue and fat of the larger breast are excised to make it smaller.

The advantage of using implants over performing breast lift is that it is possible to use less and shorter incisions, thereby the risk of visible scarring is almost not a concern. 

While it is possible to make an incision in the underarm and within the navel’s rim during breast implant surgery, these incision sites are not ideal when dealing with existing breast deformity.  This is because doctors have to work far away from the breasts, making it more difficult to create a balance appearance.

When dealing with asymmetry, it has become sacrosanct to use the peri-areolar technique in which a U-shaped incision around the edge of areola (dark pigmented skin around the nipple) is made; or breast crease approach in which a hidden incision is made within the skin fold where the breasts and chest meet.

In some cases, breast implant is performed in conjunction with breast lift particularly if there is some obvious sagging in one or both breasts.

The implant surgery, with or without breast lift, usually requires one to two weeks off from work.  However, patients should always bear in mind that residual swelling and tenderness often takes several months before they completely subside.

To support the new contour, most patients are required to wear a surgical support bra for several weeks.  This special garment also encourages quick recovery, leads to better contour, and minimizes swelling.

For at least two to four weeks, patients should avoid heavy lifting, pushing, arm extension, and rigorous activities.  However, it does not mean that they should remain sedentary during the entire recovery as doing so can exacerbate the swelling and may prolong the healing time.

As soon as possible, patients should take a gentle, short walk every day to encourage quick recovery and minimize swelling.