Fat transfer breast augmentation – too good to be true?

You may have seen through social media and on recent cosmetic surgery websites, that some medical practitioners are advocating that you can have breast augmentation with your own fat as an alternative to breast implants. Fat transfer has increasingly gained popularity in the last 5 years, particularly as part of breast reconstruction after cancer, where we use it routinely.

However, trying to use your own fat to create an acceptable breast augmentation result is very difficult indeed. Fat is inherently soft, and it is difficult to get the projection that can be reliably achieved with implants. Further, the amount of fat that survives the transfer is unreliable, and is never more than 50 % of that injected.

It means the procedure must be repeated at least once, usually twice. And the extensive liposuction that is required raises the very real risk of irregularities and contour deformities in the areas where the fat is harvested, particularly in slim patients.

Because of these problems, most experienced plastic surgeons would only use fat as an adjunct, or in addition, to an implant, particularly to enhance the ‘cleavage lines’ or to narrow the gap between your breasts.

Beware the practitioner promising perky, natural looking breasts using your own tissue, without the need for implants. In reality, the end result could be saggy, droopy, very expensive, and not wait you expected.

If something seems to be too good to be true, it almost invariably is.

Breast Augmentation Procedures by Mark Ashton:

Professor Mark Ashton is a Melbourne-based plastic surgeon who specialises in breast augmentation procedures using the latest in breast enhancement techniques.

As former Head of Plastic and Reconstructive Surgery at the Royal Melbourne Hospital (2001-2016), Mark enjoys a reputation as one of Australia’s most respected and internationally renowned plastic surgeons.

Looking for some more information? Ashton Plastic Surgery can help – Call 8560 0590!

The Role of Anastomotic Vessels in Controlling Tissue Viability and Defining Tissue Necrosis with Special Reference to Complications following Injection of Hyaluronic Acid Fillers

There is no such thing as risk free cosmetic surgery.

Every cosmetic procedure including the “non-surgical” injectables have risk. Soft tissue death and blindness are well documented complications of soft tissue filler injections.

Beware of the training of your injector. Do your homework. Some injectors are well trained and know how to minimise risk, others simply don’t.

Skype consultations are not in the best interest of the patient. They do not allow a full explanation of risk or nuance of the treatment required. The doctor is remote from the patient and is therefore unable to treat complications should they arise. Using Skype consultations in shopping centres to prescribe Botox and Fillers is simply designed to maximise profits and is not ethical complete patient care.

I am an expert in this field, both in the aetiology of the blindness and soft tissue necrosis. I am frequently asked to comment on the complications, because I care deeply about empowering patients with the right information.

If you want to dive deeper into the risks, you can read more in this journal article, one of many, I have published on the issue.

Mark

The Role of Anastomotic Vessels in Controlling Tissue Viability and Defining Tissue Necrosis with Special Reference to Complications following Injection of Hyaluronic Acid Fillers

Ashton, Mark W. F.R.A.C.S.; Taylor, G. Ian A.O., F.R.A.C.S.; Corlett, Russell J. F.R.A.C.S.

Plastic and Reconstructive Surgery: June 2018 – Volume 141 – Issue 6 – p 818e-830e
doi: 10.1097/PRS.0000000000004287
Cosmetic: Original Articles
 
ABSTRACT:

breast surgeon Melbourne

Background: Most target areas for facial volumization procedures relate to the anatomical location of the facial or ophthalmic artery. Occasionally, inadvertent injection of hyaluronic acid filler into the arterial circulation occurs and, unrecognized, is irreparably associated with disastrous vascular complications. Of note, the site of complications, irrespective of the injection site, is similar, and falls into only five areas of the face, all within the functional angiosome of the facial or ophthalmic artery.

Methods: Retrospective and prospective studies were performed to assess the site and behavior of anastomotic vessels connecting the angiosomes of the face and their possible involvement in the pathogenesis of tissue necrosis. In vivo studies of pig and rabbit, and archival human total body and prospective selective lead oxide injections of the head and neck, were analyzed. Results were compared with documented patterns of necrosis following inadvertent hyaluronic acid intraarterial or intravenous injection.

Results: Studies showed that the location of true and choke anastomoses connecting the facial artery with neighboring angiosomes predicted the tissue at risk of necrosis following inadvertent intraarterial hyaluronic acid injection.

Conclusion: Complications related to hyaluronic acid injections are intimately associated with (1) the anatomical distribution of true and choke anastomoses connecting the facial artery to neighboring ophthalmic and maxillary angiosomes where choke vessels define the boundary of necrosis of an involved artery but true anastomoses allow free passage to a remote site; or possibly (2) retrograde perfusion of hyaluronic acid into avalvular facial veins, especially in the periorbital region, and thereby the ophthalmic vein, cavernous sinus, and brain.

Prof Ashton spoke to the Herald Sun & ABC 774 with Jon Faine about the dangers of cosmetic skype consultations

30.09.19 Botox video consult hazard

Mark spoke to ABC 774 with Jon Faine

Patients ‘risk blindness’
LEADING doctors are calling  for an end to video-only consultations before fillers or Botox injections are applied at clinics in suburban shopping centres. Two leading plastic surgeons said the legal Skypeonly consultation practice was putting patients at risk.

Last year, regulators received 81 complaints about cosmetic treatments. A Herald Sun investigation found beauty clinics at shopping centres including Chadstone and Fountain Gate offering patients brief Skype consultations with doctors, who then authorised nurses to inject the Schedule 4 drug.

Leading plastic surgeon Professor Mark Ashton has slammed the consultation-by video practice and said patients risked blindness and other serious complications. “The biggest problem with Skype consultations is that if something were to go wrong (in the procedure), that doctor is not physically present,” Prof Ashton said.

“We know things can go wrong with cosmetic injections, so patients are putting themselves at real unnecessary risk.” If complications occurred, patients in shopping centres were unable to get the appropriate care such as they would in a clinic with a doctor present, Prof Ashton said. And he warned of the “dangerous risks” when complications did occur. “If it ends up in the eye, instantaneously the person goes blind and that blindness is permanent and irreversible.”

Age Reduxion Clinic plastic surgeon Dr Alie Ajam, who specialises in cosmetic procedures such as injectables, said he had seen complications in women who had gone to underqualified practitioners. A woman, 21, of Mt Waverley, who asked not to be named but provided photos of the shoddy work she received at a Chadstone clinic, said her lips were left “disfigured” after a Botox lip-flip treatment that offered a slight pout to the top lip. “They injected the Botox into the wrong places and my lips became so swollen — I was terrified that something had gone seriously wrong,” she said. “I had to go elsewhere to get everything fixed as my lips were disfigured, but the whole experience was traumatising and I urge people to do their homework.”

Herald Sun – 1.10 Prof Ashton spoke to the Herald Sun about the dangers of cosmetic skype consultations

Australian doctors weigh up whether breast implants linked to cancer should be banned

A woman inspects x-rays while sitting at a desk.

Photo: Professional ballerina Lily Bones had Allergan breast implants after a double mastectomy following breast cancer. (ABC News: Alison Branley)

A group of women who underwent mastectomies following breast cancer is considering legal action after having reconstructions with a brand of implant that’s now been linked to a rare type of lymphoma.

Key points:

  • The TGA is set to meet to decide whether lymphoma risks warrant a total ban
  • Recent research shows the risk of developing cancer for those with highly textured implants was about 1 in 2,800
  • Australian women who received Allergan implants after mastectomies are considering a class action

It comes as the Therapeutic Goods Administration (TGA) calls an emergency meeting to decide whether to follow the lead of French regulators, who last week decided to ban textured breast implants.

There are more than 13,300 breast implant procedures in Australia each year, mostly for cosmetic reasons.

Among those closely watching the outcome of the TGA meeting is professional ballet dancer Lily Bones.

She was diagnosed with breast cancer after finding a lump at the age of 29.

A woman looks at the camera as she poses for a photograph while seated at a table.

Photo: Ms Bones’ implants have ruptured mildly but not severely enough to qualify for Medicare funded MRI scans. (ABC News: Alison Branley)

“For me at the time, it seemed very out of the blue, quite a surprise,” she said.

“You feel like a bit of a leper, it’s quite lonely, especially in a ballet company.”

Wanting to get back to work as quickly as possible, Ms Bones took part in a clinical trial where she had a double mastectomy and breast implants in one surgery.

A ballerina in costume smiles as she poses for a photo with her hands on her hips

Photo: Ms Bones was in Swan Lake in the Slovak National Ballet in 2015. (ABC News: Supplied)

“We didn’t talk a lot about implant choices. Basically, I was just told what would be involved,” she said.

“I was told that my implants wouldn’t rupture, I remember that quite distinctly.”

A decade on, the Allergan implants she was given have started to rupture.

Now the mother of a two-year-old, she is concerned about the continuing threat that leaking silicone and the risk of lymphoma pose.

“I’ve got enough to worry about. I don’t need other issues to be playing on my mind,” she said.

“I’ll be very interested to know what they [the TGA] decide obviously since Europe’s already rejected them. That really just raises alarm bells in my mind as to the safety of having those implants in my body.

“I think that they should put women’s health first.”

The safety of medical implants has been under the spotlight after the ABC and the International Consortium of Investigative Journalists revealed women around the world were suffering significant health problems after regulators failed to the detect the threat from receiving textured breast implants.

Regulator to consider total ban

The TGA meeting, to be held on Monday night, will consider whether the risk of developing Breast-Implant-Associated Anaplastic Large Cell Lymphoma, or BIA ALCL, warrants a total ban.

France banned implants made by six manufacturers, including Allergan.

Countries that have banned textured implants

  • France
  • Canada
  • The Netherlands
  • Australian implants with European approval mark after December 17, 2018 can’t be sold

(The Allergan brand has also gone by the name of Natrelle and McGhan prior to company takeovers.)

Australian surgeon Professor Anand Deva sits on the TGA expert panel and is hoping for swift action.

He said his latest research showed for women with highly textured implants, the risk of developing the cancer was around 1 in 2,800.

“We would be hoping that the TGA makes a decision sooner rather than later,” he said.

Australian women are particularly affected by the health scandal because doctors here are much more likely to use textured rather than smooth implants.

A breast implant infected with bacteria looks yellow.

Photo: US health authorities have called for more data on the risks of breast implants. (Supplied)

Are textured implants still used in Australia?

Late last year, the TGA followed the European regulators lead and removed the approval of any textured implants with a European stamp of approval, prior to December 17.

But it meant that technically, any existing implants in warehouses or on hospital shelves with approval prior to that date could be used.

What is BIA-ALCL?

  • Breast implant-associated anaplastic large cell lymphoma is a type of blood cancer
  • It often presents as a build-up of fluid in a sac on the breast, and grows in the scar tissue around the breast
  • It is thought to be linked to a bacteria that grows in a groove of textured implants and enters during the initial surgery
  • Symptoms typically appear after about seven years
  • Any women with concerns should consult their surgeon

The Australian Society of Plastic Surgeons told the ABC they understood that its surgeons were no longer using the Allergan textured implants.

But the ABC has received anecdotal reports from patients of surgeons continuing to offer the products early in 2019.

A number of Australian women who received Allergan implants after mastectomies are now considering a class action.

The law firm Slater and Gordon has also been contacted by a number of women and they are currently looking at their cases.

President of the Australian Society of Plastic Surgeons, Professor Mark Ashton said surgeons always had a discussion with patients about the risk of BIA ALCL and textured implants.

“The Australian Society of Plastic Surgeons would support the TGA should it decide to ban Allergan textured implants,” he said.

He said they would also support banning of a second newer type of implant made from polyurethane, which has also been linked to the lymphoma.

How long have authorities known about the link?

US health authorities began investigating the link between the textured breast implants and the risk of developing BIA ALCL, a form of non-Hodgkin’s lymphoma, in 2011.

A spokesman for the Food and Drug Administration said in most cases, BIA ALCL was found in the scar tissue and fluid near the implant, but in some cases it could spread throughout the body.

Last week, the FDA held two days of meetings to discuss the long term risks of textured implants and cancer.

It did not issue any recommendations after the meeting, and instead called for more data.

In the past, the FDA has not recommended that surgeons stop using the implants, or that they be removed

“Because it has generally only been identified in patients with symptoms such as pain, lumps, swelling, or asymmetry that occur after the surgical incision has fully healed, breast implant removal in patients without symptoms or other abnormality is not recommended” the FDA website said.

As of September 30, 2018, the FDA had received a total of 660 medical device reports (MDRs) of BIA ALCL worldwide, including the death of nine patients.

In Australia and New Zealand, 90 patients have been identified, including four who have died.

Manufacturers say they are safe

The makers of Allergan textured implants defend the product, saying its safety was supported by extensive data.

Mark Marmur, from Allergan, said patient safety and product quality were the company’s highest priorities.

“There is more than a decade of successful European and US clinical use as well as a large number of peer-reviewed and published studies,” he said.

He said the company strongly disagreed with the French decision to restrict the use of highly textured implants ‘because this decision was made without any new safety information”.

Ballerinas stretch their arms horizontally and raise their left legs as they practice moves in a studio

Photo: Ms Bones has to pay $500 for every scan she needs to assess the state of her implants. (ABC News: Chris Taylor)

Women left high and dry

Ms Bones’ concerns have been compounded by the lack of services in the health system for women in her position.

She faced extensive delays in the public system but after having breast cancer, she does not have the funds to get scans in the private system.

She has mild rupturing of her implants, not severe enough to qualify for a Medicare funded MRI.

“I need to pay $500 for an MRI every time I need to monitor the state of the implants,” she said.

“The reality is I have a chronic illness which I have to live with and I have to manage along with the trying to maintain normality, which is very much expected of me.”

Source: ABC News

First posted

Creating deformity where there is none: the sudden rise of the ‘explant’ surgeon

As we wait for our regulator, the Therapeutic Goods Administration, to deliberate before making its final decision on whether to suspend a variety of textured breast implants linked to cancer in Australia, news of the now worldwide recall of a particular type of Allergan implant linked to cancer has broken. The recall was prompted by the US regulator announcing a sudden increase in deaths from what was once thought to be a “rare” form of Lymphoma related to breast implants.

I do feel for the regulators trying to protect the public. They are often held to account for failure in cases where the blame lies first with commercial forces and greed. Undertrained or untrained doctors get their hands on an implant and then place them badly into a poorly informed, impressionable and vulnerable patient, primarily for the purposes of making a profit. This is not a failure of the device or even a failure of regulation, it is a failure of ethics, standards and professionalism.

And even as the ink is yet to hit the paper on the lastest regulatory action, we are witnessing another example of profit before professional ethics: the sudden rise of the “explant” surgeon. These professionals build business and marketing plans designed to target women who are now understandably anxious from reading the bad news about implants.

One of the most recently minted websites lists that the low-cost breast explant option (which is unsurprisingly the same price for low-cost breast augmentation) is for women who have no local complications at all, i.e. a normal breast and a normal implant.

Let me be clear. No one advocates preventative removal of an implant that does not have a problem. All this will do is create deformity where there is none and subject a healthy, but frightened, woman to the not inconsiderable risk of unnecessary surgery.  And this surgery can be major because often surgeons recommend not just removing the implant but all the tissue surrounding the implant. It can be a very destructive operation, particularly if the implant is placed under muscle.

But in a way I am not surprised – the same doctors that made money from implants going in can now make money from implants going out. I guess this instantly doubles their market opportunity!

So where will it all end? Where we have landed with crisis, anxiety, unnecessary and potentially dangerous surgery is the result of not truly tackling the root cause – which is to ensure that we dial down the sales and marketing and become more focused on being good doctors by putting the patient’s interests first.

Professor Deva is an Australian clinician and academic. He is the founder and director of the Integrated Specialist Healthcare Education and Research Foundation and head of plastic and reconstructive surgery at Macquarie University.

Source: The Sydney Morning Herald

First posted

Breast implants linked to cancer to still be available after Australian regulator stops short of ban

Professor Anand Deva examines two different types of breast implant, a smooth version and a textured model.

The TGA is asking manufacturers to provide in-depth data on implants. (ABC News: Jack Fisher)

Textured breast implants linked to a rare cancer will continue to be available to Australian women having surgery, despite a crackdown on similar products by regulators in France and Canada.

Key points

  • France have banned textured implants after they were linked to a rare type of lymphoma
  • Therapeutic Goods Administration (TGA) has decided not to ban them, instead requiring more data from manufacturers
  • Women say they are not properly informed about risks and specialist surgeons want breast device registry to be mandatory

The Therapeutic Goods Administration asked an expert panel for advice on whether to follow the lead of these countries and on Tuesday released its decision.

Textured implants are used in about 90 per cent of Australian breast augmentations and there are more than 13,300 procedures in Australia each year.

Instead of banning the products, the TGA will write to all implant manufacturers, asking them to provide in-depth data on how many implants have been supplied as well as physical samples of the products within 10 days.

“After receiving information from suppliers, the TGA will consider whether to suspend or cancel particular products from the Australian Register of Therapeutic Goods,” a spokesman said.

Many patients have contacted the ABC saying they were not told about the risk of breast implant-associated anaplastic large cell lymphoma (ALCL) when their doctors discussed giving them textured implants.

A breast implant infected with bacteria looks yellow.

The cancer is believed to be caused by a bacteria which builds up in the grooves of highly textured implants, causing infections. (Supplied)


A female doctor, who did not want to be identified, had both breasts removed because of cancer and was given textured implants.

She said her plastic surgeon never mentioned the potential risk.

“Despite seeing a top plastic surgeon, my surgeon provided me with absolutely no information on [the possible link]. It was not mentioned once,” she said.

Australian health regulators have urged doctors to use the Australian Breast Device Registry to record details of removal of implants and lymphoma.

Currently about 10 per cent of surgeons do not use the register.

Countries that have banned textured implants

  • France
  • Canada
  • The Netherlands
  • Australian implants with European approval mark after December 17, 2018 can’t be sold

Specialist plastic surgeons said that to be effective, the registry should be made mandatory.

Australian Society of Plastic Surgeons president Professor Mark Ashton said a full register would allow clinicians to contact every woman with an affected implant, let them know whether they were at risk, and what action to take.

“At the moment there are lots of patients out there who are saying: ‘Am I at risk? I don’t know what my implants are’ or ‘They gave me some information but I’ve lost it’, or ‘I don’t even know if I can find my surgeon’ or he might have died or moved on, or so forth,” he said.

“So it would be enormously helpful if we could have, in one central location, a record of every breast implant that’s inserted into Australian women.”

Infection control the key to cancer

Plastic surgeons said the rising rates of lymphoma could be traced back to some “cosmetic” surgeons who weren’t as qualified as fully trained specialist plastic surgeons.

The lymphoma is believed to be caused by a bacteria which builds up in the grooves of highly textured implants and reacts in those who have a genetic predisposition.

Professor Ashton said it was possible the bacteria was being introduced by surgeons with improper infection-control procedures.

He pointed to high numbers of cases being traced back to commercial cosmetic surgery companies and practitioners.

“One of the key components is that the implant must become infected, so if it has been put in in a proper hospital by a proper surgeon, then the chances of that occurring are very low,” he said.

But he emphasised patients with Allergan or other highly textured implants didn’t need to be concerned if they had no symptoms.

“It’s not that if you have an Allergan product you need to have your implant removed,” he said.

What is BIA-ALCL?

  • Breast implant-associated anaplastic large cell lymphoma is a type of blood cancer
  • It often presents as a build-up of fluid in a sac on the breast, and grows in the scar tissue around the breast
  • It is thought to be linked to a bacteria that grows in a groove of textured implants and enters during the initial surgery
  • Symptoms typically appear after about seven years
  • Any women with concerns should consult their surgeon

“It means that you need to be aware of your implant, and like everything else you need to monitor it and keep in close contact with your surgeon.”

If people do develop the rare cancer, it can be treated.

“If we get onto it within 12 to 18 months, it is eminently treatable and curable,” Professor Ashton said.

“It’s a very rare disease affecting a very select group of people and can be cured but it is something, like everything, we need to be aware of.”

The society has also published a list of specialists who are offering free consultations to women with concerns who have a referral from their GP.

Source: ABC NEWS

First posted 

Professor Ashton to assist Coroner and Safer Care Victoria

Professor Ashton has been appointed as:

  • Expert Council assisting the Coroner in the Coroner’s Court of Victoria
  • Expert Investigator for Safer Care Victoria- a new Government Body/ Organisation set up by the State Government of Victoria to protect Victorians against unethical and unsafe medical practices and doctors

Breast augmentation placement

 

The decision to undergo breast enlargement surgery using breast implants (often referred to as a ‘boob job’) is a very personal and private one. Melbourne Plastic Surgeon Prof. Mark Ashton discusses the best position for your breast during a breast augmentation procedure.

Although being one of the most common cosmetic surgery operations performed worldwide, breast augmentation is not straightforward and there are many pitfalls for the unwary.

Interested in breast augmentation? Ashton Plastic Surgery can help – Call 8560 0590!

Discover the different types of breast implants

Melbourne Plastic Surgeon Prof. Mark Ashton discusses the different types of breast implants for a breast augmentation procedure.

Although being one of the most common cosmetic surgery operations performed worldwide, breast augmentation is not straightforward and there are many pitfalls for the unwary.

There has been a radical change in the type of devices used for breast augmentation in the last four years. Whereas in the late 1990 and early 2000’s the most common type of breast implant used was a saline implant. This has now rapidly been replaced by a cohesive silicone gel implant.

Basically the decisions that you need to make in choosing a device are:

  1. Saline or Gel filled implant.
  2. Round or tear drop / anatomical shaped implant
  3. Textured or smooth implant.

Interested in breast augmentation? Ashton Plastic Surgery can help – Call 8560 0590!

 

Surgery preparation