Solving "separated breast" deformity on thin women with composite breast augmentation

Today, I would like to introduce a thesis on the fat transplantation in between the breasts, especially for the thin patients.



The article is from a renown magazine, Plastic and reconstructive Surgery 135. April version. It is written by Francisco Bravo from Madrid, Spain. The name of the thesis is “Parasternal Infiltration Composite Breast Augmentation”. (You can think of this as solving the separated breast deformity of thin patients)



There were many others before Dr. Bravo, who conducted composite breast augmentation that requires using an implant along with fat transplantation.

The thinner you are, your breasts would look unnatural if you use larger implant than that is appropriate, and therefore, one uses fat as a covering tissue to make the breasts look natural.

But there is a limitation in such a method. It would be difficult to get sufficient amount of fat from a thin patient. Also the fat cannot be engrafted properly on to the implant therefore; the outcome is rather disappointing to many.

The characteristic of Dr. Bravo’s research is that you transplant fat between the breasts of a thin patient making the upper body look more beautiful.



This process does not require much fat and solve is judged to be helpful in providing solution to the ‘separated breast deformity’ of thin patients after their breast augmentation with the implants.

Fat transplantation cannot be a substitute of the implants but is helpful for the implant outline or the contour. This is more applicable to re-correction patients and thin patients.




The original breasts are important for the shape of the breasts with the implants.
Those thin patients with thin soft tissue on the breast bones complain about one being able to see the edges of the implants.

The patients think that their breasts have been “separated” far apart in such case.
But the fat transplantation  on the edges of the implants make the breasts look more natural and less separated apart.

We can see the improved results from the experiment done on the 2 groups; one with just implant and the other with implant + fat transplantation.



The amount of fat used was about 6-~140cc , an average of 117 cc, which is rather less that the amount that we usually use, 300~500cc. The fat is transplanted just under the skin.

The fat transplantation was done through the breastbone line.

I have used this method many times before, and there are other doctors who have used this method as well. But I believe that Dr. Bravo is the first person who announced such structured thesis.

Here is the summary.
Fat transplantation cannot solve all the problems that thin patients have with the breast augmentation. However, fat transplantation can be a solution to the separated breast deformity.

Thank you very much for reading.

Anesthesia for Breast augmentation

This is a frequently asked question. Today, I will answer this question through this post and also share some wrong information that some advertisements state about the breast surgery.


 
The difference about the breast augmentation and other surgeries is that breast augmentation requires a large substance to be put inside the body.
The important factor here is that, this large substance should not cause any discomfort on the body and that there should be no side effects also.
Therefore, it is very important that there is absolutely no problem while doing the breast augmentation.

Important factors to consider in breast surgery
1. The form of the breast must be stable for a long period
2. Implant should not have any influence on the original breast tissue
3. 24 hour recovery system, i.e. the patient must be able to recover within 24 hours (Quick recovery = Low possibility of side effects)
4. There should not be any bleeding or damage on the tissue
5.There should be semi-permanent stability / harmony of the implant and the breast tissue


I was really surprised at what I found on the internet about breast surgery. I found marketing statements as the ones listed below. Many of these surprised me. Here are a few.

Others apply general anesthesia, we apply local anesthesia
- When we refer to the textbooks of breast surgery, there is no recording that IV sedation has quicker recovery time than the general anesthesia
- Some might be quick to think that conscious sedation may lead to a quicker recovery, but this is not true. If you have breathing problems, or others that may danger your life, there is no way to solve these problems
-  An experienced surgeon can have the patient leave the hospital after 2 hours of the surgery although the surgeon has applied the general anesthesia
- Using conscious sedation as a marketing source to attract the patients is wrong and dangerous activity

Other hospitals cause 5cm incision but we only cause 3.5, therefore, the scar is very small
- An implant is pushed through a small hole and it needs to remain there for decades maintaining its form and shape. Size of the incision cannot be appealing marketing information
- The possibility of damage, breaking, contracting of the implant is higher than normal. For example if the implant is about 275cc and this goes through 11~12cm inlet. The small inlet might cause the implant to lose its shape inside the body.
- If a hospital wants to appeal that the incision size is 3.5cm or less, then it must also provide research data of MRI or ultrasound that an implant put through this small inlet has no problem for 10 years or more. Just using this advertising message is not appropriate for the patients in the long term.



We has our special technique that makes your breasts larger than 300cc
- This is absolutely false. The size of the implant is decided by the patient and also the size should not cause harm to the original breast size and shape. It is wrong to say that a surgeon will just make the breasts bigger.

I really hope that such marketing activities by the hospitals are avoided in the future.


Here are additional details about the anesthesia.

In plastic surgery, we use the general anesthesia that has muscle relaxant and other anesthesia so that the patient does not feel pain in the muscles. This is done through using anesthetic gas and oxygen put into the respiratory system.
Conscious sedation uses sedative, pain killers such as propofol. This does not relax the muscle so the patient may be able to move about during the surgery.

The reason why we use general anesthesia for the breast surgery is so that the breast muscle has no movement that may cause harm on the breast tissue or discomfort on the patient.

If you have conscious sedation, your muscles (i.e. pectoral muscle) might move without any intention causing tissue harm and inaccurate desquamation causing delay on recovery and bad outcome.

One must apply general anesthesia when doing the breast surgery.

Conscious sedation does not lead to quicker recovery but instead, a long one. Also, conscious sedation is more dangerous and has higher possibility of causing problems.

Anesthesia is very important to a surgery. Today we looked at various anesthesia methods and some problem associated.
Breast surgery cannot be corrected like eye/nose surgery.

 

I hope you will be able to get accurate information in deciding what is right for you. This is all for today.

Have a great day.

How the shape of the implant and different methods change the shape of the breasts 

An interesting report on how the breasts change according to the shape of the implants has been introduced based on various experiments conducted on 17 corpses. It was written by Dr. Antonio Jorge Forte of Yale University and Dr. Alonso of Sao Paulo, Brazil. (Plastic and reconstructive surgery, Apr, 2015. vol.135-4)




21.8% of re-correction of the breast surgery in US was done to change the size of the implants, and 8.2% was to reposition the implants.

Getting the right position to make the breasts look better is an important factor when knowing if the surgery is successful or not, however, it is not always easy to find the appropriate position for the implants.

The research team experimented on how the nipple position changes when using the tear drop implant or round type implant. One of the difficult things about such experiments is that we cannot apply various implants on the same person. It is difficult to state that tear drop implant produces one result and the round type produces the other result unless the tested bodies are of same condition.

So, it is meaningless if different implants were used on different persons with different conditions.

Therefore, using corpse to test various types of the implants makes this experiment an important one.



We call the state where the nipple sticks up front as “projection”.

Projection becomes bigger when using the tear drop implant compared to when using the round type. The nipple sticks out forward and this degree of nipple sticking out is directly associated with the cup size.

The experiment shows that 100cc leads to a projection of 0.6~0.8cm.
Implant on sub-glandular leads more projection than sub-pectoral.
Also, the distance between the lower wrinkle lines becomes wider when using the tear drop type implants. This means that the sagging breasts become higher after the surgery.

As the volume of the implant increases by 100cc, the diameter of the areola increases by 6%.

So what influences the projection of the nipples after the breast augmentation? The  research shows that the type of the implant, whether it is the tear drop type of the round type, does not matter, but the volume (cc) of the implant influences the projection. So it is common to see a patient with not too severe case of sagging breasts corrected due to the breast augmentation.

However, there is a limitation to this research.

The corpses used were 8 to 12 hours after death, so the body might have been little stiff and also the results were based on the findings of the short period after the surgery.



Summary:
1. Sub-glandular implant leads to more projection of the nipples and higher positioning of the areola. (When compared to sub-pectoral and when using the round type implant)
2. Larger implant leads to more projection.

Thank you for reading the post. Have a great day.

Today we will talk about accessory breasts.

What is accessory breasts(polymastia)?

This is a term related to multiple breast syndrome, or additional breast tissue. The additional breast tissue is found elsewhere than the breast. When the mammals are born, mammary gland tissue is formed but this does not go away and the tissue stays due to some problem.




This can be found anywhere from the armpit down to the groin.



There are some cases where this multiple breast syndrome also has nipple and areola as well. There are cases that do not have the two.

If you have multiple breast near the armpit, you might feel pain during the pregnancy and also might have secretion coming out from it.

Revealing of the accessory breast

This is very common with the American Indians. This is also passed down from one generation to another within the same family line.
This is less common on the women. This can be found in 1~3% of men and 0.4~0.6% of women.
The ectopic breast tissue can be found anywhere in the body, but 20% of the accessory breast can be found on the armpit.


 

Symptoms of accessory breast

This can be seen during puberty, and a lot of fat and tissue are centered around the mid part of the body. Some patients come to the hospital or clinic because they do not like how it looks.

This might hurt a lot as well in the beginning stages.
It reacts according to the hormone level, therefore the pain and the side effects are greater during pregnancy, breast feeding period, etc.




Another fact that is important to know is that all things that happen on the breast can happen to the accessory breast as well. Breast cancer, and fibroadenoma can be found in the accessory breast as well, but the recurrence rate is low
If you are concerned about a tumor, then it is recommended that you get a check up on it.

Diagnosis 

There are many who are not aware of this accessory breast. Also it is difficult to get diagnosis on it. It cannot be seen easily from the outside unless there is a nipple or areola. But, if not, we cannot virtually make out if it is accessory breast or not.
It becomes bigger or smaller during period, and also cause discomfort, pain, secretion, restriction on the arm movement during pregnancy.
If you want to know if you have the accessory breast or not then you need to take X-ray, biopsy, etc.



We also do ultra sound. The accessory breast tissue look similar to those on the actual breast as well.
Some do the MRI as well but some do not if the accessory breast is too big or look too bad.

Treatment

The best treatment is to surgically remove it. You can also apply liposuction to remove it.


Today’s post was on the accessory breast. I hope the details have helped you understand it.
Thank you for reading.

Areola reduction surgery

Let’s talk about the areola reduction today.

The diameter of the areola in an average woman should be about 4.7cm.
Also, we would consider the shape of the breasts along with the proportion in the upper body to decide on the size of the areola.

If the areola is larger than 4.7cm then one must seriously consider getting the areola reduction surgery. However, there is no right answer on how much you need to reduce. One must consider various aspects in order to decide on this.




We remove appropriate amount of tissue from around the areola and permanently stitch up so that there is no possibility of recurrence.
Also, we use the dissolving threads to pull, using the 'purse string suture' method to finish off the procedure.




Areola reduction is for permanent effect. The scar is limited on the boundary of the areola. Local anesthesia is used. The recovery period is very short as well.

The exterior skin tissue is tightly pulled making the nipples stick outwards a little more.
There are some patients with areola sticking out as well. These patients have large breasts with nipples that stick out too much. These patients may require breast reduction as well along with the areola reduction.

There are some with areola that are not shaped rounded. This may be oval shaped. We can make the shape round also.

Some might have the areola color different from others, and also might have small bumps on the areola. We can use the medical tattoo to change the color and apply incision for the small bumps.

I hope this post has helped you.
Thank you for reading.