Slight breast asymmetries are easily corrected by lipomodeling +++, and it is one of the ideal indications of the breast lipomodeling. In very slight asymmetries, it is a so-called aesthetic surgery procedure, and the intervention charged to the patient. This technique makes it possible to correct the asymmetry in 1 session and to obtain an almost perfect symmetry. As for major breast asymmetries, this solution is much preferable to an implant that never allows a satisfactory symmetry in the long term, because when an implant was placed unilaterally, the breast with the implant never evolves in the same way as the normal contralateral breast. At the end of the lipomodeling procedure, as for all cases of breast asymmetry, it is desirable to over-correct a little, so as to obtain a comparable result within the contralateral breast, approximately 3 months after the intervention.
In patients with mild asymmetry who are somewhat optimistic about the quality of the result, it is necessary to highlight the importance of having a stable weight because a small asymmetry may be insufficiently corrected if the patient loses weight, or conversely over-correct if the patient was gaining weight. Weight stability is therefore one of the important conditions necessary to obtain the best possible quality in terms of symmetry of the two breasts.
Bilateral breast augmentation with aesthetic breast lipomodeling or Lipoaugmentation
The aesthetic lipomodeling of breasts, also sometime referred as Lipoaugmentation, lipofilling of the breasts, or “Natural Augmentation”, makes it possible to correct the bilateral breast hypotrophy. This can exist from the start, in a constitutional way, or can appear secondarily as a result of a significant weight loss or pregnancy. The classic solution for the treatment of hypotrophy is the placement of bilateral silicone breast implants.
Following the experience gained in breast repair surgery, then in Aesthetic Breast Surgery, we now have significant experience in bilateral aesthetic breast augmentation using fat transfer. The technique has gradually been codified and improved to make it a fully-fledged technique ++, which currently gives very good results, if the technical realization is irreproachable and if the indication was well set, according to the demand of the patient to obtain a moderate increase of the breasts. This technique can only respond to precise indications and requires that the patient has a sufficient “fat capital” to allow the fat harvesting in good conditions and in large quantities. Very thin patients are therefore not good candidates for this technique.
The ideal indication of this technique is a patient wishing a moderate breast augmentation, or wishing to find a more harmonious curve in the upper part of the breast following a weight loss or pregnancy. This technique has two major advantages: it allows the moderate increase of breast volume while being completely natural +++ (hence the term “Natural Breast Augmentation”), without any foreign body; and secondly, the fat is harvested from disharmonious localized areas of fat overload known as steatomeries (fat harvesting areas). The two limitations of this technique are the amount of tissue that can be harvested, and the volume of the recipient tissue (if the breast is very small, the amount of fat that we can inject will necessarily be limited, because the “spaghetti box” to accept the “fat spaghetti” will be automatically limited).
If the patient wants a significant increase of the breast, or if she has a weight that is not stable and subject to weight variations, it is better to stay with the conventional solution, which is the establishment of breast implants, or alternatively, the Composite Breast Augmentation, which currently gives superb results (See Composite Breast Augmentation Link).
The technique of Aesthetic Lipomodelling probably has many indications, but it is still little known, because we had not sought to mediate it. The majority of the patients who consult us at present are often very thin patients like “mannequins”, and who have little fat available, and for whom we will not be able to give a satisfactory breast augmentation. There are, however, many candidates with “saddlebags” ++++, wishing to attenuate or treat it, and who would like a moderate breast increase. It is estimated that about 30% of the French female population has fat that bothers them and would like an increase in breast volume +++. This intervention will therefore probably undergo significant development in the coming years, when quality information will be available on this subject +++ for the general public, and that surgeons will have been trained in this very interesting technique.
Before considering this procedure, a careful examination and mammography imaging with mammography and ultrasound should be performed by a referent radiologist (ultrasound only before 30 years old, mammography-one incidence and ultrasound between 30 and 40 years old, and mammography-two incidences and ultrasound after 40 years old). This radiologist ensures that there is no contraindication to perform the lipomodeling (ACR1, or ACR 2). If a suspicious lesion was found, we should of course first check this lesion (microbiopsy to reclassify ACR 2), and treat it specifically. In the same way, the patient agrees to have the same assessment performed by the same radiologist 1 year later to ensure that there is no suspicious lesion.
Composite Breast Augmentation (Lipomodeling and implants)
In some particular cases, it may be appropriate to combine the lipomodeling and the placement of implants. Indeed, in some very thin patients we can see folds related to the implants at the neckline or at the infra-external part of the breast. In some cases, it may be necessary to utilise lipomodeling so as to increase the cover tissues and reduce the visibility of the implants and thus allow obtaining a more natural bilateral increase. When we perform this type of procedure, we prefer to perform lipomodeling first on a provisional implant that can be inflated during the procedure, then adding the definitive implants, to not risk traumatizing the implants with the lipomodeling cannulas.
This concept, which we have used since early 2000 in difficult cases of augmentation like tuberous breasts, was developed by Dr. Auclair – Paris from 2005, who proposed to use it also in “simple” cases. He has systematized this approach, and has given it the term Composite Breast Augmentation (see this chapter in my main site), and has presented it in a didactic and convincing way in several scientific articles, and in many international communications.
Improvement of insufficient results of bilateral implant breast augmentation Lipomodeling in the breast can improve some results of bilateral implant breast augmentation. The lipomodeling makes it possible to improve the neckline, increase the coverage by the local tissues, and finally reduces the risk of recurrence of the capsular contracture after an implant replacement. In these different secondary cases, we start with the lipomodeling, then we change the breast implant, always in the same spirit not to risk to traumatize the new implants. In the cases we treated, we found a significant improvement in the neckline, and especially in the flexibility of the breast. We had to manage patients with severe capsular contracture, and we did not have a severe capsular contracure recurrence after lipomodeling. This data is very encouraging, and need to be confirmed on long-term results. In these cases of Secondary Composite Breast Augmentation, the improvement is usually dramatic ++, and very much appreciated by the patients.
Mastopexy and complementary lipomodeling or “Mastopexy-Lipomodeling”
In the borderline cases of ptosis in patients with a slightly low breast volume who do not wish to have breast implants, it may be advantageous to combine a bilateral breast ptosis treatment with lipomodeling at the upper part of the breast (Mastopexy-Lipomodeling) to give a satisfactory cleavage, and improve the effectiveness of the ptosis treatment. We then begin to harvest the fat, usually on the thighs in the prone position, then we perform it a second time, in a half-seated supine position, the cure of ptosis and the fat injection in the neckline, the pectoral region, and in the volume deficient areas. It is necessary to make sure to perform the lipomodeling in the areas where the tissue hasn’t been detached to ensure an optimal fat graft uptake. Usually, the Mastopexy-Lipomodeling can give very satisfactory results for the patients not wishing a major breast augmentation and wishing to find a harmonious cleavage in line with their morphology. Often the technique of mastopexy uses a combinaison of the posterior flap to get the most beautiful cleavage possible.
Sequelae repair of previous breast aesthetic surgery
Thanks to our considerable experience in breast reconstruction, secondary cases of severe sequelae of breast cosmetic surgery (see this chapter in main website – emmanueldelay.fr) are often addressed to us, whether as a result of necrosis during aesthetic mammoplasty, complications of breast implants, or patients who had their breast implants removed. Lipomodeling also makes it possible to provide, by a simple and elegant solution, a significant improvement of the result. The breast is fuller, and rounder, and often an improvement of its sensitivity is noticed – results much appreciated by the patients.
Lipomodeling may provide a solution for a delicate situation where patients are disappointed and upset by the complication of initial aesthetic breast surgery. Rectifying the complication and achieving a satisfactory result can bring the patient satisfaction and allow them to move on with their life. This intervention of sequelae correction, thus helps the patient, but also the initial surgeon who is always in a very unpleasant situation and feels guilty, even in the absence of therapeutic fault. It is particularly gratifying to be able to help in a spirit of humility, humanity, efficiency, and professionalism.