Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_654_Библиотеки_им_академика_М_И_Перельмана
.pdf
ab
10 Breast Augmentation: Autologous Fat Transfer
https://t.me/medicina_free
133
c
Fig. 10.8 (a) Fat being collected in a sterile container. (b) Excess saline being ltered through the seive after washing the fat. (c) Collected fat is
being centrifuged. (d) PRP and Gentamycin has been added to the fat and ready for transfer
When injecting fat by holding the breast up using a
hand, fat can easily be injected into the deepest layer of
the breasts without involving the pectoralis muscle.
Injections in some cases can also be done in the subpectoral space but it is very important to anaesthetize the
muscle as well as be careful not to enter into the pleural
space through the intercostal region.
d
7. Inject fat till the breast skin feels rm, but not tight.
The adequacy of fat transfer is based on a rm feel to
the breast, shape that is planned to be achieved as well as
appearance of symmetry. Take care so as not to inject fat
as a bolus as it will stay as a lump and will most probably
necrose due to the “Lake effect” (Fig.10.12).
8. Small dressings to the incision site (Fig.10.13a, b)
134
https://t.me/medicina_free
K. Brecht
Dressings after fat transfer to the breast are relatively
simple, as incisions are very small, and no bleeding is
present. Small dressings for 48–72h until incisions are
closed and not sleeping on the chest for 3 months during
the healing process is recommended. Smooth, minimally
compressive but well supportive sports bras are recommended for 6 weeks after the procedure.
Compression garments are required for the liposuction
regions, and will be customized to the body site from
where the fat was removed from.
10.2.4.2 Before andAfter Photos
Patients before and after photos are a very important documentation tool to demonstrate changes over the months.
These photos are repeated at each follow up appointment to
demonstrate healing and settling of fat over time (Figs.10.14,
10.15, and 10.16).
10.2.5 Post Procedure
10.2.5.1 Recovery
Recovery of fat transfer to the breast is relatively simple, as
the process of fat transfer placement is very delicate and
there is minimal pain and bruising with the tumescent technique, in most cases. Arnica pellets, sublingual, before and
after surgery for 3–7 days may offer added benets in the
healing process by minimizing bruising, swelling and facilitate the early stages of healing.
10.2.5.2 Nutrition Optimization
Decreasing inammation by eating healthy fruits and vegetables rich in antioxidants and adding adequate protein into the
daily diet are essential for optimal healing.
10.2.5.3 Exercise Optimization
Walking and/or aerobic activity daily for 15–30 minimal
intervals are the minimal requirement for healthy individu-
Fig. 10.9 Small incisions (yellow arrow) made in the breast to undertake tumescence as well as fat transfer
Fig. 10.10 Expansion of the tissue matrix as fat is transferred into the breast tissue. When fat is injected as small aliquots, the lipocytes develop
blood supply and survive
als. Excessive activity or inactivity is discouraged.
10 Breast Augmentation: Autologous Fat Transfer
https://t.me/medicina_free
135
Fig. 10.11 Images showing access of the complete breast through small incisions in the anterior axilla as well as in the inframammary crease
136
ab
https://t.me/medicina_free
Fig. 10.12 The completed fat transfer
K. Brecht
Fig. 10.13 (a) supine position, (b) in the upright decubitus. Showing small dressings at the incision sites
ab
10 Breast Augmentation: Autologous Fat Transfer
https://t.me/medicina_free
137
c
d
Fig. 10.14 (a, c) 38 year-old transgender came for breast augmentation, (b, d) after 545cc fat transfer to each breast
138
ab
https://t.me/medicina_free
ab
cd
K. Brecht
Fig. 10.15 (a, b) 41 year-old female before 430cc fat transfer to each breastac, d) after Liposuction of abdomen and anks along with fat grafting
to the upper pole of breast
Fig. 10.16 47 year-old female before (a) after 612cc fat transfer to each breast (b)
10 Breast Augmentation: Autologous Fat Transfer
https://t.me/medicina_free
139
10.3 Final Results
Although fat transfer looks good immediately, with minimal
bruising, the healing process takes several months. Healing
from fat transfer to the breast occurs over about a 3–4-month
period. Percentage of fat transfer that remains long term in
the body ranges widely depending on the patients age, breast
genetics, and environmental components. Although over
80% fat survival can be expected in a good candidate, setting
the expectation for lower percent take is very important to
prevent disappointment by the patient.
10.4 Potential toDo More Treatments
The best aspect to fat transfer is that it can be done multiple
times at the same site over the years, as long as there is an
adequate healing period of about 3–4 months between
surgeries.
10.5 Potential forLess Than Optimal
Outcome
Smokers who wish to have fat transfer should quit completely at least 2 weeks before the surgery, and never resume
after that. Resumption of smoking will lead to less than optimal fat transfer take.
Patients with poor brous network in the breast will have
less fat transfer take, relative to those with more brofatty
breast.
Patients with loss of weight after the procedure, can
expect to lose volume of all fat cells, transferred or native.
Individuals with disease pathology, stress, and increasing
age may put their bodies at a higher inammatory state
resulting in less than optimal outcome.
2. Breast Cysts: if formed usually do not need any treatment. If they are symptomatic, then they can be treated by
excision.
3. Fat necrosis and inammation: Infection can extend from
Gram +ve, Gram −ve to Atypical Mycobacterial infection. The best way to manage infection of the transplanted
fat is not to have it at all.
Pearls
1. Right patient selection
2. Low suction and power settings on device for optimal fat
collection
3. Always inject when withdrawing the cannula
4. Inject primarily in the Prepectoral and subcutaneous
plane.
5. Don’t overll the breast
6. Set realistic expectations for your patients.
References
Hoyos AE.High denition body sculpting. Art and advanced lipoplasty
techniques. Berlin: Springer; 2014.
Kristine S.Brecht MD.Methods for performing cosmetic surgical pro-
cedures using tumescence anesthesia and oral sedation. 10,624,840
United States of America: Patent Granted on 4.21.2020.
Nahai F.The art of aesthetic surgery. Principles and techniques. 2nd ed.
St. Louis: Quality Medical Publishing; 2011.
Peer LA.Loss of weight and volume in human fat grafts with postulation
of a “Cell Survival Theory”. Plast Reconstr Surg. 1950;5:217–30.
Romeo M, Elmeligy A, Elsherbeny K.Fat grafting in body contour-
ing. In: Serdev NP, editor. Body contouring and sculpting. London:
IntechOpen; 2016. https://doi.org/10.5772/65486. https://www.inte-
chopen.com/chapters/52645.
Shiffman MA.Autologous fat transfer. Art, science, and clinical prac-
tice. Berlin: Springer; 2010.
Suga H, Eto H, Aoi N, etal. Adipose tissue remodeling under ischemic:
death of adipocytes and activation of stem/progenitor cells. Plast
Reconstr Surg. 2010;126:1911–23.
Zhao J, Yi C, Li L, etal. Observation on the survival and neovascu-
larization of fat grafts interchanged between C57BL/6-gfp and
C57BL/6 mice. Plast Reconstr Surg. 2012;130:398e–406e.
10.6 Complications ofBreast Fat Grafts
1. Unevenness due to Breast Lumps: Breast lumps may be
formed due to large deposits of fat in an area. These can
be treated by using ultrasound assisted liposuction of the
lump or direct excision.
Part III
https://t.me/medicina_free
Breast Reduction and/or Breast Lift
Mastopexy
https://t.me/medicina_free
JulianDuran
11
Breasts in a woman go through a lot of physiological changes
which may be cyclical or unusual. Most of these changes
will not cause a concern but some breasts undergo changes
which make a woman feel less condent or incomplete.
Youthful breasts are composed of dense glandular tissue
which is required for breast feeding. Post-breast feeding and
as women age, the glandular tissue shrinks and is replaced by
fat. By menopause, most women’s breasts are completely
soft and lost a lot of the volume as well as perkiness.
Breast has no skeletal support to keep it in place as it goes
through its changes of enlargement during breast feeding and
later involution while gravity is continuously working on it.
It is suspended to the chest wall by its soft brous structures
and its shape substantially inuenced during growth by the
genetic predisposition and the bone, cartilage, and muscle
elements that surround the breast’s base. A “Perfect Breast”
for an adult woman involves the right match of glandular tissue, fat, skin, and connective tissue that hold everything in
place on a chest which is proportionate to her height, weight,
and lower body (Kotti 2018).
Breast uplifts (also known as a mastopexy) are breast
reshaping procedures, the principal aim of which is to reposition the droopy breast with a lower positioned nipple and a
large areola into a well-positioned, uplifted, and perky breast
with nipple pointing forward and outward. Breast lift surgery
involves repositioning the nipple on a pedicle which provides the blood supply to the nipple along with reshaping the
breast tissue and tailoring the excess skin without reducing
the breast volume. It may be combined with an implant to
add volume, rmness, and enlarge the breast which is called
an augmentation mastopexy.
11.1 Types ofFemale Breasts
Female breasts are of various shapes and sizes and also go
through various changes during the female’s life. The breasts
may have the following differences (Fig.11.1a–c).
• Asymmetries: In volume, shape, presence of furrows,
position of the areola-mammillary complex, concentric or
divergent breasts, tubular, thin or wide base.
• Skin: Quality, turgor, laxity, stretch marks, skin wrinkles,
spots, pigmentations, retractions, axillary region, sentinel
nodes, tumor lesions.
• Mamillary areola (CAM/NAC): secretions, inverted nipples, supernumeraries, etc.
1. Breasts can be differentiated based on the extent of their
base on the chest which lies between the anterior axillary
and mid sternal line (Fig.11.2a–c)
2. Breasts may be differentiated by the asymmetries caused
due to developmental deformities or after surgery for
breast cancer or following injury (Fig.11.3a, b)
3. Breasts may also be differentiated by the volume of the
tissue (Fig.11.4)
(a) Hypovolemia (Small volume)
• Amazia (without gland), severe hypotrophy. Vol.
0–50cc (Fig.11.4a)
• Moderate breast hypotrophy. Vol. 50–150 cc
(Fig.11.4b)
• Mild breast hypotrophy. Vol. 150–250cc. Bra 28
to 32A—full A (Fig.11.4c)
J. Duran (*)
Antonio Narino University, Bogota, Colombia
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023
M. Thomas, J. D‘silva (eds.), Manual of Cosmetic Medicine and Surgery, https://doi.org/10.1007/978-981-99-3726-4_11
143
144
ab
https://t.me/medicina_free
J. Duran
c
Fig. 11.1 (a–c) Different types of breasts which are encountered in the practice
• Normal breast. Vol. 250–350cc. Bra 32B—34B
full (Fig.11.5a)
(a) Lack of pectoralis major muscle or Poland syndrome
• Mild hypertrophy. Vol. 350–450 cc. Bra 32B—
34B full (Fig.11.5b)
• Moderate hypertrophy. Vol. 450–550 CC.Bra 36C
full—38D (Fig.11.5c)
• Severe hypertrophy. Vol. 550–1000 cc. Bra 38D—
40D (Fig.11.5d)
(b) Pectus Carinatum (Protruding breast) (Fig.11.6b)
(c) Pectum excavatum (Pecho hundido) (Fig.11.6c)
(d) Atelia y amastia (Fig.11.6d)
(e) Bilateral supernumerary nipple (Fig.11.6e)
(f) Supernumerary breast with Spencer’s nipple or tail
• Gigantomastia Vol.>1000cc. Without Bra>40D
logical alterations
(Fig.11.6a)
(Fig.11.6f)
(Fig.11.5e)
Breast hypertrophy b and c is often accompanied by
sagging skin, hypertrophy d and e there is always sagging
skin.
Соседние файлы в папке Библиотека им академика М.И. Перельмана