Adipose Derived Stem Cell Fat Transfer for Breast Augmentation

Cell-Assisted Lipotransfer for Cosmetic Breast Augmentation: Supportive Use of Adipose-Derived Stem/Stromal Cells
Kotaro Yoshimura,1 Katsujiro Sato,2 Noriyuki Aoi,1 Masakazu Kurita,3 Toshitsugu Hirohi,4 and Kiyonori Harii3
Aesthetic Plast Surg. 2008 January; 32(1): 48–55.

I have had the great opportunity to reacquaint with a mentor who has sparked my interest in the use of autologous fat transfer for breast augmentation. As I read through the selected reading articles, I have found excellent results published by Japan and Korea on the use of adipose derived stem cells of autologous fat transfer for cosmetic breast augmentation.

My interest in this grows, as I continue to having a growing group of patients who are interested in a small to modest increase in breast size and who do not want an implant of either silicone or saline. In these patients, available fat can be harvested from the lower abdomen, buttocks, and thighs and transferred to the breast for augmentation.

I am very satisfied with the results we are achieving with silicone gel implants and find that there will always be a continued role for them in women who desire a larger augmentation or require replacement of significant breast volume following mastectomy. I believe that fat transfer will not replace silicone breast augmentation, but serves as an alternative for those women who do not want a large volume augmentation and who do not want an implant based augmentation.

Brian P. Dickinson, M.D.

Family Testimonial

Testimonials from patients and family are one of the highest compliments that I could ever receive. This patient family member writes:


Dr. Dickinson,

I would like to thank you from the bottom of my heart for helping my son through this. You are an extraordinarily skilled surgeon and a very special person. You took the time to help him, not many people do that anymore. I cannot thank you enough or express what your kindness has meant to me enough. My family and I will be forever indebted to you. Please tell your staff that they are the most caring people in the world and thank them for me.

Thank you again,

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Breast Augmentation: Testimonial

www.drbriandickinson.com

Patient testimonials are one of the highest compliments I could ever receive. This happy patient writes in her testimonial:

"This experience couldn't possibly have been any better, and bless Dr. L for referring me to you! You're the best -- Dr L told me you were going to be the next big bev hills plastic surgeon, and I think he's right.... from the first visit I felt comfortable and am soooooo pleased with my results, you have NO idea!

Every visit has been a true delight, and actually fun and entertaining (not usually the case half naked in a dr office!).... I love that I found a Doc that I didn't feel all weird with, and that I NEVER felt judged, and was always treated with the utmost respect. Thanks!;"

No Touch Teqhnique Breast Implant Delivery

I have been using the Keller Funnel routinely for my periareolar and transaxillary breast augmentation cases. The Keller Funnel allows me to deliver larger implants through a smaller incision without traumatizing the breast implant, the skin, or having the breast implant come into contact with the skin.

I believe strongly that this "no touch technique delivery system" can help reduce the incidence of capsular contracture. It is of paramount importance to me that my patients receive great results and that I try to do everything possible to minimize complications.

Brian P. Dickinson, M.D.

http://www.drbriandickinson.com/

Microsurgery. Nerve Repair

Microsurgical nerve repair and use of the operating microscope is a particular area of interest for me and has become a significant part of my practice. I enjoy the optics of the Carl Zeiss Pentero microscope. The Pentero provides adequate resolution for nerve repair on the magnitude of 2mm and even less.

Peripheral nerve injuries in the upper and lower extremity are common with the frequent physical activity in southern California. Activities such as biking, surfing, motorcycles, climbing, as well as occupational hazards can cause peripheral nerve injury.

In the photograph above, the blue background contains a grid with 1 mm squares, allowing the surgeon to assess the dimensions of the injured nerve.

Brian P. Dickinson, M.D.

http://www.drbriandickinson.com/

Revision Augmentation Mastopexy Surgery

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I have found an increasing number of women who present to my office in consultation who had saline breast implants placed ten years ago and who are now requesting removal and replacement of their mammary implants for highly cohesive silicone gel mammary prosthesis.

Often these women underwent reduction mammoplasty with an implant to maintain upper pole fullness, but now want to change to an implant with a slightly higher profile to deliver more breast projection.

We are seeing more women present from out of state who come to Newport Beach and Beverly Hills who have capsular contracture and who now want to have their breast implant capsules removed, saline implants replaced for silicone gel implants, and a simultaneous breast lift.

These operations are challenging to preserve the blood supply to the nipple areola complex as previous operations contribute to scarring and necessitate experience with these cases to deliver consistent results.

Bilateral capsulectomies, implant exchange, and mastopexy are commonly performed operations in Newport Beach and Beverly Hills.

Brian P. Dickinson, M.D.
www.drbriandickinson.com

Abdominoplasty & Panniculectomy at RoxBariatric

The post-bariatric body contouring surgery program at the Roxbury Clinic & Surgery center continues to grow with more patients enrolling in post-bariatric body contouring procedures.

Patients present to our office and are very excited about having their body contouring procedures done at either the Newport Beach or Beverly Hills, CA surgery centers.

We encourage all patients who desire to have post-bariatric body contouring procedures to bring their insurance cards with them during their consultations. It is a great time to utilize health insurance plans to undergo lap band procedures. Typically after patients undergo their lap band operation they return for their post-bariatric body contouring surgery within 9 months to one year. Patients are very happy after having their panniculectomy and abdominoplasty surgeries and greatly look forward to having their mastopexy, breast reduction, brachioplasty, or medial thigh lift.

Performing post-bariatric plastic surgery is very gratifying for the patient and physician.

Brian P. Dickinson, M.D.

www.drbriandickinson.com

Roxbury Clinic & Surgery Center: Orbital Fractures

Orbital fractures are very common. There is an increasing frequency of orbital fractures being repaired at the Roxbury Clinic & Surgery Center in Beverly Hills, CA. Orbital fractures are becoming frequently more common in older individuals who may fall and suffer a trauma to the region of their eye.

By nature of the design of the globe and bony orbital frame, the bone tends to fracture first to prevent damage to the eye itself. Repair of the bony defect is often required for greater than 1 square cm defects and/or defects comprising greater than 50% of the floor of the orbit.

Patients who come to the Roxbury Clinic & Surgery Center in Beverly Hills to have their surgery are fortunate to have the expertise of Dr. Kami Parsa. Dr. Kami Parsa is a world renowned ophthalmologist with exceptional talent in oculoplastic and reconstructive surgery of the eye. Smaller orbital floor defects are often repaired with ear cartilage harvested from the ear, while larger defects or defects of the orbital rim often require repair with titanium mesh or porous polyethylene.

Brian P. Dickinson, M.D.

http://www.drbriandickinson.com/

Revision Breast Augmentation Surgery for Saline Implant Deflation

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Breast implants are medical devices and over time, like all medical devices, are subject to fatigue. Over time, the development of a capsular contracture around a breast implant can cause folds in the shell of a saline implant. Repeated creasing in the fold of a saline implant can cause the shell to fatigue and allow the saline to leak.

The leak of saline into the body is not harmful to the patient, but is nonetheless, psycholocially distressing. These patients have been coming to our office with an increasing frequency and request the removal of their saline implants for silicone implants. Often patients who have a deflation of their saline implants have had their devices for over 8-10 years.

These patients who have undergone removal and replacement of their saline implants for silicone gel implants are starting to tell their friends how happy they are with the improvement in the shape and feel of their breasts. As a result, I am seeing an increase in the number of patients who present to the office requesting their saline implants to be exchanged for silicone implants.



Brian P. Dickinson, M.D.
www.drbriandickinson.com

Strattice in Aesthetic Breast Surgery. Self-Study. Conference. LifeCell-Strattice

I had the great pleasure of attending the LifeCell educational forum this past weekend in Las Vegas, Nevada. The meeting was very helpful to solidify my experience with regenerative tissue matrices.

This conference came at a timely fashion for me as it reinforced my educational experience on the use of Strattice for revision aesthetic breast surgery in women with thinning tissues.

I have seen many women in consultation recently with fitness model physiques and a history of recurrent capsular contracture and severe thinning tissues.

As was taught to me by my mentor, the reinforcement of the thin lower pole skin with Strattice can help visible and palpable ripping in this population. The Strattice held in by marionette sutures and then sutured with long-acting absorbable will decrease the incidence of palpable rippling and may reduce the rate of capsular contracture.

Brian P. Dickinson, M.D.
www.drbriandickinson.com

Breast Implants. Saline Implant Valve Failure with Capsular Contracture

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I am seeing more and more women in consultation in my office with deflation of their saline breast implants. In fact, twice this month we had women who presented with the development of pain around their breast implant with an associated distortion of the breast shape secondary to breast implant valve failure.

It has been my experience that the development of a capsular contracture around the breast implant changes not only the shape of the breast implant capsule complex, but may incorporate around the valve of the saline implant (as shown in the image above).

Either continued contraction of the breast capsule resulting in a change in the surface area to volume ratio and/or ingrowth of the capsule to the valve disrupts the valve and allows the saline to extravasate. These women often present with continued pain and the apparent deflation of the implant can be distressing to the patient.

In these cases I recommend that women undergo removal and replacement of their breast implants and capsulectomy. Many women are opting now to exchange their saline implants for silicone gel breast implants.After these surgeries, patients are very happy with the new contour of their implants and their pain is often markedly improved.

Brian P. Dickinson, M.D.
www.drbriandickinson.com

Rox Bariatric: A Team Effort

The Rox Bariatric program continues to grow. I was very fortunate today to hear some excellent feedback from one of our patients who is recently post-op from her panniculectomy and medial thigh lift.

She was very thankful for her results as well as to have had an excellent team of surgeons tend to her care. This group of surgeons not only pays close attention during her surgery, but also to the post-operative care that is so important to ensure proper healing.

I was truly thankful to hear how highly our patient spoke of our team of doctors. Specifically, the patient expressed her gratitude to Dr. Jay Calvert, Dr. Anita Patel, as well as the USC plastic surgery resident Dr. Joe Carey was so helpful during our case.

Dr. Patel has been taking a great interest in post-bariatric body contouring surgery and post-bariatric patients. Together with Dr. Patel, Dr. Shafipour, and the help of the USC residents we are able to provide complete and excellent care to these great patients who have lost massive amounts of weight. I am very proud of how hard our patients work to achieve their goals.

Brian P. Dickinson, M.D.

www.drbriandickinson.com

RoxBariatric. More Body Contouring. More Patients Enroll for Lap Band.

The Rox Bariatric program continues to gain significant traction. We are seeing many patients return for the second stages of their operations. I continue to be impressed by the power of panniculectomy to facilitate weight loss.

Not only does the removal of the abdominal pannus seem to allow patients the ability to workout and exercise, but also significantly motivates them to loose weight through appropriate dietary measures.

Today in the operating room I was truly impressed with a patient who returned for her bilateral mastopexy and bilateral brachioplasty after she continued to loose weight after her panniculectomy a few months ago. I continue to be very proud of how hard our patients work to improve themselves and their health.

Brian P. Dickinson, M.D.

http://www.drbriandickinson.com/

The Keller Funnel for Silicone Gel Implant Delivery

Today was truly a great day of cases. As the breast augmentation, revision breast augmentation, and capsular contracture surgery practice grows, I continually look for ways to improve patient outcomes, reduce patient recovery time, reduce incision length, and prevent capsular contracture.

I have found that the Keller Funnel facilitates delivery of silicone gel implants through smaller incisions and allows me to employ a no-touch delivery technique whereby the gel implant does not come into contact with the nipple areola complex or the axillary skin when placing implants. I found that the Keller Funnel greatly facilitated today's cases and I will use it for the breast augmentation cases later in the week.

I anticipate that the no-touch delivery technique is one method to further reduce the prevalence and incidence of capsular contracture. I look forward to continued success with is device.

Brian P. Dickinson, M.D.