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Hyaluronic acid filler adds value as minimally invasive option for breast enhancement

Dr. Hedn
Hyaluronic acid gel for breast augmentation (Macrolane VRF20/VRF30, Q-Med) is a new tool with a clear indication because of its simplicity, safety and high patient acceptance, says Per Hedn, M.D., Ph.D.

"If we consider the population of patients interested in breast enhancement, those willing to undergo implant surgery are only the tip of the iceberg. This leaves a huge population of women looking for alternatives," says Dr. Hedn, associate professor of plastic surgery, Karolinska Institute, and chairman of the private Akademikliniken hospital, Stockholm.

"Hyaluronic acid gel injection helps to meet this need. It provides immediate results with minimal discomfort, and in clinical trials, it was associated with high ratings of breast general appearance, shape and firmness. In addition, satisfaction with hyaluronic acid gel breast augmentation can open the door to implants. In my practice, the conversion rate is more than 30 percent," Dr. Hedn says.

PROS AND CONS Just like implants and fat injection, hyaluronic acid gel has both advantages and disadvantages that need to be discussed with patients so they can make an informed decision, Dr. Hedn says. There have been no early or late serious adverse events noted in studies with the product to date. However, patients must also be told that even though more than 15 million injections of the non-animal stabilized hyaluronic acid gel has been given in the face in the last 15 years, because hyaluronic acid gel for breast augmentation is still relatively new, data from long-term experience and large series are lacking, he explains.

Other limitations include the fact that absorption of the material is unpredictable, but it may be rapid. The amount of gel remaining after one year varies from 5 to 85 percent, and patients should anticipate the need for a touch-up after nine to 12 months, he says.

Capsular contracture also can occur. In clinical trials, the rate of capsular contracture resulting in firmness, displacement, visibility, nodularity or asymmetry ranged from 4 to 22 percent during the first 12 months after injection. Left untreated, the problems disappeared spontaneously in most cases. By 24 months, the complication rate was 2 percent, Dr. Hedn says.

There were 17,195 breastlifts after massive weight loss (MWL) in 2010, according to the most recent statistics reported by the American Society of Plastic Surgeons (ASPS) — up 6 percent from 2009. And with the continued success of bariatric surgery-related weight loss, experts predict that demand for contour deformity correction of the breast will continue to rise.

In patients who have undergone massive weight loss (MWL), a circumvertical approach to breast augmentation mastopexy allows surgeons to perform these procedures together, says Dennis Hammond, M.D.

Megavolume lipografting, enabled by pregrafting external tissue expansion that creates an enlarged, vascularized recipient space, is a safe and predictably effective approach for breast augmentation, says Roger K. Khouri, M.D.

From traditional labiaplasty to filler injections, patients interested in female genital rejuvenation have a growing array of options, says Christine A. Hamori, M.D.

Mastopexy inevitably results in a visible scar, and the scar is particularly lengthy after parenchymal reshaping and dermal suspension mastopexy, acknowledges J. Peter Rubin, M.D. Nevertheless, satisfaction is high among its target population — massive weight loss patients — because it successfully addresses their extensive deformities and with long-lasting results, he says.