The use of BOTOX® Cosmetic to lift breasts has been suggested for a number of years but there has never been a good study documenting its ability to actually do so. If you consider the factors that actually lead to ptosis (or drooping) of breasts, it makes sense that simply weakening muscle pull would provide little to no benefit.  As you age or following pregnancy and/weight gain or loss, ligaments within your breasts can tend to lengthen and lose support.  These Cooper’s ligaments are a chief contributor to loss of perkiness over time and, unfortunately, are completely unaffected by the administration of BOTOX®. Even with a conventional breast lift, these ligaments are really not addressed; with surgery, the surrounding skin envelope is simply reshaped and tightened with or without addition of breast volume viz a viz placement of a breast implant.

And so given these changes, it is not conceivable that injection of BOTOX® Cosmetic alone would have any significant effect on breast lifting.  And even if it did, would the slight lifting effect warrant the upfront and maintenance costs associated?

I encourage you to submit your comments and questions to drbuford@beautybybuford.com .

I look forward to hearing from you.

I respectfully disagree.

Most plastic surgeons, such as myself, recognize that a breast lift primarily addresses reshaping of the lower pole of the breast and achieves very little with respect to restoration of fullness to the upper pole. Because of this, a small implant to restore this lost volume is often added when performing a breast lift procedure in order to achieve a more uniform and more optimal reshaping of the breast as a whole. I personally feel that unless a woman has very glandular breasts (which many do not have) or has a cup size larger than a small C, that she will benefit from the addition of a small breast implant beneath the muscle to help restore upper pole fullness in conjunction with a breast lift. Without it, while the nipple position and lower pole may be optimal, the upper pole is left with the tell-tale involutional concavity reminiscent of the post-pregnancy breast.

I look forward to your comments. Please send them to us at lauren@beautybybuford.com

And so it is not surprising that fat grafting would eventually make its way to breast enhancement. Since many of us have a little extra fat here and there, surgeons put two and two together and realized that breasts could potentially be volumized simply by taking fat from another place and injecting it into a woman’s breasts. And so the media caught on and results were shown of beautiful breasts made more beautiful simply by adding fat. But its’ not that simple.

The American Society of Plastic Surgeons (ASPS) banned the use of fat grafting for cosmetic augmentation in 1987 but recently revisited its use by conducting a study to evaluate just how safe it actually is to use fat for breast augmentation. The concerns range from slight imperfections (due to local fat necrosis) to severe infections and potentially induction of breast cancer. Although plastic surgeons have used fat to reconstruct breasts after mastectomy, in this case all breast tissue is removed before the fat is actually added. And so fat, which excretes estrogen (a hormone that stimulates breast cell growth) has very little risk of stimulating breast cancer cells. But in the case of cosmetic augmentation, breast tissue obviously still remains and so there is a theoretical risk, albeit small, of increasing the risk of breast cancer. The current study, although not large (50 patients) to date has not shown an increased risk but nevertheless the risk potentially still remains.

And so the question is asked, will fat transfer ultimately replace the need for breast implants and is it a safer alternative to the saline or silicone gel implants currently being used. To best answer this, keep in mind some potential advantages and disadvantages.

Fat Is Readily Available

• Advantage: there is no implant cost
• Disadvantage: fat can be unpredictable and the procedure may need to be repeated to achieve long-lasting durable results whereas with an implant the volume is known

Fat Is Your Own Tissue

• Advantage: there is no chance for rejection
• Disadvantage: numerous studies have documented the safety of breast implants and their results are predictable

Cost

• Advantage: liposuction is performed at the same time and so you are getting two procedures at the same time
• Disadvantage: most surgeons currently performing AFG for breast augmentation are charging significantly more for this procedure than for a conventional implant breast augmentation (many times the cost may run upwards of $10,000 or more!)

The Technology For Fat Grafting is Becoming More Refined

• Advantage: better fat survival is being seen and the results are potentially more predictable than they were previously
• Disadvantages: aside from a few highly trained specialists, many plastic surgeons are not actually trained to use fat for breast augmentation and so the risk for complications can be very high. A recent study in the Journal of Plastic & Reconstructive Surgery documented just how dramatic these complications may be and warned of these dangers.

And so what is the consensus? Most plastic surgeons are still very wary to fully embrace fat grafting for breast augmentation until the process is more adequately refined and until the question of breast cancer stimulation is satisfactorily answered.

If you have any questions about this interesting topic, please do not hesitate to call me or my staff at 303.708.8234. We look forward to your input.

To address the first concern, most patients are concerned about side-effects related to narcotic pain medications.  They simply don’t have the time nor the patience to be senseless, nauseated, and lose their appetite simply to achieve effect pain control.  Thankfully, times have changed.  Today’s Plastic Surgeon is armed with more options including non-narcotic pain relievers, localized nerve blocks, and topical devices aimed at reducing their post-operative discomfort.  In my practice, all patients begin on a loading dose of Celebrex, a non-narcotic pain reliever, the night before surgery.  Following their surgery, they continue with a lower dose of this medication and supplement with a narcotic pain reliever as needed.  In addition, to help reduce the need for any pain medication following surgery, I not only inject their breasts with numbing medication during the procedure, I also wash out the implant pocket with antibiotic solution and additional numbing medicine. Most importantly, I also perform an Intercostal Nerve Block immediately before the procedure which I feel is extremely effective in reducing immediate post-operative discomfort.  As a result, a majority of my patients are able to greatly decrease their reliance on narcotics and transition to non-narcotic pain medications within 24-48 hours following surgery and continually remark to both myself and my staff that their recovery was much easier than anticipated.

As far as activity restrictions, I recommend that they not lift anything heavier than 6-8 pounds (including their children) for one week after surgery and that they hold off on any aggressive physical activities for the first few weeks during their recovery.  They are encouraged to return to light exercise one week after surgery as long as it doesn’t involve the use of their shoulders or chest muscles.  From here, they can usually return to aerobic activities, running, Yoga, and Pilates within 4-6 weeks.

A majority of my patients return to work as early as 3 days after their surgery as long as their profession does not require extension lifting or use of their chest muscles.  As compared to years past, Breast Augmentation is now a more finely tuned procedure in both what we do during and after the actual procedure.  The result is a more comfortable and more rapid recovery and an overall very happy patient population.