Breast enlargement with own fat

As early as 1896, the German physician Dr NEUBER successfully transplanted the patient's fatty tissue into a different body site of the same patient where a defect had been caused by accident. In 1910, an almost 300-page paper on fat transfer from Dr LEXER appeared. In the time between the world wars, it became quiet around this method. It was not until the seventies that the transfer of own adipose tissue was resumed in the USA, and especially the doctors SHIFFMAN and COLEMAN have made a particular contribution.
In Germany, it is Professor PALLUA, from the RWTH Aachen, who initiated the most scientific work in this field.

Regarding the breast augmentation with its own adipose tissue, there were up to about 2005 more depths than heights. Only in the last few years has it been understood which basic conditions have to be considered so that the fatty tissue is not damaged during the removal and the composition of the other components is not significantly changed. It is therefore important how the adipose tissue which is to be sucked is pre-treated by the anaesthetic solution, the size of the perforations of the suction cannula, the vacuum which prevails during suction, and how fast the cannula moves. The aspirate must be washed to reduce inflammation-mediating cells, and the fibrous tissue must be gently removed from the adipose tissue without injury to the adipocytes. Depending on the further use, the fat cells are mechanically ruptured so that the oil can be centrifuged. Everything is done under extremely sterile conditions, which is only possible in the clean room laboratory with laminar, Hepa filtered airflow, existent in the Medical Well Clinic Dresden.

The transfer of the adipose tissue into the breasts is difficult because small fat droplets must be evenly distributed. Here a special machine is used which, on the one hand, serves the fine distribution of adipose tissue and, on the other, shortens surgery for the benefit of the patient. If the fatty tissue is only simply injected, oil cysts can develop, which always lead to discomfort from a certain size. These are important work steps in the process of fat tissue production, processing and application. There are other factors that need to be considered, still.

In the processing of the adipose tissue obtained for further use in the same patient, there is a trend away from the (1) enzymatic, chemical separation of the regeneratively active cells from the adipose tissue (here, considerable regulatory hurdles have to be overcome) to (2) little manipulative, purely physical processing.
In the 1st method, one runs the risk that the isolated stem cells lead their uncontrolled self-life and, for example, emigrate from the actual target area and withdraw themselves from further control. In addition, there has been increased scarring in the target area. To this extent, the legislator is right to apply strict standards here. Also, the admixture of these chemically dissolved stem cells to the normal fatty tissue (so-called "enhanced fat") has not brought any gain in breast enlargement, only more valuable adipose tissue consumed (according to a prize-winning study by Dr PELTONIEMI, University of Helsinki).
In contrast, in the second method, the regeneratively active cells (stromal vascular fraction) remain within their niche, consisting of an extracellular matrix, providing intercellular communication, and are controlled by this in their further behaviour. The adipose tissue is only micronized but remains retained with approximately 90% of its cells in its composition. The stem cells do not migrate from their niche and behave along natural signals from their surroundings in the target area.

At the Medical Well Clinic Dresden, adipose tissue transfers have been carried out since 2002. Since 2009, we have been working intensively on the fast-growing biotechnological insights and scientific results. This led to the installation of a cleanroom lab in the operation line in 2012. For nearly 5 years (as of May 2017), we have been able to reproduce validated scientific studies in our laboratory and are thus always up to date in our daily practical application. Without having to undertake costly examinations and laborious investigations, we know from the scientific literature exactly how the tissue cells to be transferred are composed in numbers. We can observe all factors that lead to a maximal acceptance of the transmitted tissue cells. Permanent volumes (eg, in breast enlargements) of about 70-80% of injected substance are often possible. The present description represents the current standard.

A current research topic is the bacteria-free inflammation reaction, which prevents a better growth of the transferred tissue parts. There are already approaches to solving this problem.
We review the latest scientific literature every month.

In the medium term, women with little adipose tissue and thus few regenerative cells will achieve an even better volume result by applying a vacuum before and after surgery. This will make the number of women who have previously required a breast implant smaller.

  Stay in contact.

Dr. med. Michael Meinking
Senior physician of the Medical Well Clinic Dresden

Breast Enlargement with breast implants - what should patients expect?

Most patients would like well-formed breasts, which are cohesive with their bodies and therefore look natural. You would prefer to take only a few days of vacation due to the breast enlargement procedure, and to avoid any unnecessary pain. The result should be disability-free, with no impairment of normal arm movement. The operation should be completed with as few risks as possible. You expect healthy healing after the surgery, with discreet scars (if any). You expect excellent results from high-quality silicone implants, and a surgery performed without general anesthesia. You prefer to work with a highly-skilled and friendly group.

At the Medícal Well Clinic Dresden, we have developed an approach with which every one of these desires can be met. 
We proceed by:

The investigation and questioning of the patient, as well as having the patient trying on dífferent sizes of imitation breasts to help provide insight to both the patient and surgeon as to what the proper size of implant will be. At the time of surgery, we have neighboring sizes of implants available (at least six implants per patient) for optimal patient selection. Most implants we use are between 240-310 ml. Other sizes are available. The position of the implant between the breast and the large pectoral muscle allows the surgeon the freedom of all necessary positioning for a well-formed and natural-looking female breast.

Implant positioning above the pectoral muscle

The operation associated with our specific  procedure (see below) has such a low risk of injury and such mild postoperative pain that most patients require only mild painkillers for a day or two. Following this surgery, 15% of our patients return to work the following day, and approximately 95% return to work within a week of the procedure. This is only possible if the large chest muscle is not partially separated from the rib and the sternum, keeping the implant above the large breast muscle. The pectoral muscle naturally has a "compartment" which can be easily expanded to accommodate the implant with the use of Tumescent Local Anesthetic. Using this method, no structures have been injured that would later cause severe pain. This modern local anesthetic helps to inhibit bleeding during surgery. lt also prevents the pain which usually appears immediately following the operation. Tumescent local anesthesia lowers subsequent pain and makes general anesthesia unnecessary. Bacteria find the tumescent-created environment uncomfortable, thereby supplementary reducing the risk of infection.

lf the implant is placed, in part, under the chest muscle, a separation of the pectoralis major

muscle (pectoralis major) from the rib and partially from the sternum is required. This causes more severe paín, that lasts much longer (sometimes for months) than our preferred method of above-muscle placement. This longer-term pain delays the return to work and normal life activitíes. Additionally, this approach is associated with a loss of strength and a limitation of fine motor coordination of both arms, ln many such operated patients, there is a curvature (bulging) of the upper outer breast tissue for at least the first few months after surgery. Only years later, after the implant settles deeper under the tissue and has no more contact with the pectoral muscle (under which it was once set), does the breast feel better. One wonders why the injury during the under-the-muscle operation has to be so great. We have a series of photos with which one can understand these claims. Moreover, under-the-muscle placement may lead to the peculiar "double bubble" formation which occurs when the intact remainder of the pectoralis major muscle contracts and pushes the implant down (towards the feet). Due to the implant's placement below the chest muscle, the "snoopy nose" deformity can also occur and the result is unattractive.

We understand that patients do not expect such phenomenon ("double bubble" and "snoopy

nose") and pain. Therefore, we place the implant under the gland and gently on the pectoralis major muscle. A few years ago, only about 20% of breast augmentation operations in Germany were performed this way. Today, it is closer to 50%. The trend shows that we are right.

Various measures can be used to reduce risk during surgery.

The advantage of tumescent local anesthesia

Unfortunately most breast augmentations are still performed under general anesthesia. Using a special local anesthesia in this operation, ín our practice, has shown to increase benefits and reduce drawbacks. Some of the benefits were previously mentioned above. lt is noteworthy that patients having this operation would not enter the risky world of general anesthesia under our care. We have drawn the conclusion: it is safer and healthier for our patients to perform breast augmentation without general anesthesia.

lnfections should be avoided

lnfections are not only evidenced by fever, warming of the chest, and festering wounds. So called "water bubbles" or gatherings, and just about any wound that does not immediately heal/close should be seen as signs of infection. Circulatory disorders (smoking or surgical technique) can promote infections. ln our clinic, special antiseptic intraoperative measures make ínfections almost impossible. Simultaneously with the antiseptic principle in the MedicalWell Clinic Dresden (proven by scientific studies), improved blood flow and supportive metabolic changes in the wound area are achieved, which leads to accelerated wound healing. In the absence of germs scarring is reduced. Antibiotics are always avoided, wound healing thereby not disturbed.

All living organisms (excluding bacteria) have a similar defensive system which made possible the emergence of higher developed life after the microbes. This system we complement (and replace if necessary) with our biomimetic concept. As a result since opening the MedicalWell Clinic Dresden (July 2002), we have never had a patient suffer a postoperative wound infection. Guest doctors are impressed by the clean incisions after all the operations, in each stage of healing (see link [3]).

The typical sequence of breast augmentation with treatment in our clinic looks like this:

1.  Mondays: Operation/Procedure. Streching arms vertically same day possible. Simple  painkillers, if necessary
2.  Tuesdays: dismissal with tape and bra (about 15% of our patients return to work from   the first post-op day)
3.  Wednesdays: remove drainage, clean incision area, begin wearing specíal sports bra  for 2 months
4.  Thursdays: about 30% of our patients return to work
5.  Fridays: apply a thin dressing that is appropriate for full showering (rarely is another   appointment necessary)
6.  Monday: after one week, approximately 95% of our patients return to work
7.  Monday: after two weeks, removal of stitches, as well as delivery and explanation of   silicone tape.
8.  After six months: first follow-up with doctor
9.  After one year: second follow-up with doctor
10.  Promise: If capsular contraction (Baker III or IV) within 3 years after operation in  our clinic, complete operation free of charge, new implants included.