Breast Enlargement by Fat Injection (BAMBI) is another important area. Another area of the body where more fat is often desirable is the breasts. The amount of breast tissue a woman has, as well as the contours she is naturally endowed with, will vary from woman to woman. So will the way she feels about her breasts.
1. Front view of patient with atrophic breast–shrunken breasts, though there is fat enlargement elsewhere in the body.
3. Side view of the same patient.
Some women are extremely self-conscious about their breasts, and readily admit their concerns. Others, who may secretly care just as much, are reticent to discuss their fears. It is only in a private consultation, with the assurance, as always, of a strictly confidential doctor-patient relationship, that they reluctantly bring up the question of breast size or shape. Still others, who may be just as disappointed in what nature has provided, do not realize that liposuction and lipoinjection provide a possible remedy.
From the experience gained in working with several thousand patients, we know that often, a new patient may not have the medical sophistication to ask such questions. That is why, when I examine a woman who has come for an initial consultation about liposuction, I schedule enough time to talk about her feelings and concerns. Through skillful probing, I encourage her to talk freely about her self-image and how she feels about her various body parts. Frequently, I learn she feels inadequate about breast size or shape.
BREAST TISSUE LOSS AFTER PREGNANCY
Cheryl was such a woman. Married to an accountant tant for seven years, she had borne two children, nursing both of them for several months. Since weaning her second child, however, she had been disappointed in the way her breasts looked.
Many women are like Cheryl. Pregnancy and nursing - and the hormones involved in both - do affect breast tissue. By the time she came to The Liposuction Institute, the upper portion of Cheryl's breasts had receded, giving her chest a sunken appearance. In fact, she had actually lost breast tissue, as confirmed by her measurements. She was not unattractive, but she felt inadequate because of her breast size.
Cheryl had also gained weight during each pregnancy that was difficult to lose. She dieted. She exercised. But the saddlebags stayed with her. Her matronly, bulging hips, coupled with the reduction in breast tissue she had noticed, made her extremely self-conscious about her "changed" appearance.
THE ROLE OF LIPOINJECTION
1. Diagram indicates transplanting fat through small incisions in the breast.
Liposuction of the saddlebags was what Cheryl wanted, and it was not difficult to reassure her that this condition could be helped. After a careful examination and a long discussion, we made plans for her surgery. Cheryl was surprised and delighted to discover, as well, that lipoinjection - the technique of transplanting her body's fat cells - could help augment her breasts.
The name I have given this surgery is Breast Augmentation Mammoplasty By Injection, or BAMBI. Like the autologous fat transplants for facial areas discussed in Chapter XXI, this injection technique uses the body's own fat cells to achieve desired results. Breast augmentation - making breasts larger - is a goal of many patients, and BAMBI can help them achieve it.
Traditional cosmetic surgery has used silicon implants as a way of increasing breast size. The implants are small sacs or bags, filled with medically-approved silicon. That technique has worked well, with few complications, and has improved the appearance of thousands of persons. Nevertheless, I believe that in appropriate cases, BAMBI can provide equally as good, and often better, results.
1. Three-quarter view of this patient's breasts before surgery and fat transplant.
2. Only a needle is required for transplanting fat into the breast. After surgery, the patient's breasts appear normal size.
4-5. (Opposite page). Fat transplant makes a difference. Here are ftont and side views of the same patient after surgery.
During Cheryl's liposuction of her saddlebags, I removed a total of 2000 cc of fat However, that would have been far too many fat cells to inject in her breasts. Instead, I injected each breast with 350 cc of fat cells. In the office visits before Cheryl's surgery, we discussed the results she could expect from the BAMBI technique. I told her that approximately 25 percent of the fat cells I injected would be reabsorbed into her body. No one is certain why this happens. Our own theory, however, is that a network of tiny blood vessels must develop at the site of the injection or close by so the injected cells can receive the Anourishment@ and oxygen necessary for their survival. During the time needed for this development, a portion of the transplanted cells will remain "undernourished," and will disintegrate and be absorbed.
I told Cheryl that for her particular needs and optimum appearance after the transplant, she should have about 275 cc more fat in each breast. That is why I injected - intentionally - more than enough volume of fat cells, so the final result would be appropriate for Cheryl.
I cannot stress enough the individuality of such delicate surgery. The amount of transplanted fat cells for one woman may not be 'right' for another. A woman who wants to increase the size of her breasts through this technique must work very closely with her surgeon throughout the entire liposuction experience, and must be guided by his experience in this unique body contouring.
BREASTS OF DIFFERENT SIZE
It is not necessary to have nursed a child, or even to have been pregnant to have breast problems. The case of Judy, another of my patients, represents one example. Judy's breasts had been an embarrassment to her since her early teen years, because they were not the same size. The right breast was noticeably smaller than the left. As a teenager, Judy had padded her first bras to compensate for the problem. Now that she was a 26-year-old successful saleswoman, she was even more concerned about her appearance in the corporate world, since she dealt with appearance-conscious executives every day For Judy, what had been a personal emotional problem had become a sore point for practical reasons in her competitive professional world.
Although Judy originally consulted me to ask about liposuction on her bulging hips and her flabby, fat abdomen, she too was delighted to hear that lipoinjection offered help for her problem. At her second visit, she brought in snapshots of herself as an adolescent in a bathing suit - embarrassed at being photographed, and trying to hide behind a tree to conceal her uneven breasts.
During liposuction of Judy's iliac area (the "love handles" flab) and her bulging abdomen, a total of 2000 cc of fat was removed. The right breast only was injected with 200 cc of fat cells. As I had predicted, about 25 percent of the injected cells were absorbed, so when her recovery period was complete, her right breast was actually enlarged by about 150 cc of fat cells.
BREAST TISSUE LOSS AFTER LIPOINJECTION
1. Before surgery, this patient's breasts sagged and drooped.
2. Following surgery, their contour is normalized.
3. Side view of sagging breasts shows a drooping contour.
4. After surgery, the patient's contour is much more normal.
I did warn Cheryl and Judy, as I do all my patients who have lipoinjection of their own fat cells, that the cells which have been transplanted are still fat cells, and will continue to behave like fat cells. That is, after the initial reabsorption, when the breast which has received the injection is at the indicated size (for Cheryl, about 255 cc increase, and for Judy, about 150 cc), the fat cells - breast tissue - will diminish if she will lose some of the breast tissue she has gained through lipoinjection. For that reason, I work closely before and after surgery with such patients. If they can achieve their appropriate weight through diet and exercise before liposuction is performed to eliminate their bulges, the eventual results will be much closer to their hopes and dreams. Body contouring is both an art and a science. Nowhere is this more true than when liposuction and lipoinjection are performed. The skill and experience of your surgeon in both procedures is essential, if you are to achieve the maximum benefits that are possible.
1. Preparing for surgery, the patient's flat breasts are apparent.
2. Immediately after surgery, the improvement is apparent.
3. The proper taping and support of the breasts during recovery, and the support of a surgical garment especially designed for this area are important.
1. Photographs below show patients before and after surgery for breast augmentation.
2. Below, the patient has had fat removed from troublesome areas of the lower body, and injected into the relatively flat breast area. The results are clearly apparent. Final photos show the position of the post-surgicalbandaging and support garments.
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