Breast Revision

Breast augmentation is one of the most popular procedures, especially in Beverly Hills and Los Angeles. Breast implants are very safe but definitely not free of complications: in fact up to 50% of patients that undergo a breast enhancement with implants will need a reoperation in the next 10 years for problems connected with the implants. Some of the problems are related to the size of the implants and the placement of the implant (over or under the muscle) etc. One of the most visible and disturbing problem is called “rippling” which consists of seeing or feeling the edge of the implants. This usually happens in the medial part of the breast and in the lower lateral part. The causes of “rippling” are multiple: often is due to the fact that there is not much breast tissue between the skin and the breast implants especially in very thin patients or patients that don’t have a lot of breast tissue. Sometimes the cause of “rippling” is iatrogenic one (it means that it is caused by the plastic surgeon) and it is due to poor technique. The pectoralis muscle has been over-skeletonized in order to create projection and cleavage and the breast implant protrudes trough the muscle. Sometimes the problem is so severe that the two breast pockets communicate. (Synmastia) .It is a very difficult problem to resolve.

It is only with the advent of fat grafting and stem cell regenerative procedures we can now address the problem with confidence.

Fat grafting and Stem cell-enriched fat grafting are very effective way to treat these kind of problems. The fat is harvested from an area of your body with syringe liposuction then it is re-injected in the areas of the breast where the rippling is present. Particular attention is placed to avoid injury to the breast implants.

The problem encountered with fat grafting in general and fat grafting to the breast in particular is that the retention rate is unpredictable and it is possible that the entire quantity that was injected will completely disappear. Therefore multiple treatments are often warrant.

Preliminary studies (the one in Japan in particular) has shown that stem cell enriched fat grafting has longer survival rate than fat grafting alone. In stem cell breast revision, the fat is harvested in the usual fashion with liposuction and then the SVF (stromal-vascular fraction) where the stem cell are is separated from the fat with an enzymatic process.

At this point the stem cell are placed back in the fat and a “turbo-charged” fat grating is created where the concentration of stem cell is much higher than in regular fat grafting.

This stem cell enriched graft is then injected into the breast.

This procedure seems to improve dramatically rippling and indentations secondary to breast implants and it is becoming the procedure of choice in these difficult cases.

Another issue that patients which had breast augmentation face often is the formation of scar tissue around the implants (capsular contracture). This phenomenon can cause hardening of the breasts, severe pain and obvious distortion of the breast shape.
Traditionally in this cases a capsulectomy is performed with removal of the scar tissue.

Sometime, this scar tissue can recur more than once and at this point the only option left is to take the breast implants out.
Now days, with the advent of breast augmentation with fat grafting or stem cell enriched fat grafting the patient has an alternative and the breast can augmented without the breast implants so the problem with capsular contraction is avoided forever.

More studies are needed to further clarify the safety of stem cell enriched breast revision and fat grafting to the breasts in general and more scientific evidence needs to be gathered to assess any possible correlation with breast cancer.