BREAST REDUCTION "NON-SCARRING"
By Liposuction alone
Background
This year Dr Lanzer was featured on "Good Medicine" (TV & Magazine),
"A Current Affair", "Woman’s Day"
and ‘New Idea’ magazines with his world pioneering "new" technique. (See Articles)
Breast reduction until now, has been performed with surgical intervention called
mammoplasty. The procedure involves cutting out sections of the breast and usually
cutting around the nipple and elevating the nipple and loose skin.
Unfortunately the procedure is invasive and often complicated, involving a number
of hours in theatre under general anaesthetic. Complications include a high
risk of scarring due to the poor healing on the upper chest altered sensation
of the nipple infection, bruising, prolonged pain, blood transfusion and inability
to breast feed.
Liposuction underwent a dramatic change in 1987 when an American Dermatologist
discovered the tumescent technique. This involves filling the fat with a very
dilute form of local anaesthetic which numbs, softens and prepares the fat.
Over the last two years, dermatologists and surgeons have been investigating
the possibility of using this technique on the breast.
Using extremely small and thin micro-cannulae, the fat can be removed smoothly
and evenly through tiny 1mm incisions from around the breast. Dr Lanzer has
helped pioneer the "new" technique of reduction by liposuction alone.
He is an accepted world pioneer in this area and has presented his work at the
American Academy of Cosmetic Surgeons - San Diego 2001 and the Surgical Symposium
of the American Academy of Dermatologists in Washington 2001.
In February
2002, Dr Lanzer was invited to lecture at the American Academy of Dermatology’s
2002 Annual Meeting in New Orleans.
Click Here to read the American Academy of Dermatology’s news review
regarding Dr Lanzer's talk.
Click
here to read the WebMD Medical News review about Dr Lanzer's presentation
of this procedure.
Click
here to view a VIDEO of Dr Lanzer's lecture at the American Academy of Dermatology’s
2002 Annual Meeting in New Orleans.
Procedure
Pre-operative patients require mammograms of the breast to see where the fat
lies within the breast and also to assist in long-term follow-up of the breast.Breast
size is measured through a dip test by seeing how much fluid is displaced from
a container. Routine pre-operative blood tests and antibiotics are arranged
and a full history to exclude breast cancer including an awareness of high risk
patients who would need closer monitoring in the future are identified.
Patients with a direct family history of breast cancer such as mothers and sisters,
will require an examination by a specialist breast surgeon, which will be arranged
by Dr Lanzer.
The procedure time is approximately 1 hour and a compression garment is applied
afterwards and worn for the ensuing 2-4 weeks. Post operatively there may be
some tenderness and bruising and there may be weeping of fluid through the small
nicks during the next 24 hours. Most patients can return to ordinary duties
after 24 hours, however there may be variation between patients
Results
Between 1/3 and 1/2 of the breast can be reduced in size with this technique.
Generally older patients have more fatty breasts and therefore more can be removed.
The amount that is removed may vary from 200ml to 2000ml of fat from each breast
and it is important that pre-operatively, some guidance is given to Dr Lanzer
as to what would be the ideal size the patient wishes to obtain.
Often large breasts are associated with a breast tail, where the fat continues
around the side of the chest and under the axillae. This area and others can
be removed at the same time with liposuction.
Most people having liposuction are surprised at the extent of the skin contraction.
Nipple elevation varies from 3-10cm. By using the "superficial technique"
of removing the fat layers immediately under the skin, maximum skin contraction
and breast elevation occurs. There is more lift of the nipples when breast reduction
is performed through the surgical alternative. *(Based on initial study on 160
patients)
Dr
Lanzers Study - on 200 patients
• Virtually all noted significant improvement in symptoms
• Virtually all extremely happy with the result
• All mild deep bruising
• No Scarring
• No infection, necrosis, or loose skin
• No permanent sensation change
• Average reduction DD to C
• Maximum 2.7 Litres removed G to C
Complications
Ordinary surgical complications include bruising, pain, swelling and infection.
The tumescent technique reduces the infection rate, due to the fact that the
fluid is anti-bacterial. The procedure is performed under high sterility with
pre-operative antibiotics. No guarantees can be made to the extent of nipple
elevation or skin retraction. In the first 250 patients treated, there was no
loose skin but Dr Lanzer still warns that a second surgical procedure may be
required in very droopy breasts.
Significant scarring does not occur with liposuction, as there are only 3mm – 5mm nicks on the skin, which normally heal up nicely. The risk of skin
necrosis and skin loss is significant with the mammoplasty surgical option and
extremely rare with liposuction.
In Dr Lanzers study there was no permanent altered sensation to the nipple.
There have been no long-term studies to ascertain the effect of liposuction
on the ability to breast feed, although groups overseas report that patients
can. A major issue with all forms of breast reduction is whether changes will occur
in the breast that would be identified on the mammogram at a later day and confuse
a mammographer as to whether they are marks from previous surgery or in fact,
breast cancer developing. This area is under investigation and in early studies
there were no long-term effects seen on the mammogram after six months in all
patients. Dr Lanzers routine is to perform a pre-operative mammogram and to
have it repeated at six months to see if there are any changes which will then
be used as a reference for mammograms later in life. This hopefully will avoid
any confusion and requirements for unnecessary biopsies. If you do not understand
this issue, please speak to your local doctor or breast surgeon.
It is important to understand that cosmetic surgery is not an exact science
and no guarantees can be given as to the exact outcome. Also, all patients react
differently and liposuction of the breast tissue is still considered a new procedure
in its development stages.
Summary
Three breakthroughs have allowed liposuction alone to be the first-line treatment
for breast reduction. These are the tumescent technique, Micro-cannulae and
superficial Liposuction. Dr Lanzer has been recognised throughout the world
as a major contributor to this new and exciting procedure. His pioneering work was published in the International Journal of Cosmetic Surgery and Aesthetic Dermatology. See Articles
Top