autologous fat transfer a case of congenital breast hypoplasia - liposuction australia ·...

Dr Josef Goldbaum – ACCS & CPSA Annual Conference – 27 Aug – 30 Aug 2004

Dr Josef Goldbaum MBBS FAMAC FACNEM FFMACCS

Liposuction Australia 668 Chapel Street, South Yarra 3141

MELBOURNE, AUSTRALIA

Presented to ACCS & CPSA COMBINED ANNUAL CONFERENCE 2004

Canberra – 27th – 30th August, 2004

Autologous Fat Transfer A Case of Congenital Breast Hypoplasia


Autologous fat transfer to the breast is generally regarded as a controversial and experimental procedure for 3 main reasons:-   Unpredictability of short and long term results.

  Occasional formation of micro-calcification that has been confused by radiologists with micro-calcification produced by breast cancer.

  It’s dependence on operator skills and/or operator methodology.

Autologous Fat Transfer

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Advantages of Autologous fat transfer to the breast are:-

  Enhancement of breast shape and size without augmentation or significant increase in breast weight.

  Selectivity of fat placement e.g. cleavage and superior

aspects.   Can be performed at the same time as liposuction /

liposculpture under local anaesthesia.   Recycling a natural resource.

  Emotionally and intellectually satisfying.

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From my experience with autologous fat transfer to breasts performed over the past 4 years. I am confident that provided the fat is Harvested gently and treated gently injected atraumatically in droplet fashion and injected into specific regions of the breast.

Then consistent and reproducible results can be achieved. I expect a volume retention rate of 40 – 80% of fat injected; and if a subsequent top-up is required, the retention rate is 60 – 80%.

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The role of autologous fat transfer to breasts is for breast enhancement being particularly suitable in breast volume depletion as seen after childbirth, weight loss and exercise. This presentation relates specifically to a case of congenital unilateral breast hypoplasia that improved satisfactorily with autologous fat transfer.

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J F is a 22 year old single office manager. She presented with a small left breast that had failed to develop with puberty. Her general health was good with an occasional bout of mild asthma. She exercised 3 – 4 times per week either gym or cycling. There was no family history of similar dysplasia.

History

She was very self conscious of her abnormality and was unable to dress down in public or to wear even partly revealing clothing. A shoulder pad provided the necessary filling for the left bra cup.

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Examination Her outward appearance was in all respects normal with the exception of hypoplasia of the left breast. The hypoplasia affected breast size, breast volume and the areola/nipple complex. She did not admit to any differences in sensation between the breasts.

Informed Consent J F did not wish to have her left breast built up with silicone gel implants, preferring to use her own body fat. Her main aim was to build up the hypoplastic breast to a level where she did not require major bra augmentation. Her reasoning and desires were sound and without any psychological deficit.

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Following a detailed informed consent process she was referred for basic pathology (FBE, LFT) and breast ultrasound. These were reported as normal. Three weeks after the initial consultation J F underwent manual Liposculpture/Fat harvesting to the inner thighs where a total of 550 – 600cc of fat was removed.

Procedure

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After washing with N. Saline, 235cc of fat was microinjected and layered into the left breast through a 3mm incision at the lateral infero mammary crease. 240cc of fat was decanted into 50cc syringes and stored frozen for future use. The whole procedure was performed utilising dilute local anaesthesia with mild pre-op anxiolysis and analgesia. The procedure was uneventful. There were no incidents or complications.

Before Immediately After Before Immediately After

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2 months later she was very satisfied with the result. Fat loss had been minimal estimated to be less than 20% and there was good breast volume and shape.

Review

4 months later prior to top-up

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J F underwent a Top Up procedure 3 months later (April). The 240 ml of stored fat had “settled” to 215cc which was injected through the previous incision site via micro-droplets and layering. During the top up some attempt was made to enlarge the circumference of the breast by directing some of the fat into the inferior mammary fold. There were no incidents or complications.

Top Up Review 2 months later

Top-Up

Before Top-up Immediately After

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Adipose autografting can be a useful procedure for volume replacement of the breast either unilaterally, such as congenital hypoplasia and post surgery, or bilaterally as seen after child birth or weight loss programs.

Discussion

This effective procedure can be performed under local anaesthesia on several occasions until the desired result is achieved.

Before Immediately After Top-Up 4 months later Immediately After Top-Up

3 Dec 2003 24 May 2004

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Dr Josef Goldbaum – ACCS & CPSA Annual Conference – 27 Aug – 30 Aug 2004 12


Dr Josef Goldbaum MBBS FAMAC FACNEM FFMACCS

Liposuction Australia 668 Chapel Street, South Yarra 3141

MELBOURNE, AUSTRALIA

Presented to ACCS & CPSA COMBINED ANNUAL CONFERENCE 2004

Canberra – 27th – 30th August, 2004

Autologous Fat Transfer A Case Of Congenital Breast Hypoplasia

Thank You

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autologous fat transfer a case of congenital breast hypoplasia - liposuction australia ·...

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