BREAST LIPOFILLING AND FAT GRAFTING

Mammary hypotrophy can be constitutional (from adolescence) or secondary to or pregnancy or an important weight loss. It can sometimes be associated with breast sagging (mammary ptosis).

The treatment requires an augmentation of the breast volume with implants. When there is an associated breast ptosis, a breast lift (or mastopexy or breast ptosis treatment) can complete the implant installation.

A new technique allows an increase of the breast volume without implants in Switzerland. It is the autologous graft of fat tissue, which is still called lipostructuring, lipomodeling or lipofilling. This new technique has proven effective but must be done by a good cosmetic surgeon who has been trained at it properly.

Breast lipofilling does not interfere with the radiological interpretation of a mammogram or an ultrasound made by an experienced radiologist.

Until today, no scientific study has shown that breast lipostructuring favored the occurrence of breast cancer. However, it cannot prevent the occurrence of cancer if it should occur.

To minimize the coincidence between the onset of a cancer and lipomodeling, each patient should:
– Make a radiological assessment before the procedure: mammography and / or mammary ultrasound.
– Make a radiological assessment after the procedure (between 6 months and a year after surgery).
– Be regularly followed after the procedure by a cosmetic surgeon (as for any surgery).

It should be remembered that not all breast augmentation can be performed with this new method, and that breast implants are still a valid method:
– The autologous fat tissue graft is intended for patients who want a natural and moderate volume increase. The patient should also have some reserves of fat tissue to be removed.
– The breast implants are for patients who want a greater volume increase.

The two main advantages of breast lipofilling are:
– An natural but moderate increase of the breast volume without the installation of a foreign body.
– A liposuction treatment of the patient’s fat overloads.

Before the surgical procedure, the patient should be seen twice in consultation, at Laclinic-Montreux, or at the Beauty Suite in Lausanne, (only 30 minutes from Geneva by car):

• The first appointment will be to find out what is bothering the patient, what her wishes are and to inform her of the therapeutic possibilities to obtain the best result. Also, a complete clinical examination and especially of the breasts will be performed.

A radiographic examination of the breast will be prescribed.

• The second appointment will be to review the results of the preoperative radiological assessment, plan the surgical procedure, discuss its modalities and answer the patient’s new questions.

As with any surgical procedure:
– A preoperative blood test will be prescribed.
– A consultation with an anesthetist will take place one week to fifteen days before the scheduled date of the procedure.
– Taking aspirin or anti-inflammatory drugs should be prohibited at least two weeks before surgery.
– It is strongly recommended to refrain from smoking a month before, tobacco consumption altering the healing process.
-It is necessary to be fasting when you check-in the clinic on the day of the procedure.

The procedure is usually carried out under general anesthesia.

Generally, the hospital stay in Laclinic Montreux lasts one day: the patient checks in in the morning, is operated during the day and stays under monitoring for the night. The check-out can be done the next morning after the visit of Dr. Jean-Charles BAYOL, the control of the dressings and the delivery of the prescriptions. In some cases, surgery may be performed as an outpatient surgery.

The surgery takes place following several stages:
– Fat is taken from areas that have been previously determined and located while the patient is awake and standing (Figure 1). The sampling is done through small incisions using foam cannulas with a small diameter (3 or 4 mm).

Figure 1: Sampling areas using small cannulas

The fat is then cleaned, prepared and sometimes centrifuged to get rid of blood debris.

The graft of the fat tissue is done with micro-cannulas through puncture incisions uniformly distributed around the mammary base (Figure 2).

Figure 2: Graft with the shape of a fan through micro-incisions around the breast

This “injection” of fat is done under the skin and in depth in front of the pectoral muscle following a fan-pattern. It is important to note that the graft does not occur in the mammary gland itself (Figure 3).

Figure 3: Breast lipostructuring areas

The graft intake varies between 60 and 80% and is definitive. The grafted fat will remain alive.

This fat tissue will follow the patient weight evolution: if the patient gains weight, the volume of the breast will increase, in case of weight loss, it will decrease.

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Most often the pain is moderate and may be more severe around the liposuction areas. Edema and ecchymosis (bruises) appear within the first days after surgery and will disappear within 15 days to 3 weeks.

To reduce the importance of the postoperative follow-ups, you will be systematically taken care of by the department of physiotherapy, for a postoperative care. The check-out will happen on the same day, in the case of an outpatient hospitalization, or the next day, if you stay in hospital overnight. Gentle massages of the operated areas and LED care (lien vers LED) will ensure the lymphatic drainage and will promote the healing process. Several weeks after the procedure, an LPG treatment can be undertaken on the areas where the fat tissue has been collected.

A postoperative radiological monitoring (mammography and / or ultrasound) should be systematically performed between 6 months and one year after surgery.

It takes 3 to 6 months to judge the final aesthetic result in terms of volume and shape of the breast as well as the silhouette (regarding the sampling areas).

The scarring evolution (scars due to the fat tissue removal) is longer since a scar evolves for a year or a year and a half. Note that the scars around the breast are almost invisible since they were made by puncture incisions.

However, the aesthetic aspect of the breast will change over time as the aging of the breast will continue normally.

To improve the volume and / or the shape of the breasts, a second session of breast lipostructuring can be carried out 3 to 6 months later if necessary. This second procedure will entail constraints and expenses comparable to that of the first surgical act.

Patients are most often very satisfied by the result. The breast has a natural appearance without the use of breast implants, the silhouette appearance is also improved.

However, a secondary procedure is possible in order to perfect the result in terms of both volume and form.

There may sometimes be small imperfections (moderate asymmetry for instance) which can also be treated secondarily under local anesthesia. It takes at least 6 months to treat these imperfections.

A cosmetic breast lipostructuring remains a surgical procedure that involves risks even if they are rare.

The complications associated with anesthesia must be distinguished from those associated with the surgical procedure.

During the preoperative consultation, the anesthesiologist will explain the risks associated with the chosen anesthesia. Because of the recent progress regarding anesthesia, these risks have become very rare.

By choosing a qualified, competent, and skilled cosmetic surgeon trained in this type of intervention, you minimize these risks, but do not completely eliminate them.

Apart from the complications inherent in any surgical act (infection, hematoma, disunion and scarring defects) and complications specific to liposuction, one must be aware of the following risks:

• Pneumothorax: very rare, it would have to be suppressed with an intra-thoracic drain.
• Cytosteatonecrosis: a zone for which the fat tissue graft has not worked and has transformed into scarring fibrous tissue. These areas gradually diminish in a few months and slowly soften. Otherwise, and / or in case of a gradual increase, you should speak to your surgeon. The latter will prescribe additional tests if necessary. Hence the absolute necessity of carrying out a postoperative radiographic examination six months to a year after surgery, in order to detect clinically unnoticed cystic lesions of cytosteatonecrosis.

It is important to remind that the grafted fat tissue will follow the weight evolution of the patient: if the patient gains weight, the volume of the breast will increase, in case of a weight loss, it will decrease. It is therefore important to keep a stable weight after the procedure.

Breast augmentation without breast implants is a new method that will more and more develop in the future in Switzerland, Montreux, Lausanne, Geneva and the rest of the world.

It is essential that the patient seriously undertakes an imaging assessment 6 months to a year after this procedure, if possible by the same radiologist.