Lipo innovations: Female breast reduction, 'plasty' alternatives expand

New York - Interest in tumescent liposuction has expanded to a variety of new indications, including postmenopausal "lumpy" back fat deposits and as an alternative to more invasive procedures such as abdominoplasty and surgical mammoplasty, according to Naomi Lawrence, M.D.

"Researchers have found gold in garbage," Dr. Lawrence said here at an American Academy of Dermatology press conference held in conjunction with National Healthy Skin Month.

While fat can be used as facial filler, some patients who need a lot of filler don't have adequate fat in donor areas. "For these patients, using their stromal cells and expanding them could work," Dr. Lawrence says. "They are much smaller, more resilient cells, and I think the survival of the fat graft would be better."

An article on stromal cells from liposuctioned fat will be published in an upcoming issue of Dermatologic Surgery.

Breast reduction in women For years, men have sought liposuction to treat gynecomastia, but now, there is increasing interest among women in the use of liposuction to reduce fatty breast enlargement. "Women looking for a moderate one to two-cup size reduction actually do beautifully with liposuction," Dr. Lawrence says.

There have been many reports on treatment of breast hypertrophy in the medical literature, but these have generally been based on small series. Recently, however, Moskovitz et al reported a 117-patient survey suggesting liposuction breast reduction is effective and has high rates of patient satisfaction (Plast Reconstr Surg. 2004; 114: 55-60).

In the 78 questionnaires returned (67 percent response rate), the "vast majority" of women reported resolution of complaints such as neck and back pain, intertrigo and shoulder ruts; on average, women returned to work in five days, and resumed full exercise after two weeks. In addition, 80 percent were very or completely satisfied with outcomes, and nearly all (92 percent) said they would recommend the procedure to a friend.

Nipple elevation is a possible added benefit of liposuction breast reduction. Currently, Dr. Lawrence and colleagues are performing a study looking at the predictability of cup size reduction and amount of nipple elevation after fat removal. "We are also following mammographic changes, such as breast calcifications and scarring," she says. "Because liposuction is less invasive than traditional breast reduction, there are fewer mammographic changes."

Tummy tucks and bumpy backs It is the resiliency of the skin, also among older women, that allows for the success of the liposuction breast reduction procedure. Even women over 40 years of age can experience retraction and redraping of the skin following liposuction of the arms, neck and abdomen (Bank DE, Perez MI. Dermatol Surg. 1999;25:673-676).

Consequently, liposuction is increasingly being recognized as an alternative to abdominoplasty - perhaps for the majority of women desiring this procedure.

"In fact, it's very rare for me to send patients for a tummy tuck at all," Dr. Lawrence says. "The only people I actually send (to abdominoplasty) are those who have very little fat in the abdomen and only hanging skin, or who have undergone a weight reduction procedure and lost tons of weight and have a lot of excess skin."