16
October
2008
Sydney Coleman presented his experience with breast reconstruction using LipoStructure® at the American College of Surgeons Annual Meeting this week in San Francisco. In the section Reconstruction & Breast Cancer: Techniques & Approaches to Optimize Outcomes in Reconstruction after Partial & Total Mastectomy, Dr. Coleman gave a lecture “Fat Grafting in Breast Reconstruction.” During the lecture, he recounted his twelve-year experience with fat grafting in breast reconstruction. Of particular importance, the effect of grafted fat to reverse the problems of therapeutic irradiation and hard breast implants was presented.
Dr. Coleman began his lecture by discussing a lumpectomy patient (above leaning forward) who had a lumpectomy on her left breast followed by six weeks of therapeutic radiation. A few months after the treatment, she developed severe pain and hardening of her breast. Her treated breast became so hard that mammograms were not possible, and she had to have MRI’s instead. She could barely raise her arms over her head without encountering shooting pain.
When the patient returned at 2 weeks (above) she was amazed at how rapid her recovery had been. She also commented that her shooting pains in the site of the radiation were notably less. When she returned at 6 weeks, she said that the pain had almost completely disappeared, and the hard areas of her breast were much softer. At 13 weeks, she went to see her surgical oncologist, who was so impressed by the softness of her breast that she went ahead and ordered a mammogram, which was now easy on a soft, painless breast. She returned at 7 months ready now for a second procedure this procedure aimed this time at adjusting the contour of the breast.
Dr. Coleman explained that after conservative breast therapy for cancer (lumpectomy followed by irradiation), a woman is left with a defect that is often difficult to reconstruct. Therapeutic radiation is a critical component of breast conservation treatment to decrease the possibility of the cancer returning near the site of the original cancer. Unfortunately, radiation combined with a saline or silicone gel-filled implant remarkably increases the incidence of scarred or hard breasts (breast capsular contracture), infection and rejection of the silicone implant. Therefore, placement of an implant in these conditions often results in a poor cosmetic result. Putting fat to a breast after lumpectomy and irradiation not only restores the breast by adding volume and reshaping the breast, but also promotes the in creation of a blood supply and the healing of the radiation damaged breast. This effect also occurs in the face after treatments with radiation (see facial reconstruction) and may also be similar to the effect of fat grafting on sun damaged skin (see progressive improvement in skin quality after fat grafting).
Dr. Coleman concluded his lecture with the comment that long-term studies still need to be completed. He is currently working with other plastic surgeons, oncologists and radiologists at NYU to develop a multi-center prospective study examining the use of fat grafting in the breast.
For more detailed information about fat grafting to the breast, please refer to LipoStructure.com.
Related articles:
Lipofilling: a role in breast reconstruction surgery?
From “Behind the Medical Headlines” produced by the Royal College of Physicians of Edinburgh and Royal College of Physicians and Surgeons of Glasgow
Breast Augmentation Via Fat Grafting
From “Plastic Surgery Practice”
Breast Implant Problems Solved with Coleman Fat Grafting
Fat Grafting to the Breast Revisited: Safety and Efficacy.
Plastic & Reconstructive Surgery. 119(3):775-785, March 2007.
Coleman, Sydney R. M.D.; Saboeiro, Alesia P. M.D.
© Coleman 2008
Posted: Breast LipoStructure
20
August
2008
Rhonda Rundle of the Wall Street Journal today wrote an article entitled “Stem Cells and Breast Surgery” in which they discuss the process of “super-charging” fat grafts with stem cells and other factors by a special processing method. This process has been developed for commercial use by Cytori Therapeutics. Ms. Rundle does a nice job of explaining the process and the controversy.
She used the diagram below from Peter Rubin of the University of Pittsburgh, recent recipient of the Presidential Early Career Award for Scientists and Engineers (PECASE). I think that the diagram is helpful in understanding this process. Click on the image to open up the diagram in another window.
More discussion of this the impact of stem cells on fat grafting and breast surgery will appear in future posts.
Posted: Breast LipoStructure
13
August
2008
The degree of sculpting possible with structural fat grafting to the breast is particularly advantageous in the challenging correction of tuberous breast deformity. The tuberous breast is a deformity in which the lower skin of the breast (the lower pole) is abnormally constricted (tight) and short. In addition, the normal fold of the breast (the inframammary fold) is higher that it would be under the normal breast. These two combined make the breast shape distinctly abnormal, and prevents the fluid roundness of a normal breast. In the more problematic cases, the tightness of the lower breast makes the nipple and areola appear much larger and more puffy than in a normal breast. treatment for this problem using structural fat was first described in the journal of Plastic and Reconstructive Surgery last year by Coleman.
In the case below, the skin envelope of the breast was selectively expanded with fat placed immediately beneath the skin. No fat was placed under the central breast (the nipple-areola complex). This changed the relative proportions of the breast creating a natural appearing and shapely “A cup” after one procedure (see below). The patient desired larger breasts after the first correction, so further augmentation with fat grafting was performed (see below) to bring her up to a “B-cup.”
The time requirement of such a fat grafting procedure should not be underestimated. The time to harvest, refine, and place fat into the breasts in this fashion will take many hours. In the patient shown placement of fatty tissue into the breasts took about seven hours for the first procedure and five hours for the second. The reward of the time and effort is a dramatic change, which is much more natural than if implants had been used. Fat grafting for correction of tuberous deformity leaves the patient with natural appearing, normal breasts. As with any breast procedure, patients must be aware of the potential risks and complications of fat grafting to the breast.
28-year old woman with a bilateral tuberous breast deformity before any procedures(left ). Result after first fat grafting procedure with placement of 370cc on left and 380cc on right (middle). Photo on the right was taken at almost 5 years after the second fat grafting procedure in which 300cc was placed into the left breast and 340cc into the right.
Long-term studies still need to be completed. Dr. Coleman is currently working with other plastic surgeons, oncologists and radiologists at NYU to develop a multi-center prospective study examining the use of fat grafting in the breast.
For more detailed information about fat grafting to the breast, please refer to LipoStructure.com.
For more details about fat grafting to the breasts, please refer to the article in Plastic and Reconstructive Surgery.
© Coleman 2008
Posted: Breast LipoStructure
16
June
2008
Problems that women experience after silicone and saline breast implants include visible implant edges, rippling, hardness, and scarring. Also, the breast can be left with an unnatural shape: for example with poor cleavage, inadequate upper breast volume or deficient fullness up into the armpit. The Coleman technique, which moves a woman’s own fat to her breasts, may be a solution for all of these problems.
These photos illustrate what can be done to improve the look of artificial implants without removing them. Photos on the left were before fat grafting. Photos on the right are 8 years after placement of about 2 ounces of the patient’s own fat around the visible implant edges and over the bony breastbone and ribs using the Coleman method. No surgical procedures or implant exchanges were performed. The grafted fat softens the appearance of the bony chest allow natural cleavage to occur. The scar around the implant has softened so much that the orientation of the implant has changed from an obvious hard, vertical position to a softer, more horizontal position. The result is a natural appearance and softer breast with despite the presence of the original silicone implants .
On the current website of the American Society of Plastic Surgery the advisory: “Fat Grafting for Breast Augmentation – What Women Should Know” asks the question, “Is there an acceptable application for this procedure currently in use?” They advise women that fat grafting to the breast can be effective in breast reconstruction and to soften the appearance of existing implants, specifically in thin women and those with visible rippling.
Even though fat grafting around breast implants may be “acceptable,” women need to know that there are potential complications or problems. Women should go to plastic surgeons that are familiar with those problems and have the experience necessary to minimize possible complications. The results of fat grafts are incredibly dependent on the technique used and fat must be placed with extreme care.
I have been grafting fat to the breast in New York City since 1995, and published my initial experiences in the main plastic surgery peer review journal in 2007. Since then, I have lectured on fat grafting to the breastat every major plastic surgery meeting in the United States . I have also been invited to lecture at many major meetings in North and South America, Europe, and Asia on the topic.
Long-term studies still need to be completed. I am currently working with other plastic surgeons, oncologists and radiologists at NYU to develop a multi-center prospective study examining the use of fat grafting in the breast.
For more detailed information about fat grafting to the breast, please refer to LipoStructure.com.
Further references:
Article in WebMD
Lipofilling: a role in breast reconstruction surgery?
From “Behind the Medical Headlines” produced by the Royal College of Physicians of Edinburgh and Royal College of Physicians and Surgeons of Glasgow
Breast Augmentation Via Fat Grafting
From “Plastic Surgery Practice”
Breast Implant Problems Solved with Coleman Fat Grafting
Fat Grafting to the Breast Revisited: Safety and Efficacy.
Plastic & Reconstructive Surgery. 119(3):775-785, March 2007.
Coleman, Sydney R. M.D.; Saboeiro, Alesia P. M.D.
© Coleman 2008
Posted: Breast LipoStructure
