Breast augmentation with bilateral deepithelialized TRAM flaps: an alternative approach to breast augmentation with autologous tissue

Since the 1980s, many patients have benefited from the use of the transverse rectus abdominis musculocutaneous (TRAM) flap for postmastectomy reconstruction. In addition to cancer reconstruction, this technique has recently been used to treat patients with breast implant intolerance and for reconstruction after siliconoma resection. However, physicians and patients alike believe that such an extensive procedure should not be used for aesthetic purposes, and to the authors' knowledge, no study has been reported on the use of pedicled TRAM flaps for aesthetic augmentation mammaplasty. In the past several years, a number of the authors' patients have requested simultaneous breast augmentation and abdominoplasty. These patients objected to the use of prosthetic implants because of potential complications such as implant failure, capsular contracture, wrinkling, and palpability. Therefore, from 1995 to 2000, the authors performed 14 cases of bilateral breast augmentation with deepithelialized, pedicled TRAM flaps. In this series, the donor-site complication rate was similar to that of the traditional TRAM flap. Surprisingly, no cases of complete or partial flap loss were clinically detected. The only complaints were pedicle bulges at the costal margins. These patients were all extremely satisfied with the results. It was concluded that the TRAM flap is safe for augmentation in a subset of carefully selected women with hypoplastic or atrophic breasts. The authors discuss patient selection, technique, and their experience with this method of breast augmentation.     

Calf augmentation: a new calf prosthesis

This paper describes a method of calf augmentation by using gel-filled implants to correct thin or asymmetrical legs. The implants are placed over both heads of the gastrocnemius muscle beneath the fascia cruris superficialis. In order to simplify Glitzenstein's procedure, modified implants were developed by the author. In over 25 cases, this technique gave encouraging results.     

Facial soft-tissue augmentation with injectable autologous and allogeneic human tissue collagen matrix (autologen and dermalogen)

Facial soft-tissue augmentation has become increasingly popular as an option for those patients in whom age-related changes manifest as contour defects or who desire volume enhancement for various areas of the face. A variety of agents and techniques are currently available that, when used appropriately, can improve or correct facial rhytids and regional volume depletion. Failures of some agents are due to reduced biocompatibility, inadequate administration technique, or failure to match the actual underlying defeat with the most appropriate solution. Dermal soft-tissue augmentation with human tissue collagen matrix (Autologen and Dermalogen) is physiologic, appears to be ultimately safe and effective, and has many qualities consistent with an ideal dermal filler. Several autologous, allogeneic (cadaver-derived), heterologous, and alloplastic agents will be discussed in this article with regard to rationale, patient selection, optimum administration technique, and persistence.     

Autogenous augmentation mammaplasty with microsurgical tissue transfer

Many patients dream of reducing their abdominal or gluteal fat tissue and, in the same procedure, enlarging their breasts without the need for implants and their related problems. Following this demand, a new "natural" alternative to breast augmentation with autogenous tissue is presented. Since 1993, 16 patients have undergone either unilateral or bilateral breast augmentation with free fat transfer. These 20 augmentation mammaplasties consisted of nine deep inferior epigastric perforator flaps, eight superior gluteal artery perforator flaps, and three superficial inferior epigastric artery flaps. The postoperative results were judged aesthetically by independent examiners and by the patients according to Netscher's score. The additional operations for final shaping of the breasts and the postoperative complications at the donor and recipient sites are reported. The augmented breasts improved the aesthetic proportions more than 100 percent. All flaps survived, and except for minor postoperative complications such as small areas of wound dehiscence, the breasts could be shaped aesthetically in a second-stage procedure several weeks later. Breast augmentation with autogenous tissue offers a natural alternative to alloplastic augmentation mammaplasty.     

Fat-grafting injection for soft-tissue augmentation

Autogenous graft tissue is better than homologous and heterologous tissue for the improvement of body contour to eliminate deep defects in the skin surface. This paper presents techniques for fat-graft injection obtained from liposuction and the instruments specially designed for this procedure. An analytical study is presented, and the final results obtained with this method are compared with different filling materials used for aesthetic and reconstructive purposes. A statistical study of 253 operated patients in a long-term follow-up (1984-1988) is registered. Special comments have been included relative to patient recovery, the amount of fat absorption and the amount of fat tissue remaining, and fat injection revisions and complications.     

Breast augmentation using the spectrum implant with exteriorized injection domes

The author describes the use of implants with exteriorized injection domes for patients undergoing breast augmentation. Domes were exteriorized for 1 to 5 days to allow the implant volume to be altered in the early postoperative period. Thirty-three patients were treated without any infections.     

Cosmetic breast augmentation utilizing autologous fat and liposuction techniques

I have presented a new technique of autologous fat transplantation which utilizes fat obtained by liposuction. I believe that this technique will have wide application in the future of cosmetic and reconstructive surgery.