Lipomodelling

IMPLANT REMOVAL AND COMPENSATORY LIPO-MODELING

There are three stages of the operation plus tests and three positions on the operation table.

First Stage

First stage of the operation uses lateral positions for fat harvest on one side then turn to the other side. The aim is for 300cc graft or above to fill bed capacity on each side of breast tissue in front of implant as this gives best results.

The harvest is done with smaller instruments and half the pressure of ordinary liposuction to preserve cells. Harvest is taken from areas of excess particularly targeting small cells for grafting.

The fat harvest takes much of the morning to get the required volumes, gravity separated, washed and centrifuged in preparation for transfer back to the body.

The lipo-modeling softens scar from cavity collapse after implant removal, softening the scar reaction following removal of capsules which is usually infiltrating muscle and adherent to chest wall.

Second Stage

The second stage is positioning on back in mild beach chair position and removal of implants and capsules with special lighted retractors with slow detailed separation of the inflamed scar to avoid injury to chest wall and complete removal. This takes between 2 hours and 4 hours if very stuck and adherent.

The fluid around the implant is drawn off and sent for cytology (to rule out Giant Cell Lymphoma) and bacterial cultures are taken. The capsule is sent for histology with some of the capsule  sent  fresh for specialised biofilm culture…

Once the implants are out, grafting can commence as the third stage.

Third Stage

The aim is to fill the available bed of breast tissue to its safe capacity, which involves specialised cannulas attached to 3 ml syringes to deposit a fine slurry of fat cells. Three mls is deposited at each pass into its own individual tunnel to maximise revascularisation and survival. There are hundreds of passes on each side to get the best modeling effect. The bed is full when no further tunnels are available.

This takes an hour or so each side. We aim to get above 300cc graft each side provided that the bed has this capacity as this virtually guarantees that the operation will be completed in one stage.

The bulk of the costs are in theatre and anaesthetic time. Surgery is a smaller part of the costs.  Anaesthesia is usually Total Intravenous or TIVA, combined with copious local anaesthesia for quick recovery.

We have tracked our outcomes using the widely validated breast Q patient self-assessment of results and they compare very favourably with international experience. The results were presented at the recent international plastics conference held recently in Auckland August 2018, where the French also gave their experience with similar results.

The procedure and approach was described by the French surgeons as a completely different paradigm, or way of thinking and working, to achieve the results. I agree with this.

It is certainly possible to be offered simple implant removal, which is relatively quick and inexpensive but would not result in complete capsule removal particularly in the inflamed cases.

Failure to test properly and remove the capsules,  exposes patients to a life time risk of Lymphoma in the French experience.

Typically patients go into theatre at 8.30 am and get out at 4.30 pm for the full three stages.

Whilst removal can be done separately and grafting later it gets a better result to do it straight away as the grafted fat reduces the scar retraction that can occurs after removal of inflamed implants and collapse of the cavity from which the implant has been removed. However, in some cases of rupture and leakage with spread into surrounding tissues a stage approach is better.