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Ayman Shahine,
M.D.
FACS, FACOG, FICS, MACS, FISCG
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Recipient of the American Academy of
Cosmetic Surgery. Very
experienced and skillful doctor, voted
by other doctors as "best doctor teacher
of the year". Innovator and inventor in
the field of cosmetic medicine. Top of
the line technology at really
affordable prices. We promise you will be
happy. Your beauty is our passion. |
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FACE --
BREAST & CHEST --
ABDOMEN --
ARMS & HANDS
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BUTT & GROIN AREA
-- THIGHS & LEGS
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SKIN & BODY TREATMENTS |
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LIPOSUCTION |
Breasts, Female |
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Tumescent Liposuction of the Female Breast
Tumescent liposuction of the female breast totally by local
anesthesia can produce both a significant breast reduction and a
moderate but gratifying breast lift. The use of microcannulas
permits breast reduction with minimal postoperative pain, rapid
postoperative recovery, quick return to normal activities, and
virtually no scaring. Not only can liposuction reduce the female
breast by more than 50 percent in size, the breasts are also
lifted to a significant degree. This breast lift is the result
of the reduced weight of the breast, which allows the breasts'
natural elastic properties to contract and produce elevation.
The breasts do not change shape after tumescent liposuction,
they simply become smaller and somewhat elevated. After
liposuction, the breast's shape is simply a smaller version of
the shape before liposuction.
No Surgical Scars
Surgical scars are not visible in most patients after breast
reduction by tumescent liposuction using microcannulas. Evidence
of micro-incisions usually disappears within a few months. The
use of microcannulas permits the use of extremely small round
incisions that are 1 millimeter (approximately 1/25 of an inch)
in diameter. These tiny incisions produce scars that are much
smaller than 1 millimeter and therefore almost invisible. In
contrast, traditional breast reduction is associated with much
larger scars and more visible scars. Patients whose natural skin
color is darkly pigmented can expect to have some tiny spots of
increased pigmentation at the incision sites where the
microcannula enters the skin. This post-inflammatory
hyperpigmentation usually fades away after 1 to 2 years.
Tumescent Liposuction Lifts the Breasts
Both breast reduction and breast lift can be accomplished by
tumescent liposuction. Liposuction reduces breast size in direct
proportion to the volume of fat removed. Liposuction reduces the
weight of the breast and allows the natural elastic tissue in
the breast to retract and produce a visible breast lift.
Older Techniques for Breast Reduction
Older techniques for breast reduction, known as
surgical-excision breast reduction, involved cutting the breast
with a scalpel to excise or remove large amounts of breast
tissue. Problems associated with surgical-excision breast
reduction include the risk of keloids or excessively large
scars, uneven sized breasts, abnormal appearance of the skin
near the nipple, impaired nipple sensation, and possible nipple
damage. Other risks include bleeding, blood clots or hematoma in
the breast, seromas (fluid collection in the breast), fat
necrosis with cyst formation in the breast, and scarring of the
deep breast tissue that can produce mammogram abnormalities.
Besides requiring general anesthesia, breast reduction by
excision is also associated with significant pain and prolonged
recovery.
Advantages of Breast Reduction
Advantages of breast reduction by tumescent liposuction using
microcannulas include 1) Rapid recovery. The typical patient can
return to work and normal social activity within two to three
days after surgery, 2) Virtually no scars, 3) Reduction of 20 to
50 percent of the breast volume, 4) Minimal risks of
postoperative complications.
Problems with Excessively Large Breasts
Excessively large female breasts cause pain and suffering,
physical impairment and psychological problems. Athletic
activity is significantly limited. Chronic changes in posture in
an effort to compensate for the weight of excessively large
breasts can lead to chronic pain in the back, neck, and
shoulders. Chronic pressure from bra straps can cause permanent
indentations of the shoulders. Large breasts can predispose
women to candida yeast infections of the skin in areas where the
skin rubs together, such as between the breasts and beneath the
breasts. A woman who has very large breasts may regard them as
cosmetically undesirable. Finding a bra that fits and is
comfortable may be impossible. Clothing does not fit well.
Who is a Good Candidate?
Some women are likely to have better results than other women
after breast reduction by liposuction. Tumescent breast
reduction totally by local anesthesia is only appropriate for a
certain subset of women. However, for the appropriate patient,
the results of tumescent liposuction can be extremely
gratifying. The best candidates for breast reduction by
tumescent liposuction have breasts that contain a large
proportion of fat. For example, women who have passed through
menopause typically have breasts that contain a larger
proportion of fat than do teenagers. A good candidate must also
have realistic expectations.
Breasts Containing a Large Proportion of Fat
After menopause, much of the glandular tissue in the breasts is
replaced by fatty tissue, thus, old women with large breasts are
usually very good candidates for tumescent liposuction of the
breasts. Young women who continue to have menstrual periods and
are somewhat overweight might also have breasts that contain a
significant amount of fat, and therefore would also be good
candidates for liposuction of the breasts. The proportion of fat
in the female breast can be determined by a mammogram.
Realistic Expectations
Breast reduction by liposuction will produce a smaller version
of the breasts that a woman had before liposuction. One can
expect the breasts to be significantly smaller, to be elevated
and to show virtually no scars. However, the breasts' overall
shape will be very similar to their shape before liposuction.
Liposuction will usually not produce young "perky" breasts. The
elevation of breast position is the result of decreased breasts'
weight and the elastic properties of the suspensory ligaments in
the breast.
Who is Not a Good Candidate?
Not every woman is a good candidate for liposuction breast
reduction. Some women have breasts that will require traditional
breast reduction surgery with large excisions and large scars.
Women who are not ideal candidates for breast reduction by
liposuction include those whose breasts contain more glandular
tissue than fat tissue.
Unrealistic Expectations
Women who expect perfect breasts after liposuction breast
reduction have unrealistic expectations. For example, most women
who have had a baby, should not expect breast reduction surgery
to recreate the "perfect" breasts of a virgin. There is usually
no surgical procedure that can achieve this unrealistic goal.
Excessively Pendulous Breasts
Excessively pendulous breasts usually contain only a small
proportion of fat. If breasts that appear to sag or droop
significantly and contain only a small amount of tissue, then
liposuction will not provide satisfactory cosmetic improvement.
Such "empty" breasts contain little fat and therefore will not
be improved by liposuction. Cosmetic improvement of "empty"
breasts usually requires excision of skin, as well as breast
implants.
Thin Young Women
Thin young women who have breasts containing mostly glandular
breast tissue with little fat are often not good candidates for
breast reduction by liposuction. For example, a relatively thin
woman with large breasts often has breasts that contain a high
proportion of glandular breast tissue and almost no fat. In such
cases there is little fat in the breasts and liposuction will
not produce a significant reduction.
Excessively Large Breasts
Liposuction can usually be expected to provide no more than a 55
percent reduction in breast size. Women who need more than a 55
percent reduction in breast size might be happier with the
results of traditional surgical breast reduction surgery despite
the unsightly scars associated with the excision of skin and
breast tissue.
Excessively Dense Breast Tissue
Some women have breasts that contain a large proportion of
glandular tissue, and relatively little fatty tissue.
Liposuction can remove fat, but glandular breast tissue is
largely resistant to liposuction. Fibrocystic disease of the
breast can make liposuction more difficult. However, when
fibrocystic disease is only mild to moderate in degree then some
women can achieve sufficient results.
Existence of a Breast Lump
Any significant breast mass must be evaluated with a mammogram
and possibly a breast biopsy prior to breast reduction. Cosmetic
breast surgery is not appropriate until the surgeon has
established that there is a minimal likelihood of breast cancer.
Breast surgery in any patient with a significant family history
of breast cancer requires very careful consideration and
detailed informed consent.
Milk Production After Breast Reduction
If a woman becomes pregnant after tumescent liposuction of the
breasts, there is a reasonable chance that she will be able to
breast feed. With the use of microcannulas, tumescent
liposuction produces very little damage to the glands and ducts
that produce milk. In contrast with breast reduction techniques
that use scalpels to cutout large portions of breast tissue, the
glands and ducts are usually damaged and blocked by excessive
scar tissue that prevents milk production and breast feeding.
Preoperative Mammograms
Preoperative mammograms should be considered in order to rule
out existing malignancies, and to establish a up-to-date
baseline mammogram with which future mammograms might be
compared. Similarly, after breast reduction, mammograms should
be done within 3 to 6 months in order to establish new base-line
mammograms. With traditional breast reduction by surgical
excision, it is not uncommon to encounter postoperative
inflammatory nodules, and lipid filled pseudocysts. These
conditions may make it difficult to interpret future mammograms
without good baseline mammograms for comparison. Inflammatory
nodules and pseudocysts are rare after tumescent liposuction of
the female breast.
Minimal Trauma to Breast Tissue
Liposuction removes fatty tissue from the breast, and mostly
spares the glandular breast tissue that is responsible for the
production of milk. There is so little trauma to the breast
tissue that x-ray examinations of the breast, known as
mammograms, usually appear normal after microcannula liposuction
of the female breast. In contrast, after excisional breast
reduction, x-ray mammograms show calcification and other changes
in appearance.
After Menopause
After menopause, breast reduction by liposuction becomes
relatively easy. Before menopause, a woman's breasts contain a
higher proportion of fibrous glandular breast tissue. Glandular
breast tissue is not easily removed by liposuction. However,
after menopause, breasts contain a significantly higher amount
of fat that is easily removed by liposuction. Liposuction is
easier in women who have already gone through menopause. Younger
women often benefit significantly from breast liposuction, but
liposuction of younger women's breasts usually requires
significantly greater effort, compared to older women.
How can There be Almost No Scars?
For breast reduction using micro cannulas, the holes that are
made in the skin are extremely small, only 1 millimeter (mm),
smaller than a toothpick. These small holes are called adits,
and they serve several useful functions (see The Functions of
Adits). Adits are made with a skin biopsy punch. An adit is so
small that it heals with virtually no visible scar. Because the
skin of the breast is stretchy and elastic, the opening of a 1
mm adit can easily be stretched to accommodate liposuction
cannulas with outside diameters ranging from 1.5mm to 2.8 mm.
Typically 8 to 12 adits are placed in a random pattern on each
breast. By using adits there is no need for larger incisions and
thus there are no larger scars.
The Functions of Adits
Adits are openings in the skin that permit 1) insertion of the
needle that injects the solution of tumescent local anesthesia,
2) insertion of microcannulas (very small liposuction cannulas)
that suck-out the fat, and 3) openings that maximize the
post-operative drainage of residual blood-tinged local
anesthetic solution which minimizes swelling and bruising.
Local Anesthesia Vs General Anesthesia
Breast reduction by tumescent liposuction using microcannulas
can be accomplished totally by local anesthesia or with general
anesthesia. Liposuction can be accomplished safely with either
local anesthesia or general anesthesia. Local anesthesia is
usually considered safer than general anesthesia (this is why
dentists prefer to use local anesthesia). In the hands of a
surgeon who is well trained and experienced at doing liposuction
totally by local anesthesia, breast liposuction is routinely
accomplished with virtually no pain. Surgeons who have not had
specific training in liposuction totally by local anesthesia are
usually unable to accomplish tumescent liposuction without the
use of heavy IV sedation or general anesthesia.
Measurement of Breast Volume
The volume of each breast is measured by a water-displacement
method. Measuring the breast volume is accomplished by immersing
the breast in a beaker full to the brim of comfortably warm
water; after removing the breast from the beaker, the volume of
water necessary to refill the beaker to its brim is recorded.
The average of two repeated measurements provides a reasonably
accurate estimate of each breast's volume. An accurate
measurement of breast volume is necessary for planning the
amount of fat to be removed from each breast. If the breasts are
originally unequal in size, then the surgeon can remove an
appropriate extra volume of fat from the larger breast, and thus
improve the symmetry of the breasts. |
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Many
other treatments are available but not mention here
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