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Dr.Alexander Amir Aslani, Plastic, Aesthetic and Reconstructive Surgeon
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Breast enlargement without implants ?
Posted on September 22nd, 2009 6 commentsDr.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.
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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