In body contouring plastic surgery, breast reduction has one of the highest patient satisfaction rates, as suggested by medical literature. This is not surprising since it can provide immediate relief from painful bra strap grooves, back pain, nerve and disc damage, postural problems, and other symptoms caused by being too “endowed.”
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley, who performs breast reduction on a regular basis, says that most complications are minor or “just nuisances,” as opposed to health-threatening problems.
The standard breast reduction incision technique favors women who require large downsizing, i.e., more than 600 gram of tissue per side.
Nonetheless, Dr. Smiley says he requires all his patients to pass lab screening to determine that they are fit for the surgery and its ensuing recovery. A careful preoperative evaluation, he adds, also allows him to identify breast reduction risk factors, many of which can be eliminated or at least controlled to minimize risk of complications.
A 2013 study, which involved more than 500 women who had bilateral breast reduction, has shown that infection at the surgical site (16 percent) and delayed wound healing (10) were the most common complications.
The study, along with other previous findings, was able to identify the risk factors or predictors of complications following breast reduction surgery.
Smokers were twice more likely to experience infection and poor wound healing than non-smokers because of the nicotine’s constricting effect on blood vessels, preventing the efficient delivery of nutrient- and oxygen-rich blood to the wound.
However, complete smoking cessation for a minimum of two weeks prior to surgery and throughout the recovery is enough to reverse most of the detrimental effects of tobacco use.
Diabetic patients have compromised healing and so they face a higher risk of necrosis (death of tissue) of the areola. Hence, prior to surgery it is highly ideal to eliminate or at least control serious medical conditions through medications and/or lifestyle changes.
The risk of poor wound healing and infection is markedly different between a patient having a 500-gram reduction and someone requiring a 1,000-gram excision.
Large breast reduction entails more breast tissue and skin removal, which could lead to increased bleeding and higher risk of comprising the blood supply. Furthermore, a significant downsize could make it extra challenging to achieve a natural breast shape.
Fat transfer to breast is a good alternative to implants and may even serve as a viable option in breast reconstruction. This is now a well-established technique that allows the patients to improve their breast shape and size with the most natural material possible—their very own fat.
One of the early criticisms of fat transfer to breast or any part of the body was the low survival rate or temporary results. However, plastic surgeons have fine-tuned their techniques that nowadays most are able to achieve at least a 70 percent survival rate.
The photo shows the difference between the breast injected with fat and the other side that is yet to receive the procedure.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says any fat volume that remains after six months is expected to be near permanent, with the breast expanding and shrinking depending on the patient’s weight.
Recently, he performed fat transfer to a patient who asked her implants to be removed, which could leave her breasts deflated—particularly its upper pole and mid cleavage—if no volume restoration procedure was performed simultaneously.
After removing the implants from their pocket, Dr. Smiley injected discrete layers of fat above the area where the prostheses were previously positioned. His goal was to inoculate the fats into highly vascularized tissue (i.e., they have more blood vessels), allowing the grafts to persist long term.
Aside from women having implant extraction, Dr. Smiley says that fat transfer is also a viable option for first-time breast augmentation patients who want to avoid implants, which carry risk of leak and displacement.
Fat transfer can also complement the results of implants; this is particularly true for women with notably poor cleavage or very little soft tissue to begin with that makes them prone to implant rippling and palpability.
While fat transfer to breast can deliver near permanent results, the celebrity plastic surgeon says it also comes with certain limitations, particularly in terms size. In general, the technique cannot double the breast size as over-filling the tissue can lead to low survival rate and other complications.
In most cases, fat transfer to breast involves around 200 cc of fat injection per side, although a 2011 study has shown that up to 300 cc can be injected provided that the breast has been pre-expanded weeks leading up to the surgery.
To expand the breasts and create more room for the fat grafts, the researchers required 25 patients to use Brava, which is a bra-like device that releases negative pressure. The technique allowed them to inject up to 300 cc of fat on average.
Fat transfer to nasolabial folds or “laugh lines” can provide the same effect as traditional fillers like Juvederm and Restylane, or sometimes even give better results because it uses the most natural material—your own fat.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted videos on Snapchat to demonstrate a female patient who received fat injection to smooth out her laugh lines.
The appearance of laugh lines stems from two things: The sagging of your skin and other soft tissues, and facial volume loss.
In “younger” patients—i.e., 50 years and below—the nasolabial folds are mainly caused by facial volume or fat loss. Hence, they can avoid or at least postpone facelift, which relies on tightening the skin and soft tissue, and instead resort to volume restoration treatments such as conventional fillers and fat injection.
Fillers made of hyaluronic acid products like Restylane and Juvederm have impressive safety record because HA is naturally found in the body; in fact, it gives the skin its youthful glow and texture. However, the improvement only lasts 4-6 months on average, says Dr. Smiley.
If you are looking for a more permanent solution for your nasolabial folds, or any depression that primarily stems from volume loss, using your fat is a much better approach. Just a few teaspoons of unwanted fat from your tummy or thigh is enough to conceal your laugh lines.
And since your body does not treat your fat as a foreign material, your immune system will not attack it. This is not always the case with facial implants and synthetic, non-degradable fillers like ArteFill.
Aside from the long-term results of fat transfer to nasolabial folds, Dr. Smiley says the approach tends to provide more natural results than facial implants and conventional fillers. Moreover, fat shrinks and expands as you lose or gain weight, further leading to its natural effects.
The fat is also rich in stem cells and so the skin in the areas where the fat has been grafted will experience “visible” improvements, says Dr. Smiley.
It may come as a surprise that not every facial plastic surgeon offers fat transfer despite its more natural and longer-lasting effects compared to conventional fillers. Take note that it entails a steep learning curve to ensure high survival rate of fat grafts.
Conventional fillers, meanwhile, are much easier to perform than fat injection.
Contrary to popular belief, breast reduction is not always a vanity procedure. In fact, studies conducted in different parts of the world have suggested that overly endowed women who have had the procedure reported improved quality of life. Some researchers even went further by saying that it could increase the patients’ life expectancy by up to five years.
To further shed light on the issue, celebrity Los Angeles plastic surgeon Dr. Tarick Smiley explains the surprising health benefits of breast reduction that are backed by science.
Before and after photos of breast reduction patient
A 2007 study conducted in US has shown that patients reported improved quality of life following surgery, which has given them relief from the debilitating effects of over-large breasts such as spinal curvature (which may lead to disc or nerve damage), postural problem, rounded shoulders, painful bra strap grooves, neck pain, lower back pain, skin breakdown, and decrease in physical performance.
- Possible increase in life expectancy
In 2008, Scandinavian researchers have estimated that the cumulative damage caused by overlarge breasts may shorten a woman’s life by five years on average. They argue that because of nerve damage, physical discomfort that force some women to rely on daily use of painkillers, and difficulty to exercise that leads to higher BMI, women who are overly endowed face more health issues after factoring in other variables.
- Smaller breasts allow women to increase their physical activities.
Several studies have shown that after breast reduction surgery a good number of patients lost weight naturally possibly due to inadvertent increase in their physical activities, as they no longer experience the disabling pain and discomfort.
However, it is a common practice among health insurance companies to require patients to be near their ideal weight before they agree to cover the surgery’s cost. This may seem like a paradox (or a haphazard requirement) since overlarge breasts can make it exceptionally difficult to keep a normal weight due to limited physical activities.
Breast revision after capsular contracture requires multiple methods to prevent the problem from recurring. Using new implants, irrigating the implant pocket with strong antibiotic solution, and removing the entire scar capsule are the most commonly accepted approach.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a Snapchat video of a patient with capsular contracture that caused visible breast asymmetry, with the left implant riding higher than ideal due to the scar capsule pushing it too high on the chest wall.
Scar capsule naturally forms around breast implants or any type of artificial prosthesis; it only becomes a problem when it has thickened or calcified, leading to pain, hardness of the tissue, and deformity. Typically, the symptoms arise in the first few months of surgery, although some patients develop them after several years.
Dr. Smiley performed breast revision after capsular contracture with the creation of a small incision around the lower border of the areola, which was the previous incision site and thus additional scar has been avoided. Then, he removed both implants together with the calcified and thick scar capsule.
While some doctors do not remove the entire capsule when doing revision for capsular contracture, Dr. Smiley believes complete removal can significantly reduce its recurrence—just 4 percent versus 15 percent when the capsule remains inside.
Furthermore, removing the entire capsule allows the implants to settle to a more natural position, which of course results in a more natural breast shape and feel.
After removing the entire capsule, Dr. Smiley is seen irrigating the implant pocket with strong antibiotic solution. Studies have suggested that capsular contracture occurs when bacterial contamination around an implant causes the body to over-react and release copious amounts of collagen fiber.
To further reduce capsular contracture recurrence, Dr. Smiley used a pair of new implants, which he propelled into the pocket with the Keller Funnel, a device that closely resembles an icing bag.
The implant is poured from its sterile packaging into the Keller Funnel, which is then squeezed to propel the implant into its pocket. This implantation process is known to reduce the risk of implant contamination and ultimately lower the risk of capsular contracture.
Capsular contracture is also linked to blood (hematoma) that forms around an implant after surgery and so the celebrity plastic surgeon uses meticulous pocket dissection to control bleeding and minimize risk of complication.
When eyelid surgery and fillers are performed together they can provide a more natural result and a more potent rejuvenating effect, said renowned Beverly Hills plastic surgeon Dr. Tarick Smiley in his recent post on Snapchat.
Dr. Smiley has posted a series of videos demonstrating a female patient who received upper and lower eyelid surgery complemented by the most natural filler material—her very own fat collected from her tummy.
The fat was injected to create a smoother transition between her lower lid and cheek and to soften the nasolabial folds or “laugh lines.”
“The fat moves more naturally and so it provides more natural results than standard fillers. Also, fat cells expand and shrink as the patient gains and loses weight, further contributing to its natural outcome,” explained Dr. Smiley.
Furthermore, Dr. Smiley said that about 70 percent of the fat volume is expected to persist long term and therefore fat grafting is more cost-effective than traditional fillers such as Juvederm and Restylane, which on average require 6-12 months “retouch.”
The patient also had bulging orbital fat in the upper eyelid, which Dr. Smiley reduced before removing the loose skin that was causing the “hooded” appearance of the lid.
The excess orbital fat must be removed to eliminate the bulging or puffy appearance. Nonetheless, fat injection remains advisable to create additional carpeting right beneath the skin. Unlike the deeper fat that protrudes with aging, the superficial fat tends to shrink.
He also reduced the deeper orbital fat in the lower lid, which was causing the patient’s under eye-bags.
While reducing the orbital fat may sound counter-intuitive given that the patient also received a simultaneous fat transfer in her lower lid, Dr. Smiley said these two surgical maneuvers accomplish two different things.
“Reducing the deeper orbital fat in the lower lid eliminates the bulging, while injecting fat right beneath the skin creates this carpeting that results in smoother and more youthful transition, Dr. Smiley explained.
In terms of scar appearance, Dr. Smiley ensured that the upper eyelid incision was placed precisely at the skin fold for optimal scar concealment, while the lower lid incision was positioned immediately below the “root” of the eyelashes so it remains undetectable at conversational distances.
Aside from “precise” placement of incision, the celebrity surgeon said meticulous wound closure further ensures invisible scar.
For the vast majority of patients, Dr. Smiley said the eyelid surgery and fillers result in undetectable scar because the skin in the area is markedly thin and thus resistant to scar tissue.