Advances in Breast Augmentation Accommodate Changing Aesthetic Preferences

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Plastic Surgeon and Breast Reconstruction Specialist Dr. Constance M Chen Offers Practical Tips

Dr. Constance M Chen

Breast augmentation remains the most commonly performed cosmetic surgery in the United States even as aesthetic preferences have changed.

Times change...and nothing changes with the times more than trends in fashion and in what constitutes the ideal body. So while the appeal of the voluptuous, full-breasted female figure from the 1950s has given way to a more slim, youthful, and athletic look, many people still pay attention to the female breast. According to the American Society of Plastic Surgeons, 300,000 women underwent breast augmentation procedures in 2019, an increase of 40% since 2000.

“Breast augmentation remains the most commonly performed cosmetic surgery in the United States even as aesthetic preferences have changed,” says plastic surgeon and breast specialist Dr. Constance M. Chen. “As these preferences have been evolving, we've also been developing new surgical techniques that accommodate the subtler, more natural-looking changes women are seeking.”

Women have embraced the active lifestyle that produces a healthy, athletic body. They recognize that disproportionately large breasts would be heavy and cumbersome to manage and may be a hindrance to activities such as running, aerobics, and yoga. Along with the trend to smaller breast sizes is a preference for a more natural tear-drop shape instead of the full, round breast favored in the past. The results women are looking for are achieved primarily with a new generation of implants and with fat grafting, which uses a woman's own tissue to fill out her breasts.

Implants have evolved since the 1970s and 1980s. The previous generation of silicone- and saline-filled implants were subject to rupture and various other complications. They also frequently felt hard due to capsular contracture over time. For these reasons, tens of thousands of women have implants removed each year. Newer implants are are filled with a cohesive gel that holds its shape better than earlier types and are firmer than the traditional silicone gel implants but softer than saline implants. These gel-based implants, sometimes known as “gummy bear” implants, are designed to ooze less if they rupture although they are not well studied.

Fat grafting transfers fat from another part of the body to the breast and is useful when only a modest increase in size is desired. The fat to be transferred to the breast is obtained via liposuction from elsewhere in the body, usually the abdomen, flank, or thigh. Tumescent fluid containing saline and an anesthetic is injected into the fat to liquefy it for extraction with tiny tubes called cannulas. The fat is processed – by washing, centrifuge, or filtering – to remove impurities and then injected into the breast.

Fat grafting, also known as autologous fat transfer, has an important feature in common with autologous breast reconstruction, which is the gold standard in post-mastectomy breast reconstruction. Both use tissue from another part of the woman's own body to recreate or modify the breast. The primary difference is that in autologous breast reconstruction, known as a “flap” transfer, tissue such as skin and fat is transferred along with a blood supply; in transferring fat, no blood vessels are relocated. “Because it has no blood supply, the fat that is transferred to the breast must receive nutrients from surrounding cells and not all of it will survive the transfer,” says Dr. Chen. “As much as 50-70% of the transferred fat may be reabsorbed by the body. For that reason, we typically overfill an area to achieve the desired outcome and because the result is unpredictable, multiple procedures may be needed.”

Fat grafting is often used as an adjunct to autologous breast reconstruction for filling small areas to improve size, shape, and symmetry. Similarly, it can be used in conjunction with implants to refine the aesthetic effect. Fat grafting is best in women with excess fat; thin women are often poor candidates for fat grafting due to a lack of donor tissue. Dr. Chen concludes: “When used for breast augmentation, fat grafting can create a natural result that eliminates or reduces many of the risks associated with implants and may have the additional benefit of reducing fat elsewhere on the body. When only a small change in breast size or shape is desired, fat grafting can be an appropriate solution to improve a woman's self-image and confidence.”

Constance M. Chen, MD, is a board-certified plastic surgeon with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine.

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