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Sunday, 9 February 2014

Could advances in fat grafting spell the end for breast implants?

Fat grafting has come a long way in the last decade or so. The techniques have been refined and remastered and, certainly as far as I am concerned, methods have changed dramatically in the last three years alone.

I remember attending a BAPRAS conference a few years ago and the Birmingham group were presenting their results for autologous breast augmentation using fat grafting techniques. The results were nice enough, but the technique illustrates how things have moved on. They described filling each breast with 250cc of fat at each sitting (most patients were needing two or three attempts to reach their desired volume) and injecting the fat in 1cc aliquots. In addition, they showed a video where they illustrated the 'correct' technique by passing the cannula (the blunt needle that injects the fat) 25 times per 1cc syringe. I put up my hand.

"Excuse me," I said. "I'm no mathematician but, if you are putting 250cc into each breast, doesn't that mean you have to pass that cannula 6,250 times through the breast tissue? Do you have some kind of relay team? Doesn't that cause scarring of the breast tissue?"

I still haven't received a satisfactory answer to my question...

These days, things are different. Using sterile collection devices (such as the Aquavage system or the Lipivage system to name but two), it is possible to remove large volumes of fat in one sitting, purify it quickly and easily, and have it ready for re-injection in a fraction of the time that the old Coleman method took. I no longer use 1cc syringes, but I use 10cc syringes and inject 1cc of fat per pass of the cannula. As you can see in the picture below, it works for me. In this way, large volumes of fat can be transferred in a single sitting and, as long as the patient has enough spare fat (you would be amazed how much spare one can find on even a thin patient) the number of procedures can be minimised.

As this technique continues to evolve, I suspect that we will see an exponential rise in autologous breast augmentation, with implants being reserved for those who do not have enough of their own fat spare to create a breast of their desired volume. I can even envisage a future where, if advances in tissue bioengineering continue at their current pace, even slim women will be able to have their fat cells cultured and re-injected to provide autologous breast augmentation.

Until then we can stick with the flawed, yet safe and predictable, technique of breast implantation. However, ask your surgeon if you are a candidate for fat grafting autologous breast augmentation - who wouldn't want a breast that looks and feels natural, grows and shrinks with the rest of your body and never needs replacing?

Right Mastopexy and Left Fat Grafting

NB The longterm safety of fat grafting is not yet known - it appears to be safe from the evidence so far, but has not been in common practice long enough for us to know for sure. Be aware, be educated, be safe.

Tuesday, 4 February 2014

Why are breast enlargements soaring despite PIP scandal?

This was one of the headlines in the Daily Telegraph today. This, of course, follows the news from BAAPS that breast augmentation (along with every other cosmetic surgical procedure) has seen a significant increase over the last year. And why not? It's a simple, predictable and effective procedure that is versatile enough that almost anyone can find a shape and size that is to their liking (within reason - although there are surgeons out there who, in my opinion, are unethically acting outside of the patient's best interest by putting in breast implants that are patently too big for the patient's frame...)

There is one good thing that has come out of the PIP scandal (although I concede that it is a pretty thin veneer of silver lining on a rather large and ominous black cloud) and that is the undeniable fact that patients are more aware. With awareness comes caution and with caution comes safety. Patient safety to be precise. If you haven't already, please read my previous blogs on 'What do the Letters after a Surgeon's Name Mean''The DOs and DON'Ts of choosing where and by whom to have plastic surgery'  - both of these are pertinent to this topic as they discuss ways and means of vetting your surgeon and hospital for markers of quality.

Breast augmentation took a dip (understandably) in the 2011/2012 period while the PIP scandal was ongoing. To use business parlance, this was an example of a decrease in consumer confidence. It's hardly surprising - the PIP scandal was fraud of epic proportions. However, just like we are now seeing the back of the Global Economic Crisis (GEC), we are now seeing the back of this hideous scandal. Unfortunately, however, the comparison does not end there. There are bankers (try saying "bankers" while pulling the corners of your mouth apart with your fingers. Much better.) in the shadow of the GEC who are behaving in exactly the same gung-ho and arrogant fashion as they were before the excrement hit the turbine. Sadly, there are still surgeons and companies (can anyone say "cosmetic chain"?) who have not learned lessons from history and so are destined to repeat it.

It is not good enough to say "oops, no one told us that these implants were rubbish and dangerous. Sure, we knew that they were unbelievably cheap and that their cost was too good to be true and that they both looked and felt of inferior quality but, hey, our bottom line was fantastic for a while and, anyway, that's behind us now and, look, we're using top quality implants now so come back to us, come back, come back..."

Poor quality implants are just a link in the chain of cause and effect. Until companies use the best quality and practice in everything that they do, patient safety will always be a concern. For example, at present there is not a single surgeon on the books of the UK's largest cosmetic chain that is a member of either BAPRAS or BAAPS - the UK professional bodies for plastic surgeons. There is not single surgeon on those same books that holds the FRCS(plast) examination - the UK exit examination in plastic surgery, widely held to be the most rigorous plastic surgery specialty examination in Europe. How can it be good practice  to meet your surgeon on the day of surgery and not before? How can it be ethical practice to have the surgery explained to you by a cosmetic sales advisor who cannot possibly answer all your questions to an appropriate standard as they cannot perform the surgery?

Until all of these quality issues are adequately addressed, I'm afraid that the next scandal is just around the corner...