Breast enlargement without implants ?

Dr.Alexander Aslani, Specialist Plastic Surgeon and Head of the Department of Plastic, Aesthetic and Reconstructive Surgery of Hospital Quiron in Malaga, Spain, on of the  most controversial  topic in cosmetic surgery: breast enlargement without implants.

Macrolane

Is currently a very popular option with a few myths around it.

With view to the popularity of breast enlargement in Spain,I see significant numbers of patients looking for this possibility, with few of them actually being aware of the limitations in indications.

Basically Macrolane is hyaluronic acid, which is well known and a has a long history as a wrinkle filler , just used in a higher density. It is the most frequently used brand for the indication with new ones coming onto the market now.

The concept is to use this as a “filler” for the breast. The idea is very appealing and there are indeed some interesting indications for Macrolane in breast enlargement for selected patients.

Macrolane is also suitable to treat small contour deformities, especially after liposuction. I think this will be one of its prime and most widely used  indications in the future. Macrolane for breast enlaregment will play a role, of course, but patients seeking breast enlargement via this route will have to understand the limitations.

Macrolane injections have to be repeated, although required injection volumes for subsequent “touch-ups” are significantly less than for the first treatment. Macrolane can be administered using local anestetic, but macrolane injections have to take place in an operating theatre though, for the sake of patient safety.

Amongst surgeons, there is a certain range of opinion as to how much macrolane may be used in one session for breast augmentation. I prefer to restrict to about 100 cc per session. Some surgeons inject a lot more, but there are concerns whether distribuition of fluid is entirely predictable or not. To my opinion, with an injection of 100 cc one stays within a safe margin, preventing the danger of unforeseen and undesired fluid distribution.

Lumipness and adverse reactions have been observed in some cases. Patients need to be aware of this.

They problem is usually temporaray, but can last for some time.

Whilst  macrolane has already been available on the market for a couple of years, this is still a comparably short time from the surgical point of view.

Downside is furthermore  that the possible volume injection is restricted.

Case example macrolane before and after 180cc macrolane breast augmentation:

Macrolane is currently the most popular solution in non-surgical breast augmentation.

The augmentation shown does exhibit the, usually, maximum possible augmentat¡on in one session.

In this case, 80 cc macrolane were applied 20 months after the initial procedure.

This reflects the usual percentage of reabsorption.

Free microvascular tissue transfer

It is possible to apply tissue transfer techniques parallel to those used for breast cancer , also  for breast enlargement.

Therefore tissue can be taken from the buttocks or from the abdomen and transferred to the breast.

Microsurgical techniques are then used to anastomose vessels taken with the block of tissue, to donor vessels,usually in the axilla. This is an extensive operation.

This makes any  implant removals in the future superflous. However it is a very expensive and long operation and will therefore remain a rather exotic indication. It may be used in cases of congenital breast deformities though, like Poland-Syndrome (failure of breast bud to develop on one side). In these cases, microsurgical free tissue transfer may be considered.

The extent and cost of this operation will leave this possibility random in the future. Some surgeons say that the extent of such surgery is disproportionate to the effort of mere breast enlargement.

I do not necessarily agree to this, but suggest that patients are entitled to decide individually after careful explanation of the implications involved.

It is a consideration in discussing breast enlargement options.

Autologous fat transplantation

The one of the dreams of Plastic surgery.

Take the patient´s own (autologous) fat from somewhere else and inject it for breast enlargement.

Unfortunately it is not that easy.

There are certain established methods to prepare fat for transfer, especially the so-called Coleman technique (centrifugation technique) and numerous preparation kits are on the market.

Success of these techniques is quite variable though.

They may, or they may not, work. The smaller the volume of fat injected, the larger the chance of “take”. Take means the percantage of fat that survuves the transplantation. This take of fat transplants is vetry variable and differs from patient to patient.

Current research is aiming at mixing free autologous fat with growth factors and even to “breed”patients own fat cells.

This may increase survival of fat tissue but there are, as I have to say, fundamented concerns that these growth factors may possibly promote growth of breast cancer.

We are still in the pioneering stages of such “tissue-engeneering” techniques.

Vacuum-assisted devices

Have received excessive marketing attention. Principle of these treatments is that continued vaccum pressure applied to te breast may assist in breast enlargement of tissues.

I personally cannot comment on possible success, since I have no experience with these.

From the strictly scientific point of view the success rates seem rather fictional. I do not see any physiological mechanism suggesting that this really works.

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www.cirumed.es

Breast enlargement-what implant to take ?

“There is no easy answer to this question, because not every breast is the same”, says Dr.Alexander Aslani, who is head Consultant Plastic Surgeon of the Cirumed Clinic Marbella and Consultant Plastic Surgeon in London´s Highgate Hospital.

“It depends very much on the breast and , more importantly, on patients preference. Different patients prefer different looks, and this has to be taken into account when planning the procedure.
Generally, The question is where fullness is required….if it is on the upper pole, a round implant may be the better option, especially if the implant is positioned behind the breast muscle, choice of breast implant,but this depends very much on the case.I prefer to show patients pictures with relevant examples, and then we make a choice together .Breast surgery is not just a “boob job” but a very individual and every breast is different and therefore requires different solutions,” says Dr Aslani.

Round implants or anatomical ? Again this this depends, says Dr.Aslani. People perceive that breast enlargement with anatomical implants as more natural.

“Anaomical implants behind the muscle can occasionally look a bit flat on top, if the breast is fairly flat on top in the first place and the muscle rather strong,” so Dr.Alexander.Aslani.

Generally breast augmentation is one of the operations with he highest degree of patient satisfaction, which tends to give patients an enormous boost in self confidence.

Materials used are, without exception, cohesive silicone-gel filled implants.

Breast augmentation/breast enlargment in Cirumed Clinic Marbella continues to be one of the most popular procedures for patients from abroad seeking cosmetic surgery in Spain, the backbone of medical tourism in Marbella.

There is a couple of other procedures breast enlargement can safely be combined with, says Aslani, depending on the nature of the request.

A frequently asked question is….can Breast enlargement be done as a day case ? Yes, it can says Dr.Aslani, but he suggest for patients not to enter without a “plan B” to possibly stay overnight.

How long do breast implants last ?

“At present, we don’t know”, says Dr.Alexander Aslani.”We presume that patients can enjoy the effects of a breast enlargement for as long as there are no problems. Should problems occur, action might naturally have to be taken and the breast implants exchanged”.

Dr.Alexander Aslani, Cirumed Clinic Marbella, Marbella, Malaga, Spain, www.cirumed.es, www.alexanderaslani.com