Technology and your recovery period.

While much of our website is dedicated to better inform you about cosmetic surgery and helping prepare you for your upcoming procedure, we would like to talk about the recovery period following any cosmetic surgery procedure.

                                              

During your pre-op appointment,  the Surgical Coordinator will review your post op instructions. This appointment normally occurs a few weeks before surgery so you have some time to review.  They will give you a description of what you should expect following your cosmetic surgery.

 Topics usually discussed include:

•    how long to wear the garment

•    when you can shower

•    when you can drive

•    drains- when do drains come out

•    pain pumps and pain control

•    swelling and bruising

•    when to contact  the office

Perhaps the most reassuring post-op instruction is that we encourage you to call if you have any questions or concerns.

But in today’s day and age, cell phones can do a lot more than place a phone call! These days most patients have smart phones, or phones that can take pictures, send e-mails, and text.  You may have questions about redness and swelling following your cosmetic surgery procedure.  All surgeries involve some amount of redness , swelling, and discomfort. However, some complications will start to present themselves with an unusual amount of swelling and or redness.   Whenever we suspect such a situation we will always insist on the patient coming into the office to be examined, no matter what time or day of the week it is.

However, sometimes the patient is vague about the symptoms and it may be hard for to judge over the phone whether you should come in sooner than your next scheduled appointment.  In these instances, when a patient calls with a question or description of a particular problem they are having, it may be a good idea for the patient to send a photo of the operative site to him by e-mail or text.

In most instances a photo will tell whether you need to be seen in the office right away.  This is a great tool for both doctors and the patient, as it often times will save everybody an unnecessary extra trip to the office!

A picture says a thousand words, and technology is wonderful.  But when ever in doubt, call the office and come in.  It’s better to be safe than sorry.

Liposculpture or Liposuction: Twenty five cents or a quarter? Kleenex or Facial Tissue?

Liposuction of often thought of by women as a way to look slimmer.  Most plastic surgeons agree.  They use liposuction as a way to shave off pockets of fat where needed.   However, as the technology and views of beauty have progressed curbs and form are now equally as important.  It is not only important to remove the fat in areas of concern, but also to add where necessary.

But the truth of the matter is that liposculpture and liposuction are interchangeable. Patients who undergo liposculpture have liposuction.  Fat is removed by different techniques:  LASER, suction, ultrasound, etc.  The inventors of the various forms of the removal claim their form of fat removal is less "stressful" to the tissue, less "traumatic" and ensures less downtime and more rapid healing.

Consider this:   the less surgery you have performed, the less healing that has to occur, and thus allowing you a faster the return to daily activities.  Therefore the more surgery you undergo, as well as the more  invasive surgery that is performed is, there more noticeable result.  

Whatever form of surgery that is performed creates local tissue injury.   The local tissue injury results in immediate post-operative swelling.  The swelling  is to be expected and is a normal part of the healing process.  It takes time to resolve.   It is not uncommon for patients immediately post-op to have less swelling than they do one week after surgery.   For the most part, patients who undergo liposuction need to wear post-operative girdles and garments to help control the post-operative edema and swelling to facilitate more rapid and controlled healing.

For more information about your liposuction, contact Dr. Berman’s office.

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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.