Breast fat transfer [KIES-U Korea]

Q. Is it effective to do fat transfer for the breast augmentation?
A. Yes, it is.
Q. Is the breast fat transfer safe?
A. Yes, it has been determined that it is safe.
Q. Which is the better method? Breast fat transfer or the implant?
A. It is difficult to say which is the better of the two. It depends.





The questions above are the frequently asked questions. Today, we will talk about the fat transfer breast augmetation.

When did the fat transfer breast augmentation start?

First, let’s talk about the history. Some people would be bored with this term, “history”, but you would be surprised to know this history of beauty surgery. You will be able to know that a lot of what we do today, has already been done in the past.
 
People do not think much differently.
In 1890, somebody started a surgery that required the usage of liquid paraffin. This was the beginning of the breast augmentation surgery.

Of course, there were a lot of problems. Infection caused inflammation and necrosis. People said that none of such this happened, but you could feel lumps on the body.
This method disappeared after the 1920’s.



 
Fat transfer breast augmentation started in the 1920’s. It was not much different from what it is today. You take the fat from the abdomen or the buttocks and transfer the fat to the breast. This fat did not cause infection like the paraffin but the problem was that the fat dissolved quickly. The result looked good however, the result was not maintainable. The number of people who wanted fat transfer decreased after the 1920’s, but this number started to increase as those patients who needed reconstructive surgery after the breast cancer surgery increased.

In 1987, US Cosmetic Surgery Association objected breast fat transfer because it perceived that the scar tissue caused from the breast fat transfer and calcification caused difficulty in examining the breast cancer through x-ray. There were many doctors / surgeon who are concerned about this, therefore, agreed to the objection.

Introduction of structural fat transfer

Then in 1990’s NYU’s Dr. Sidney Coleman introduced a new idea of “Structural Fat Grafting” and stated that the newly transferred fat with good technique would lead to good grafting and longer maintaining period of the fat.

Also, Dr. Coleman proved that the fat transfer did not cause any problem in examining the breast cancer.

There was no problem with this theory and many doctors agreed to the theory as well, leading to a big expansion of fat transfer. US Cosmetic Surgery Association backed off from its objection and accepted the fat transfer as a good method. (This happened in 2007)

Dr. Coleman is perceived to be an expert in the fat transfer sector. Most of the fat transfer originated from this “Coleman technique”.

Dr. Coleman stated that each surgery requires about 300 cc of fat. If more fat is used then this would lead to necrosis and he also stated that the fat transfer is a good alternative to solving breast size and form problems.

Limitation on fat transfer
 

Then, let’s look at some limitation on Dr. Coleman’s breast fat transfer.

"For those who want very big breast, it is recommended to use the breast implants rather than doing the fat transfer". This means that the fat transfer breast augmentation is not effective to product a large volume on the breasts.

Another limitation is the body type. Those with thin body would not have enough fat to transfer to have large breasts.
Usually, we would need to transfer 250~400cc of fat on each breast for other people to visually recognize that the breast has become bigger.
So, approximately, 800cc of fat would be needed for both breasts.
In order to get 800 cc of fat, we would need 1600 cc of fat from the abdomen or thighs.
This much amount of fat is not possible from a thin person. Also, fat transfer is not a one-time procedure. It requires 2 or 3 procedures.
If you take the fat from the stomach or thigh that do not have enough fat, it would lead to uneven shape of the stomach or the thigh.



It is important that the breasts become bigger. The fat that has been transferred properly to the breast leads to better feel than any other implants that have been used and also there are no problems with shape or structure. But, if you compromise on your thigh or abdomen to make the breast look better, you might want to reconsider this.

This is the biggest limitation of breast fat transfer. This is only recommendable to those patients who have enough fat.

To whom is the fat transfer breast augmentation applicable?

If there is a limitation on the amount of fat used in one procedure, then you might need a second one.
There must be about 4 month term between the first and the second procedures. We must check if the fat transferred remains or not after 4 months.
Therefore, fat transfer requires patience.

All the surgeries that have originated from Coleman technique must be done 100% by hands. There are many advertisements that the clinics have certain tools or products that lead to better results but these tools or products have not been verified. Fat transfer takes about 4 to 5 hours therefore, requiring a lot of labor.
You might think that your breast look larger after the long surgery, but this could be a hallucination. About 50% of the fat disappears at that moment.
Most of the patients are not satisfied with the loss of volume after 4 months. Most patients give up rather than asking for the second fat transfer.



There are some requirements for those who want breast fat transfer.
First, do not expect to have large breasts
Second, you need to have the patience to do this 2~3 times for a period of 6 months or more
Third, you need to have enough fat on your body. Your weight needs to be more than a certain level.

You need to be familiar with these three points and find an appropriate method. Breast fat transfer is a very good method but this does not apply to all patients.
Thank you for reading.

There are several number of corrections / surgeries that you can do simultaneously with the transaxillary breast augmentation. We will cover a few in details.

The most common one that the patients ask about is the bra line liposuction.



When you do the liposuction in the forearm, the incision site that you take the fat out from is different from the incision point for the breast augmentation surgery.
We put in the medication that melts the fat into a spot different from the incision spot and conduct the liposuction.

 
Therefore, there is no activity near the arm when we do the breast augmentation surgery. The two are independent from one another.
But, when we do the breast augmentation, we need to sterilize the upper body including the arm and cover the parts with draping; therefore, forearm surgery is easier to conduct.

Bra line liposuction involves removing the fat that sticks out when you wear a bra.




Let’s say that you are standing straight with arm by your sides. The part where forearm and the body meet has much fat. Removing this fat is what we call arm liposuction, and removing the fat on the body is called bra line liposuction.

There are times when you have to do the bra line liposuction on both front and back of the body.
We need to turn the anesthetized patient upside down in order to do the liposuction on the back. Although there is not much fat at the back, we need to move the body leading to spending much time on this procedure.

If you were to have bra line, forearm liposuction, and also breast augmentation that require armpit incision, what would be the order of the three procedures?

The order is as below.



First is the anesthesia.
Then we turn the patient upside down to conduct bra line liposuction on the back (at times we do the liposuction on the back side of the arm as well)
Then, we turn the patient back to the normal position and conduct breast surgery.
After implant and the rest of the procedure are complete,
We continue with the bra line on the front part of the body and the forearm.
When the liposuction is complete, we stich up the incision on the armpit
We dress with the compression bandage and complete the procedure. 

If the surgery is conducted in such a way, it is completed rather quickly although it requires many steps.

Second is the removing Axillary breast tissue
This is not much different from the bra line front part liposuction. Although the conditions of the two corrections are different, the methods are the same.


Third is the axillary osmidrosis treatment
Axillary osmidrosis treatment involves minimizing the apocrin sweat gland on the armpit.
This procedure requires using suction tool. We use this to scratch the layer under the skin to suck in and damage the apocrin sweat gland.



We are damaging the apocrin sweat gland so that the sweat does not come out easily.
This treatment is simple to do therefore; it can be done simultaneously with the transaxillary breast augmentation as well. First we need to do axillary osmidrosis treatment then do the transaxillary breast augmentation.

Today, we looked at some of the other corrections or surgeries that we can do together with the transaxillary breast augmentation. By doing several procedures simultaneously, the patient can save cost and also shorten the recovery time.

However, this might be more stressful on the body, and the patient might need to be more careful with her body during the recovery time.

This is for now. Thank you very much.

Safe breast augmentation, breast surgery without any defects

Q. People choose plastic surgery clinics considering the safety. So what do the patients need to check?

A. I think that all cosmetic surgery should not have any defects although you might not look pretty after the correction.

 

The safety and having no problem after the breast augmentation surgery is the most important factor as well.
A surgery involves incision to complete its goal. Once the incision is done, the body bleeds and there is pain. Also, much microorganism can enter the opening of the skin. In any surgeries, one uses anesthesia to kill the pain and sterilize in order to prevent bleeding and infection.

When these three, anesthesia, bleeding, sterilization (disinfection), are not done properly, a problem arises and the surgery becomes dangerous

There are three things that you need to check if you want a safe breast augmentation surgery.

Is there a proper anesthesia for the breast augmentation surgery?

Can the bleeding be stopped after the breast augmentation surgery?

Is there enough measure to prevent infection?

First, breast augmentation surgery requires general anesthesia. General anesthesia is broad in term, however it involves intubation, the suction of the anesthesia. There is another method called LMA but this also involves the suction of the anesthesia.
General anesthesia can be helpful in reacting to any unexpected situations.




We conduct blood test, x-ray, and ECG tests before the anesthesia and also check if there are any test results that are out of the normal figures. This process itself can prevent much problems and unexpected accidents.

There are some cases when the patients find some problems that they have through the blood tests that they have before the correction. There was a case where a patient found out that she had leukemia through the blood test before the correction.
However, there are some unexpected problems that arise during the surgery procedure. In order to handle such situation quickly, it is important to do intubation or LMA.

Second, if there is much bleeding then a good result cannot be expected. There are thick blood vessels underneath the pectoral muscle of the breast. If this is touched, then much bleeding can happen.

In order to conduct a safe procedure, the surgeon must be aware of such problem and also know the exact cautionary measures to react to such a problem. It is rare to have much bleeding that leads to severe threat on life when conducting the breast correction, but if the blood gets into the implant, required in the breast correction, then the implant may be damaged in shape and form, and also could be misplaced causing further problems such as pain or infection as well.

Therefore, a surgeon must be sure that he/she does not leave even a drop of blood near the implant during the breast correction. The best method that helps to stop the bleeding is inframammary incision.

If you conduct the correction from the inframammary, you can gain 100% vision of the operation therefore, a well-trained surgeon can also stop the bleeding quickly and complete the surgery properly.






Also, it is important that the surgeon does not touch unnecessary parts of the body when doing the breast augmentation surgery.

Third, preventing infection and inflammation requires much training for both the surgeon and the nurses as well. Also, it is important to do the breast augmentation surgery quickly so that there is less time for the implant locating part of the body to be exposed with the exterior environment.

The surgery room must be isolated from the exterior environment and also all the personnel in the surgery room must be sterilized.
There is a method called No Touch technique that I would like to introduce.



No touch technique is a technique that prevents any bacteria or microorganism entering the body during the surgery. It is important to maintain the clean status of the body from the incision up until the closing of the wound and also, one must not touch the pocket of the implant during the procedure. Only the tools are used.
It is important to complete the correction procedure quickly in order to prevent infection or inflammation. The longer the procedure takes; we are giving more opportunity for the contaminant to enter the body. Using drains requires the opening of the implant pocket and the exterior, therefore, it is better to prevent such activity, or do this in a very short time.

Those medical personnel who are well trained with no touch technique can prevent contaminants entering the body when doing the breast correction with the implants. One must absolutely close the incision quickly so that there is no exposure to the surgery room or the exterior environment.
Therefore, it is important that the overall procedure completes as quickly as possible.

The three issues stated today are
General inhaling anesthesia
Minimum desquamation, 100% stopping the bleeding
No touch technique, quick surgery time

These are the issues that one must first consider and examine when wanting a safe breast correction.
 
This is all for today.

Thank you very much.

Can I smoke after Plastic surgery?

Yes. “can I smoke after plastic surgery?” This is the question that a lot of people ask, and this is the topic that I would like to discuss today. First, I would like to provide you with a common sense answer.

One must take care of her own body. Everyone knows that smoking is bad for your health. Even a child knows that one must not smoke after a surgery. However, I would like to analyze this problem and share if this is medically not good for your health.

This is a happening that took place a few years ago.

I was going to take a look at a patient who just had nose correction surgery but the door was locked. 
I knocked the door and it opened after a long time.
The room was filled with smoke. 
The patient and her friend had smoked in the room. 
As a doctor, do you think that I was angry or not? 
I was really angry that a small smile appeared on my face.
I gave a ridiculous look and the patient apologized and told me that she wanted to smoke because she was feeling some pain. If she was hurting, she should have asked for a pain killer but instead she smoked.
She apologized again and she told me that she would throw away the bud. 
This made me laugh.

1. Smoking after a plastic surgery

Actually smoking is bad for the health if you smoke a regularly for a long period of time. It is not as harmful for the body if you smoke at the short time span of the recovery.

Cigarette has nicotine in it. Nicotine causes contraction of the blood vessels therefore it could have a bad effect on the scar. This is the reason why we did not allow the patients to smoke.

Nicotine has a wide, complex influence on the body. We cannot simply say that is delays the scar that is being healed. I tell my patients to not smoke for about two weeks after the surgery

However, there are no findings or reports that those patients who smoke after a surgery suffer side effects such as infection, scar not disappearing, pain, and those who do not smoke do not suffer such side effects.

I do not think that one should tell another not to smoke just because it is bad for health. Scientifically, there is no result that shows smoking causes delay in the scar being healed.

So I tell my patients this;
Just quit smoking. Then you would not have to worry about what could happen in the future. But, if you smoke again after a week or two, everything would be nullified. Smoking leads to bad health if you do it for a long period of time. It does not cause bad health all of a sudden.

Of course smoking is not good for the health after the surgery, but it does not cause a bad effect all of a sudden.

However, smoking is bad if you do it for a long term,
therefore, it is recommended that you quit smoking if you are concerned about your health.

2. Drinking after the plastic surgery

A lot of patients who have surgery close to the end of the year ask me this question a lot.
I need to meet my friends during the weekend, so can I drink?
I have year-end party and so it is difficult for me not to drink. Will it be OK to drink?
I am sure that these patients enjoy drinking. I am quite surprise that a lot of female patients rely on drinking as well. When I was in the 20’s, the ladies drank very little. So it was an insult to some if you said that a lady was a good drinker.

Anyway, I would recommend you to not drink after a surgery. 
Alcohol enlarges the blood vessels. Alcohol has an effect on the body right away compared to smoking that takes some time. The enlargement of the blood vessels leads to reddening of the face and the body. It also caused the heart to beat quicker. Alcohol also has a diuretic effect causing thirst.

After a surgery, we try to contract the blood vessels near the scar with ice in order to stop the bleeding however this would be no good if the patient drinks causing the enlargement of the blood vessels.

This might cause infection on the scar and other problems which we may not be able to find out properly. Therefore, it would be good for the patient not to drink any alcohol after a surgery.

There was a patient who had fat transplantation on the face. 
She drank right after the surgery and after a week, there was much inflammation on the face.
She took antibiotics for a few days however the transplantation had no effect on the face.

We cannot say for sure that the drinking was the cause of the inflammation however, if you are concerned about something similar happening to you, then you might want to avoid any activity that may be the cause.

Appropriate amount of drinking is good for the health in the long term compared to smoking which is not.

In summary,
First, smoking does not cause big problem in the first 1 or 2 weeks of the surgery however, smoking is not good for you in the long term. (Especially for those corrections that need good blood circulation such as nose and wrinkle correction, fat transplantation)

Second, it is a principle that you avoid drinking after the surgery. However, in the long term, an appropriate amount of drinking is good for you.

If you had a plastic surgery / correction recently, why don’t you quit smoking? Smoking is not good for the skin and also shortens your life.
Have a good day.
Thank you.