Liposuction Australia
Liposuction Australia
BREAST REDUCTION WITH LIPOSUCTION, DANIEL LANZER, M.D
HYPERTROPHIC LARGE BREASTS are a common problem to women of all ages. Complaints include back and shoulder pain, disturbance of posture, and indenting of bra straps all related to the excessive weight from breast hypertrophy. Other problems include persistent submammary maceration and psychological disturbances due to the prominence of this area. The traditional method of breast reduction has been surgical excision mammoplasty. It involves excision of breast tissue and skin with a localized flap. The procedure is complex and extensive with significant risks that include unsightly scars, keloid, necrosis, permanent numbness, prolonged postoperative recovery, blood loss, reduction in the ability to breastfeed, and radiographic changes on mammography that
may cause confusion with breast cancer. Klein(1) and Dryden(2) reported early studies on the method of tumescent liposuction alone for breast reduction. Liposuction is comparatively rapid, less invasive, essentially nonscarring, and has fewer risks. The initial work was on selected individuals and more extensive studies were necessary to ascertain if the results were reproducible, if risks were likely to occur, and to determine guidelines for patient assessment.
METHOD
A total of 250 patients underwent breast reduction by tumescent liposuction alone. All patients underwent routine preliposuction work-up, which included blood tests and administration of preoperative antibiotics and antiseptics. A personal and family history of previous breast cancer or cysts was taken. Patients were asked why they wanted reduction, what their current bra size was, and what they would ideally like it to be. Patients were asked if they had breastfed in the past and if they had a significant desire to be able to breastfeed in the future. No patient had a previous history of breast cancer. All patients with a family history of breast cancer were referred to a breast cancer surgeon for assessment and long-term follow-up. Preoperative assessment included a visual examination for assessment of shape, extent of droopiness, stretch marks, skin elasticity, and for asymmetry. Physical examination of the breast was carried out both to exclude any obvious breast lumps and to assess the nature of the breasts. Breasts were graded from 1 to 10:10 corresponded to a soft, spongy texture as one would expect if the breast tissue was made up of fat primarily; 1 described hard, firm breasts.Preoperative mammography and ultrasound were performed on all patients. Of the total, 248 patients had general anesthesia in an accredited surgical setting, 1 had sedation, and 1 local anesthesia. The breasts were marked into four or six sections with attention paid to the apex of the breast, for signs of asymmetry, and the axillary tail if relevant. Approximately five 1–2 mm nicks were made at the base of the breasts and three smaller nicks midway up the breast (excluding the medial upper regions in order to avoid any signs of surgery in this area). Both breasts were filled simultaneously with Klein tumescent fluid using 20 gauge needles. The lidocaine level was diluted to 125 g/1000 ml when performed under general anesthetic. Between 1 and 2 L were infiltrated in each breast until maximum tension was produced. Suction was via a 14 gauge Klein microcannula of the capastrano variety. Two surgeons simultaneously operated from each side of the table, mirroring each move.
Fat was sequentially extracted from superficial, midbody, and the base of the breasts. Suction was performed from all different directions, with the angle of suction varied to allow maximum and even fat removal. In large and very dense breasts, 12 gauge needles were then used. Patients wore a compression chest binder continuously for 2 weeks postoperatively and for 2 weeks intermittently. Attention was paid to keeping the nipples elevated during this phase.
For more information, visit Dr Daniel Lanzer.
BREAST REDUCTION WITH LIPOSUCTION, DANIEL LANZER, M.D
HYPERTROPHIC LARGE BREASTS are a common problem to women of all ages. Complaints include back and shoulder pain, disturbance of posture, and indenting of bra straps all related to the excessive weight from breast hypertrophy. Other problems include persistent submammary maceration and psychological disturbances due to the prominence of this area. The traditional method of breast reduction has been surgical excision mammoplasty. It involves excision of breast tissue and skin with a localized flap. The procedure is complex and extensive with significant risks that include unsightly scars, keloid, necrosis, permanent numbness, prolonged postoperative recovery, blood loss, reduction in the ability to breastfeed, and radiographic changes on mammography that
may cause confusion with breast cancer. Klein(1) and Dryden(2) reported early studies on the method of tumescent liposuction alone for breast reduction. Liposuction is comparatively rapid, less invasive, essentially nonscarring, and has fewer risks. The initial work was on selected individuals and more extensive studies were necessary to ascertain if the results were reproducible, if risks were likely to occur, and to determine guidelines for patient assessment.
METHOD
A total of 250 patients underwent breast reduction by tumescent liposuction alone. All patients underwent routine preliposuction work-up, which included blood tests and administration of preoperative antibiotics and antiseptics. A personal and family history of previous breast cancer or cysts was taken. Patients were asked why they wanted reduction, what their current bra size was, and what they would ideally like it to be. Patients were asked if they had breastfed in the past and if they had a significant desire to be able to breastfeed in the future. No patient had a previous history of breast cancer. All patients with a family history of breast cancer were referred to a breast cancer surgeon for assessment and long-term follow-up. Preoperative assessment included a visual examination for assessment of shape, extent of droopiness, stretch marks, skin elasticity, and for asymmetry. Physical examination of the breast was carried out both to exclude any obvious breast lumps and to assess the nature of the breasts. Breasts were graded from 1 to 10:10 corresponded to a soft, spongy texture as one would expect if the breast tissue was made up of fat primarily; 1 described hard, firm breasts.Preoperative mammography and ultrasound were performed on all patients. Of the total, 248 patients had general anesthesia in an accredited surgical setting, 1 had sedation, and 1 local anesthesia. The breasts were marked into four or six sections with attention paid to the apex of the breast, for signs of asymmetry, and the axillary tail if relevant. Approximately five 1–2 mm nicks were made at the base of the breasts and three smaller nicks midway up the breast (excluding the medial upper regions in order to avoid any signs of surgery in this area). Both breasts were filled simultaneously with Klein tumescent fluid using 20 gauge needles. The lidocaine level was diluted to 125 g/1000 ml when performed under general anesthetic. Between 1 and 2 L were infiltrated in each breast until maximum tension was produced. Suction was via a 14 gauge Klein microcannula of the capastrano variety. Two surgeons simultaneously operated from each side of the table, mirroring each move.
Fat was sequentially extracted from superficial, midbody, and the base of the breasts. Suction was performed from all different directions, with the angle of suction varied to allow maximum and even fat removal. In large and very dense breasts, 12 gauge needles were then used. Patients wore a compression chest binder continuously for 2 weeks postoperatively and for 2 weeks intermittently. Attention was paid to keeping the nipples elevated during this phase.
For more information, visit Dr Daniel Lanzer.
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