Every year, Plastic Surgeons from all over the world come together for the Annual Meeting of the American Society of Plastic Surgeons. This conference, known as Plastic Surgery The Meeting 2015, or for you Twitter folks out there, #PSTM15, offers hundreds of lectures and courses that cover pretty much every topic in Plastic Surgery: from skincare to advanced reconstruction, and from practice management to national and global healthcare policies. Since our practice focuses on plastic surgery of the breast, I can only really highlight the things that apply to this area:
What’s new in breast augmentation?
One major trend is toward increasing use of shaped implants.
- These breast implants are sometimes also known as tear-drop, gummy bear, or anatomic implants.
- Many surgeons are finding these devices to improve breast shape and result in more natural-appearing results in select cases.
The use of fat grafting for breast augmentation is becoming more and more common.
- Fat grafting involves removing fat from one part of the body and grafting the fat into the breast. The fat is usually obtained by liposuction of the tummy, hips, and/or thighs.
- For cases where only a small degree of breast enlargement is desired, the augmentation can be done using only fat grafting. For larger increases in breast size, fat grafting can be combined with small implants, producing smooth contours and more natural-appearing breasts.
What’s new in breast reduction?
- Having attended this meeting almost every year for several consecutive years, I can honestly say that this is one area where I did not see many new developments. Despite increasing evidence that breast reduction surgery can improve symptoms, such as neck pain, back pain, rashes, and psychological distress, an increasing number of insurance plans are treating this operation as cosmetic only and refusing to pay for it.
- The good news is that it looks very much like there is a growing comfort with techniques for short scar breast reduction, including the vertical breast reduction. There also appears to be an improved understanding of just which patients will benefit most from short scar versus traditional scar techniques.
What’s new in breast reconstruction?
- Small to moderate volume fat grafting can improve the appearance of both implant and natural tissue reconstructions that are done after mastectomy. The only thing to remember here is that fat grafting done to “smooth out” or improve contour deformities can take more than one operation to achieve a complete result.
- A large volume of fat grafting can be used to reconstruct entire breasts. That’s correct! No implant. No flap.
- BUT…it can take several separate operations to make even smaller sized breasts.
- Also…it may involve the use of external suction devices to expand the skin and tissue, but these are not yet approved by the FDA and can be quite uncomfortable and difficult to use.
- How about fat grafting after lumpectomy?
- This is one topic where I truly feel like the jury is still out and generated quite a bit of debate at the meeting.
- The concern with fat grafting into a previous lumpectomy site is that there is still a large amount of breast tissue still there. This is different from a mastectomy where virtually no breast tissue should be present.
- The good news is that there appears to be a lot of research ongoing around this topic and we will hopefully start to generate evidence to help guide us to a better understanding of the risks and benefits associated with it.
- Direct-to-implant (single-stage) breast reconstruction can be used in certain cases to save patients from needing to have a tissue expander.
- The decision to reconstruct a breast in two stages (expander then implant) or in a single stage (direct to implant, no expander) depends on MANY factors, including the blood supply to the skin that is left behind after the mastectomies, the size of the breasts being removed, the desired size of the reconstructed breasts, and patient factors such as smoking and body mass index.
- Direct-to-implant reconstruction will usually require the use of an additional implanted material, such as a biologic mesh.
- Even if reconstruction is done using this method, a second stage may be needed to correct nipple position (if nipples were spared) or to improve symmetry. As mentioned above, fat grafting can greatly improve the contour of the reconstruction, and this is only done after the first stage.
- While there are more options for natural tissue reconstruction – using tissue from the thighs, buttocks, and flanks – the DIEP flap from the lower tummy still appears to be the preferred site when available.
Well, that about sums up the big points I was able to bring home from our meeting this year. As always, if you have any questions or thoughts, please feel free to email us at firstname.lastname@example.org or reach us through our Facebook or Twitter feeds.