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Monday, August 8, 2011
LinkedIn Network Updates, 8/09/2011
Will Fat Grafting to the Breast Affect Mammograms?
Fat Grafting, also known as fat
transfers or fat injections, is a plastic surgery procedure which removes fat
from unwanted areas of your body, it is then methodically processed, once it’s
ready, it is reinjected to the particular adipose fat tissue where more volume
is desired. Fat injections are commonly used as a rejuvenation agent for the
face, buttocks, hands, or breasts. There has also been in increase in the use
of fat injections in reconstructive breast surgery. The advantages being that
fat grafting will restore volume to the breast and can be performed with or
without the need of an implant.
Being that the procedure is fairly
new, there have been some concerns expressed about how the fat injections
affect the results and efficacy of mammograms.
We would like to share a few varying perspectives on the matter
Lately we have seen some plastic
surgery blogs expressing concern regarding how fat injections to the breast
affect mammograms. We feel that both sides of the story are not being told, so
we would like to address that here. The
heated debate hit the The Plastic
and Reconstructive Surgery Journal, a journal of peer reviewed
studies from the plastic surgery community, recently published several papers
that come to different conclusions about whether fat injections to the breast
can interfere with cancer screening.
Let’s explore these publications
to review the various findings.
The
Chinese Study
April 2011, Plastic and Reconstructive Surgery
“Clinical Analyses of Clustered
Microcalcifications after Autologous Fat Injection for Breast Augmentation”
The
recently released paper, published in the April 2011 issue, put fat injections
to the breast in a negative light. The study was conducted by Chinese plastic
surgeons at Meitan General Hospital and Peking Union Medical College Hospital
in Beijing, China. The Chinese study concluded that fat injections create
issues with mammograms used to detect cancer in the breast. Based on these
findings, the study recommended prohibiting all fat injections to the breast.
This study analyzed ‘digitized mammographic films’
from 48 patients who had received fat injections to the breast from July 1999
to December 2009.
The study
focused on calcifications which occur after fat grafting is performed.
When a fat
injection does not take well, the fat cells can die (fat necrosis), and take on
the appearance of a calcification. The Chinese study concluded that mammograms
cannot distinguish between calcifications formed from fat or calcifications
that may be cancerous. The study’s abstract conclusion states “clustered
microcalcifications found after autologous fat injection for breast
augmentation, cannot be distinguished from malignancy.”
Even
though all calcifications were biopsied to be non-malignant, the study also
reached a grandiose conclusion that fat injections to the breast “should be
prohibited.”
So–should fat injections to the
breast be outlawed? Or is there another side to the story? If so, what is it?
The heart of the matter is whether radiologists can distinguish if
calcifications seen on mammograms are due to dead fat cells, or from malignant
cancer cells. First of all, not all fat grafting produces calcifications.
If a fat graft takes well, there will be fewer dead fat cells, or fat necrosis,
thus resulting in fewer or no calcifications. However, a poorly performed fat
graft will likely have lots of dead fat cells, likely resulting in more
calcifications.
Let’s look at other recent
articles that were published on the topic of fat injections and mammograms, all
within the last month.
The
Discussion Article about the Chinese Study
April 2011, Plastic and Reconstructive Surgery
Daniel DelVecchio, M.D.
The same
April 2011 Plastic Surgery Journal issue included a ‘Discussion’ article about
the Chinese study. If you had a hard copy of April’s journal, you would simply
turn from the last page of the Chinese publication to read the ‘Discussion’
section that immediately follows written by Plastic Surgeon, Dr. Daniel
DelVecchio. Dr. DelVecchio was an early adapter of fat grafting to the breast
and has been published frequently in the Plastic Surgery literature.
Dr.
DelVecchio brought up several excellent points as to why the Chinese
publication conclusion was without merit. One point addressed concerned the
issue of the resolution quality of the mammograms. What type of mammography did
the Chinese use? The Chinese publications stated that they used ‘digitized
mammographic films.’
According
to DelVecchio, this would imply that plain screen film mammograms were
initially imaged, and later digitized. Per DelVecchio: “the quality of
digitized screen film mammogram is only as good as the quality of the original
mammogram, and it is common industry knowledge that screen film mammograms are
inferior to direct digital mammograms.”
In other
words–did the Chinese study simply digitize mammogram films with inferior
resolution?
Dr.
DelVecchio pointed to the work of other fat grafting pioneers, such as Dr.
Emmanuel Delay, who have described the ability to distinguish between benign
and malignant findings on post fat grafting mammograms. DelVecchio cited the
radiologic literature which supported the general concept that calcifications and fat necrosis can be
distinguished from the malignant signs of irregularly shaped, high-opacity
microcalcifications when supplemental imaging modalities are considered.
Other
notable points made by Dr. DelVecchio included the need for standardization of
fat injection procedures in order to minimize fat necrosis, which result in
calcifications. Deviation from ideal fat grafting techniques result in poor fat
take because some of the fat dies. It is these dead fat cells that can result
in calcifications. As standards emerge for the best fat grafting techniques,
there will be less fat necrosis and calcifications to show up on mammograms as
a result of fat injections to the breast.
In
DelVecchio’s opinion, modern mammography techniques can distinguish between
malignancy and benign fat deposits found on mammograms.
The
French Study
March 2011, Plastic and Reconstructive Surgery
“Radiographic Findings after Breast
Augmentation by Autologous Fat Transfer”
Exactly
one month prior to the Chinese article publication, a group of French surgeons
published an article in the March 2011 issue of Plastic Surgery Journal. The
study compared mammograms pre and post operative mammograms on 20 patients who
underwent fat grafting to the breast. The study’s goal was to determine whether
the transfer of fat to the native breast hampers breast imaging.
Using
guidelines stabled by the American College of Radiology classification, the
study concluded that radiographic
follow up of breast treated with fat grafting is not problematic and should not
be a hindrance to the procedures. However, the study did recommend
that techniques used for fat injection patients should become standardized, so
that reproducibility could be insured.
Our
Summary:
As more and more radiographers
become more familiar with fat grafting and how it may skew results, we expect
this mammogram issue to diminish, as was seen when breast implants gained
popularity
Perhaps the more significant fact
to report yet is that of the thousands of fat graphs to the breast completed to
date, there has not been a single case of cancer missed by a mammogram that
could be attributed to a fat graft procedure.
Sunday, July 17, 2011
Get the 411 on Liposuction
What is Liposuction?
Despite the fact many people diet and exercise religiously, sometimes it's physically impossible to get rid of fat deposits in certain areas of the body such as the abdomen, thighs, arms or butt.
As a result, literally hundreds of thousands of people undergo liposuction surgery each year. According to the American Society for Aesthetic Plastic Surgery, lipoplasty has even been the top overall surgical procedure since the Society started collecting nationwide procedural statistics in 1997.
In short, liposuction is the removal of fat deposits in the body through suction.
A conventional liposuction procedure involves four basic steps:
1. Application of either a local or general anesthetic, depending on the number/area of your procedure(s).
2. An incision or incisions is made near the selected area and a thin "cannula", or tube is inserted through the skin and muscle.
3. A small amount of anesthetic is injected into the area to break up the fat deposits and the fat is removed through suction via the cannula.
4. Once the fat is removed, the incisions are closed and padding is applied to reduce bleeding and allow the incisions to heal.
No shortcut to weight loss
It's extremely important to remember however that liposuction isn't a shortcut to weight loss, and it's recommended primarily for healthy adults within 10-20 pounds of their ideal weight looking to remove stubborn pockets of fat and shape and contour their body.
Liposuction (technical term lipoplasty) is a surgical procedure that removes fat deposits from designated areas of the body. Several techniques can be used during liposuction surgery, but, generally speaking, the plastic surgeon uses a probe that is inserted into the patient’s body through a small incision. The surgeon then breaks up the fatty cells and extracts them from the targeted area of the body.
Common Types of Liposuction
Liposuction (technical term lipoplasty) is a surgical procedure that removes fat deposits from designated areas of the body. Several techniques can be used but, generally speaking, the plastic surgeon uses a probe that is inserted into the patient’s body through a small incision.
Lipoplasty surgery has become one of the fastest, most effective and safest cosmetic surgery procedures available today, and much of that is due to the technological advancement of both the techniques and the equipment
The following are the four most common liposuction techniques.
1. Tumescent Liposuction
Tumescent liposuction is the most common type of liposuction.
The basic process is your surgeon will insert the cannula through the incision and inject lidocaine and epinephrine into the fatty tissue, causing it to becomes swollen and firm, or "tumescent."
This helps break up the fat deposits for easier suctioning, and it also reduces bleeding.
Ultrasonic Liposuction
Vaser liposuction is an increasingly popular alternative to traditional liposuction. Contour Genesis is another ultrasonic liposuction solution. It has been available for the past seven years. Using this solution has been very successful in our practice.
Ultrasonic lipo technology involves using ultrasonic sound waves to gently loosen the fat for easier removal.
Tumescent liquid is still injected into the body, but instead of the cannula ultrasonic probes use vibration to break the fat cells apart.
Once the fat is emulsified, asmall cannula is used to suction out the fat cells. Some of the local anesthetic remains in the tissue and that helps to reduce post-procedural pain.
Vaser liposuction is considered gentler on the body and the remaining cells in the treatment area than more conventional liposuction methods.
2. Smart (Laser) Liposuction
Smart Lipo is essentially the earliest version of laser liposuction.
Few Plastic surgeons use this as an alternative form of liposuction. The costs of this technology far outweigh the benefits of this solution. The ability to use light energy for liposuction has not shown been shown to be clinically better. A small cannula is still inserted through an incision or incisions, but instead of sound or liquid an intensified laser is used to break down the fat deposits.
Water Jet Liposuction
3. Water jet liposuction uses a pressurized stream of saline to simultaneously break down the fat and help remove the cells.
Basically the water jet loosens the fat cells, and while it still uses tumescent fluid the cannula both irrigates and suctions the loosened fat cell from the body.
There is very little bruising or swelling with water jet liposuction and, because of the water, there is also much less trauma to the surrounding tissues.
Am I a Good Candidate for Liposuction Surgery?
Good candidates for liposuction surgery are in good health, both mentally and physically, have realistic expectations for their surgery, and have healthy skin with good elasticity.
Lipoplasty may be the perfect solution for you if you have a fatty pocket that just doesn't respond to diet and exercise.
Costs of Liposuction Surgery
Liposuction cost can vary depending on the number of procedures, where you live in the country, and the extent of your surgery.
If you are considering liposuction, please visit the website of double board-certified plastic surgeon Dr. Jonathan Berman for more information.
Tuesday, July 12, 2011
Everything you wanted to know about Injectables and Fillers!
General Information on Injectables & Fillers
Generally performed as outpatient
procedures, cosmetic filler injections are extremely safe and effective for
filling in wrinkles and scars, removing frown lines or rejuvenating sagging
skin.
The key is making sure you get the
proper filler for your specific needs―and that you have reasonable
expectations.
Some fillers are primarily used
for shallow surface flaws while others are injected deeper under the skin to
fill in more substantial folds or depressions. Some fillers can also be used to
increase the fullness of the lips or cheeks.
The newer dermal fillers on the
market even assist in stimulating creating new collagen growth to prevent
future flaws.
Whatever the procedure, there’s a
product out there for it these days, although the most common areas treated are
still smile lines around the nose and mouth, fine lines above the mouth, frown
lines between the eyes, and acne scars.
Dermal Fillers
The materials used in dermal
fillers vary from basic human fat and animal-based collagens to hyaluronic acid
and enhanced microsphere-added hydroxylapatite.
Different materials induce
different reactions within the body, so the amount of time the injections last,
potential side effects, recovery times and how often you’ll have to return for
treatments will also vary.
Dermal fillers also come in a
variety of thicknesses and brand names, with some more suited for certain parts
of the face or body than others. In general, dermal fillers fall into three
categories:
•
Fat/Collagen Fillers
•
Hyaluronic Acid Fillers
•
Hydroxylapatite microsphere-enhanced fillers
As a rule, the thicker the filler,
the deeper it’s injected under the skin and the larger the folds it is meant to
fill.
There are also two general
classifications for the duration of dermal fillers, temporary or permanent.
For the sake of this page though,
we’ll stick to the temporary facial fillers which require repeated injections
(some less than others) to maintain.
Botox and Dysport
For those interested in Botox (and
its counterpart Dysport), it’s important to note these are not technically
“fillers” but more muscle paralyzers or “wrinkle-freezers.”
“Wrinkle-freezers” are made up of
primarily of Botulinum Toxin A, a substance that essentially paralyzes the
muscles around the injection point to decrease the amount of current wrinkles
and prevent further wrinkles.
Botox is the best known of the two
having been around longer, and is primarily used between the eyebrows or on the
crow’s feet around the eyes.
Dysport is Botox’s newest
competitor, only recently approved by the FDA. Like Botox, it has botulinum
toxin A as its primary ingredient.
The main difference is Dysport
takes affect a little bit quicker (1-2 days instead of 3-7), is slightly
cheaper overall and spreads out a little bit further than Botox.
Both last about the same time -
three to four months.
For more on Botox and Dysport, visit
our Botox page here.
If
you have any questions about Botox injections or would like a free consultation
with a Botox specialist in your area, fill in the form on the right-hand side
of this page and one of our experts will contact you!
Facial Fillers
Fat Transfers
Fat transfers were one of the
first dermal filler techniques and have been used for well over 100 years to
fill in various forms of facial lines and folds.
Today, though, fat transfer is not
as common for the face as newer products have superseded it in terms of
duration and quality.
Successful fat transfer is also
very dependent on the technique of the surgeon to ensure as many fat cells
survive as possible, making results for many people very inconsistent.
Still, in certain cases fat
transfer from other parts of the body can be used to fill in some facial lines
and folds and add fullness.
Fat injections had been commonly
used to rejuvenate the lips, for bags under the eyes, to lessen the lines
around the mouth or fill out the cheeks or chin.
Collagen
Fillers
Collagen Fillers come in two basic
forms, bovine and human. They fell out
of favor with the introduction of the hyaluronic acid fillers. Few plastic surgeons use these fillers today
since there are better options available.
Bovine (cow) collagen was one of
the first forms of collagen to be used for dermal fillers. Bovine collagen is a
naturally occurring protein that is found in the skin, bones and muscles of
cows.
This collagen is so similar to
human collagen it can be used fairly seamlessly (although with some treatment
beforehand naturally) to fill in fine lines and correct scars.
Zyderm and Zyplast are the most
common brand names for bovine collagen fillers.
Zyderm I is used for the treatment
of fine lines and lesser scars, while Zyderm II is meant for longer, deeper
scars. Zyplast is used to get longer-lasting results for more damaged skin.
Since bovine collagen is a
protein, it will break down in the body over time. Generally, the results last
from 3-6 months. Once the collagen fades, the treatment can be repeated.
There are a few instances of
allergic reactions to bovine collagen injections. Those reactions can include
redness at the injection site, hives, and chest pain.
During the consultation process,
your doctor will recommend you do a skin test to see if you are allergic before
proceeding with a bovine collagen injection.
Human Collagen
Created from real human collagen,
this filler is a normal part of all skin and is naturally absorbed by the human
body.
Human collagen is best used for
fine wrinkles, especially those found around the mouth, and it typically lasts
3 – 4 months. For continued effects, repeated treatments are necessary. The
effects are immediate in onset however.
Like Bovine collagen, these fillers are not used as frequently as the
hyaluronic acid fillers.
Cosmoplast, Cosmoderm, Cymetra,
Fascian and Autologen are the most common human collagen products on the
market.
Hyaluronic
Acid Fillers
Hyaluronic acid is part of the
connective tissue of all human skin and several dermal fillers have been
developed over the years with hyaluronic acid as their base.
These fillers also stimulate
collagen production in the skin, allowing for better, longer-lasting results
and a longer period of time between injections.
Hyaluronic acid fillers are
excellent for plumping up lines and wrinkles because they attract water and are
ideal in correcting nasolabial folds, thin lips, wrinkles (especially above the
lips), reducing under-eye circles and filling out the chin or cheeks.
The most common brand names for
hyaluronic acid fillers are Juvederm, Perlane and Restylane.
Restylane and
Juvederm
Both Restylane and Juvederm are
popular hyaluronic acid fillers. The difference between the two is the
consistency of the gel, and preference depends on both the patient and the
doctor.
Perlane
Perlane is a
"mid-dermal" hyaluronic acid filler product. As a sister product to
Restylane, Perlane is designed for more pronounced facial folds and wrinkles
such as those on the sides of the mouth.
The duration of effect averages
between 6 – 9 months for Restylane and Juvederm and 9-12 months for Perlane and
Juvederm Ultra.
For continued effect, repeated
treatments are also necessary with Perlane.
Macrolane
Another hyaluronic acid derivative
used mainly for breast augmentation procedures is called Macrolane. Because it
also absorbs into the body like other fillers, Macrolane is an alternative to
chemical implants.
Hydroxylapatite
microspheres
Radiesse
Marketed under the brand name
Radiesse, calcium hydroxylapatite is physically larger in particle size than
other dermal fillers.
Basically, tiny calcium-based
microspheres form a “scaffold” to support and stimulate the growth of collagen.
Over time, the microspheres gradually break down and are safely and naturally
absorbed by the body.
Radiesse does more than
temporarily fill-in facial folds and wrinkles and can be used to restore facial
volume for a more youthful look.
Radiesse also works to stimulate
new collagen production while adding volume and lift. It’s best used for
moderate to severe wrinkles, nasolabial lines, facial fat loss and volume loss
in the cheeks.
Duration of effect is usually
12-15 months in most patients.
If
you are considering facial fillers and injections, please visit the website of
double board-certified plastic surgeon Dr. Jonathan Berman for more information.
Monday, June 6, 2011
Does the patient always come first?
Why you should choose a board certified physician.
We’ve all heard the expression “The patient always comes first.” There is a lot that goes into choosing a doctor, but one of the first things to consider is their experience and proven record of success and safety. One sure fire way to be confident about these factors is to choose a board certified surgeon, or a double board certified surgeon like myself.
Why choose a board certified surgeon? Many patients do not know, that in most states, a licensed physician may perform plastic surgery without being board-certified in plastic surgery.
Many physicians (and sometimes even non-physicians) call themselves “plastic surgeons”. American Board of Plastic Surgery is one of the 24 specialty boards recognized by the American Board of Medical Specialties (ABMS). It is the only ABMS Board which certifies in the full spectrum of the entire specialty of plastic surgery.
By choosing a plastic surgeon who is certified by the American Board of Plastic Surgery, Inc., you can be assured that the doctor has graduated from an accredited medical school and has completed at least five years of additional training as a resident surgeon. To become certified, the doctor then must successfully complete comprehensive written and oral exams. Board Certification is a voluntary process.
To become a member of the American Society of Plastic Surgeons, the world’s premier organization representing plastic surgery, the surgeon has to be board certified, practice for a certain period of time (candidate period), regularly attend medical education courses, and adhere to a strict code of ethics. Membership in the ASPS is symbolized by the “circle of excellence”:
Recently, I had a 71 year old patient who was in for surgery. Everything that morning began as expected . The patient was checked in, the scrub nurse was ready to assist and the anesthesiologist was ready anesthetize the patient. As we were going to proceed with the surgery, the patient’s blood pressure sky rocketed. After careful consideration, I made the decision the surgery would just not be safe for my patient. I put her first. We woke her up, and more than likely saved her life. Now I ask you, would your doctor put you first?
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