12. Elastic "round block" and Adipofilling of "hollowed out" breasts, without skin excision
KEYWORDS: elastic round block, breast ptosis, mastopexy, hollowed out breast
Breasts that have a "hollowed out" appearance, as is often the case in women who have borne children, can be improved by means of elastic conization and simultaneous Adipofilling. The patients who request this procedure want their breasts to have a natural look, but do not want to undergo additive mastoplasty.
Before the procedure, a circle is drawn around the areola at a distance of 4-6 cm from the nipple, according to the size of the breasts.
An 8 mm incision is made at the areolar margin and a tunnel is created at a depth of 1 cm; this extends to the previously drawn circle. The breast is conized through this tunnel by means of the elastic thread and the two-tipped Jano needle. Conization shapes the breast and broadens its base, making it more stable and more compact. Shaping of the breasts enables Adipofilling to be carried out wherever it is needed: in the anterior portion of the cone of the breast, under the base and in the quadrants that require volume enhancement. Breast conization always precedes the grafting of fat.
The two-tipped needle is rotated through 180°, while remaining at a depth of about 1 cm. Each time the needle is rotated, the elastic thread is pulled through and placed under tension. Having reached the tunnel, the operator inserts a spreader, and the Jano needle emerges from the small periareolar incision. The two ends of the elastic thread are placed under tension and knotted. The incision is sutured.
Conization of the contralateral breast is now carried out. After making the 8 mm periareolar incision, the operator uses scissors to create the tunnel and inserts the Jano needle with the aid of a spreader. The elastic thread is placed under tension and knotted.
Once the breasts have been shaped, Adipofilling is performed. The suspension of fragments of fat lobules is injected below the base of the breast and into the anterior portion, which appears more hollowed.
The Adipofilling suspension is created from the material drawn by means of liposuction through a 4 mm diameter cannula from a region anesthetized with a solution of mepivacaine and epinephrine. The lipoaspirate is then washed with Ringer solution or physiological saline solution, in a beaker equipped with a tap, until the liquid becomes clear and transparent. The quantity of Ringer or physiological solution is twice the volume of the adipose lobules. The mixture is then supplemented with 20 ml of 5% glucosate solution with 100 IU of ultra-rapid insulin. The Adipopimer, an economical disposable device, transforms the lobular suspension into a suspension of small lobular fragments in about 6 seconds. In some patients, we add a small quantity of cellular suspension, which is created by activating the Adipopimer for about 30/40 seconds. The living material is separated by means of the aspiration vortex generated by the device, which maintains the maximum integrity of the living tissue. To ensure proper separation, the amount of saline solution in the beaker must be two or three times greater than that of the lobular fat.
The small dimensions of the lobular fragments, together with their vitality, enable an extremely high percentage of rooting to be achieved.
The lobular fragments are injected into the breasts by means of 20 ml syringes and 16 G or 18 G cannulas. During injection, the cannula is always kept moving. About 100 mL is injected per breast.
The result is stable and natural. This patient was satisfied and did not request further Adipofilling.
The use of the elastic thread mounted on the two-tipped needle, followed immediately by Adipofilling, is an optimal method of improving the "hollowed out" appearance of breasts in patients who do not want to undergo additive mastoplasty with breast implants.
The conization of the breasts through an incision of a few mm is always carried out with Adipofilling.
Capurro S. (2022): Elastic "round block" and Adipofilling of "hollowed out" breasts, without skin excision. CRPUB Medical Video Journal. Elastic Plastic Surgery section. www.crpub.org
In which patients are elastic round block and Adipofilling indicated?
Patients who do not want to undergo additive mastoplasty with breast implants, who have moderately drooping breasts and sufficient body fat for liposuction to be carried out.
In volumetric Adipofilling with small lobular fragments, you almost always add a modest amount of cellular suspension, which is obtained by activating the Adipopimer for a further 30-40 seconds. Why was no cellular suspension added in this patient?
In about 40 seconds, the Adipopimer creates a cellular suspension that exerts a potent regenerative and stimulating action on the tissues. This cellular suspension is also used in volumetric applications, for example in the face, where single adipose and stromal cells are injected in the palpebral regions. Single cells are also injected into the dermis, where they rejuvenate aged skin that has wrinkles or solar elastoses. To improve the effects of volumetric suspension, the addition of a small quantity of cellular suspension is particularly useful, as it promotes the trophism of the receiving tissues.
In the case of breasts, we supplement the lobular fragments with single cells only in women under 40 years of age or those who have a negative history of breast cancer. Above the age of 40 years, we normally avoid stimulating the glandular tissue of the breast with cells that are bereft of contact inhibition. (If the patient diligently undergoes periodic examination, supplementation may even facilitate the early detection of a malignant neoformation, as this is initially made up of a small number of malignant cells and a non-malignant component with a larger number of cells).
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