Blog — Notes of a Plastic Surgeon

Welcome to my blog. I am a plastic surgeon in Seattle and have been in private practice since 1991. I've seen more than a few interesting faces and cases through my years spent in the exam room, the operating room and the emergency room. And I have an opinion on just about everything relating to plastic surgery (and a lot of unrelated stuff). If you like my blog, let me know. Thanks for reading! Lisa

Liposuction-Augmentation Mammaplasty – A Bad Idea IMHO

Liposuction-augmentation mammaplasty has been on my radar since I stumbled across an Instagram video a few months ago of a surgeon sucking the fat out of a perfectly full breast and then inserting an implant to make up for the lost volume.  I started humming Ozzy Osborn’s Crazy Train!  The rational for this procedure is to provide a bit of a lift without the lift scars. This procedure is described in detail in this April’s edition of the Aesthetic Surgery Journal.  The authors reported on 125 patients and compared them with 188 patients who had just a regular old breast augmentation.  The amount of lift achieved was very, very modest.  The authors were very meticulous in their details – age and weight of patients, how much fat was removed and how large an implant was inserted.  Their minimum follow up was 12 months. These authors put a ton of work into this study and I admire them for that.

BUT…………………………………………..Just because something can be done does not mean it should be done.  And I think this procedure is misguided.   Breast tissue is made to last a lifetime and it does.  Implants last maybe 20 years or so if a patient is lucky.  Here is a list of implant related problems:  too high, too low, too lateral, too medial, too loose, too tight, leak or rupture.  Here is a list of breast tissue related problems: benign cysts and breast cancer.  Why, oh, why would a lady trade in her natural breasts for implants (unless she has breast cancer)?  Apparently there are some patients out there, mostly young, who want a really fake look and you bet that this procedure can deliver a fake look that a breast lift cannot.  But isn’t it our duty to let these young patients know that when they are 60, they will likely be on their 3rd or even 4th set of implants with no end in sight because their natural breast volume was sucked away?????  And those high round globes will look pretty odd on their post menopausal body.

And there’s more:  Removing fat from the breast via liposuction leaves a breast more glandular and fibrous and thus harder for breast cancer detection on mammogram.  And add an implant and the mammogram is even harder to interpret!  A lifted breast poses no issues for mammograms once the internal scars have settled.  And speaking of scars, breast lift scars almost always fade to a point of being a non-issue.

There is one instance where I think liposuction-augmentation mammaplasty is a reasonable idea and that is in cases of breast asymmetry.  It is really, really hard to get a great result when one breast is mostly implant and the other either has no implant or a very small implant.  In these cases, i think it is reasonable to reduce the larger side either with liposuction or an actual breast reduction so implants of similar volume can be used.

I do not know if this technique will gain traction but I hope it does not.  My enthusiasm from breast implants has waned over my 26+ of practice.  I’ve just seen so many implant related problems.  If I can get a breast looking good without an implant, that is what I will recommend.  If implants are the only way to get a nice result, I will certainly go there but I can assure you that I am not going to sucking or cutting away perfectly good breast tissue and replacing it with an implant!

Thanks for reading and be careful out there.  Dr. Lisa Lynn Sowder

I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.

 

Category: Breast Contouring, Breast Implants, This Makes Me Cranky.

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