The typical combination procedure addressing post-pregnancy woes usually includes a tummy tuck and breast enhancement to tighten abs and lift and/or augment breasts. Dr. Ned Snyder, whose practice is based in Austin, Texas recently performed a mommy makeover with a twist. The prospective patient’s tummy was fine, thank you. But her thighs were XL and heavy, while her breasts were XS and sagging…and the age old question was posed–“Can’t we take some from down here and put it up there?” Dr. Snyder said, “Yes.” The surgical plan included a three step procedure: circumferential thigh reduction, breast lift, and fat grafting to the breast. The result? Thinner thighs, perkier breasts and an extra cup size.
by Isabel Bolt
and Ned Snyder IV, MD
Lifting the Breasts
A breast lift, also known as mastopexy is one of the most frequently requested procedures in plastic surgery. According to the latest statistics from the American Society of Plastic Surgeons, breast lifts have grown 70% since 2000, outpacing breast implants 2-to-1. A woman’s breast shape, size and firmness is compromised over time and is particularly influenced by pregnancy and nursing, but can also be due to heredity, aging and weight fluctuations. The exact techniques used to lift the breasts is determined by the size of the breasts, amount of ptosis (sagging) and the position of the nipple. A mastopexy raises the breasts by removing the excess skin, tightening the surrounding tissue to reshape the new breast contour, and in some cases, reposition the nipple. Keep in mind, the purpose of a breast lift is to reposition the breast. It does not address size.
Thinning the Thighs
Most women are not in love with their thighs. Thighs are a problem: they are among the most fat-concentrated parts of a woman’s body. Heavy thighs can be an issue for adults of all ages, even young and generally fit people. Liposuction targets those deposits of fat on thighs that never seem to go away regardless of diet and exercise. If you are within 10-20 pounds of your ideal body weight but are still frustrated by large thighs, liposuction could be the answer. Dr. Snyder performed a circumferential thigh reduction with liposuction to remove deposits of excess fat from various parts of the patient’s upper legs, tightening the skin left behind. “I was able to improve both contour and proportion. She now has a nice overall reduction of tissue in her thighs.”
Liposuction is surgery. Depending upon the total area or areas and volume of fat to be removed, either local or general anesthesia is used. Combination procedures almost always require general anesthesia. A cannula (a hollow metal rod device) is inserted into small incisions and in simple terms, the fat is melted, dissolved and removed via suction. Excess skin around the incisions is tightened and sutures are applied. Compression garments are worn for several weeks to discourage bruising and swelling. Scarring is eventually invisible and final results a usually evident at the 3 month mark.
The firmer and more elastic the skin, the better the results. It will not get rid of cellulite. Liposuction gets rid of some fat cells for good, leaving less to expand and contract and so reducing fat levels permanently.
Fat: The Beauty of Recycling
Our relationship with fat is schizophrenic. Condemned on one body part. Celebrated on another. Dr. Snyder’s patient wanted smaller thighs, but a bit more in the breast area. He explained to her that since she commented that she didn’t want implants, but just a bit more volume to her breasts, she was a great candidate for lipo augmentation. “The fat I was going to take from her thighs would typically be discarded. She indicated that an increase of one cup size was all she wanted, so why not save the fat from her thighs and inject it into her breasts?” Since a breast lift does not significantly change the size of a woman’s breasts or round out the upper pole of the breast, fat grafting is a great alternative for those who want a modest increase without the maintenance of an implant.
The methods for harvest and injection have also been refined over time but fat grafting remains one of the most technique dependent procedures in plastic surgery. It should never be done by any physician other than a board certified plastic surgeon if you want the fat to remain over time. Dr. Snyder is experienced in both liposuction and fat transfer. “In the case of this mom, we used 120ccs (about 24 teaspoons) of lipo filling in each breast.”
Augmenting the breast with the body’s own fat first became popular in the 1980s. ASAPS initially cautioned its members because of potential side effects which could potentially make mammograms difficult to interpret. However, digital mammography, especially when examining dense breast tissue has greatly improved interpretation. In addition, recently published studies suggest that radiologists are able to distinguish between the changes seen after surgical procedures to the breast and changes that are suspicious for cancer.
A Happy Ending
“This was a lady who came to us with two concerns,” says Dr. Snyder. “Excess weight around her thighs and breast rejuvenation after breastfeeding two kids. We were able to get her to her target goal and she looks just great. She’s thrilled.”