WebMD Medical News
Louise Chang, MD
Oct. 17, 2008 -- Breast implants aren't the only remedy -- and perhaps not the best remedy -- for women whose breasts are sagging and very misshapen after massive weight loss, multiple pregnancies, or aging.
An alternative to breast implants, using a technique called spiral flap reshaping of the breast, may offer more satisfactory results, says Dennis Hurwitz, MD, clinical professor of plastic surgery at the University of Pittsburgh and a Pittsburgh plastic surgeon. Hurwitz, who pioneered the technique, will offer an update of his results Nov. 2 at the annual meeting of the American Society of Plastic Surgeons in Chicago.
When implants are used in patients with extremely sagging breasts, the results are often disappointing, he says. "In patients with loose skin, implants sag a lot," says Hurwitz. If the sagging is extreme, he says, the breast implants end up looking "like a rock in a sock."
As more patients lost massive amounts of weight -- 100 pounds or more -- after diet and exercise or bariatric surgery, Hurwitz encountered more patients unhappy with their extremely sagging breasts that flatten out to somewhat of a pancake shape. Others have the so-called pancake breasts as the aftereffect of multiple pregnancies or simply aging.
Over the last five years, he has published the results of his spiral flap technique, which is technically known as a spiral flap with an upper body lift. He describes it as a "two-fer," giving the patients some body contouring along with improved breasts.
In the technique, excess tissue and fat is taken from the patient's upper abdomen, along the bra line, or from beneath the upper arms, and that flap of tissue and fat is rotated into place to augment the breasts. The breasts are usually lifted as well.
Hurwitz has now performed the technique on more than 100 patients, he tells WebMD, and many other surgeons have learned his technique or variations. "Several hundred plastic surgeons are now doing this," he says.
None of the patients had significant infections, he says, and there have been no deaths or serious complications such as blood clots in the lung.
About one-fifth had tissue death in an area that was transferred, he says, but in most cases it resolved on its own.
Overall, Hurwitz says, he has had good results with the flap technique. In all, 15 patients of the 100 asked for further enlargement with breast implants later.
One downside, he says, is that "it's hard to tell [in advance] how big the breast will be."
In a report of 18 patients who had the spiral flap technique, published in the Annals of Plastic Surgery in 2006, Hurwitz says that 14 of the 18 were pleased with results, although three of the 18 got breast implants later because they wanted more augmentation.
One of the three who had tissue death needed more surgery to correct the problem. One patient did not like the back scar resulting from the tissue transfer, and two disliked the shape of the breast but did not come back for revisions.
The spiral flap technique of improving breasts is more time-consuming, complicated, and expensive than traditional breast implants, Hurwitz says.
The doctor's fees are about $16,000, he says, but include the breast reshaping along with body contouring. Hospital costs for two days are additional.
The average doctor's fee for breast implants is about $4,000, according to the American Society of Plastic Surgeons.
A typical patient who does well with the spiral flap procedure is a woman who has lost about 100 pounds, Hurwitz says, either by diet and exercise, bariatric surgery, or a combination.
Those who seek the flap surgery for breasts misshapen by aging or pregnancy can't be too thin, he says, because they don't have enough "donor" tissue and fat. Typically, Hurwitz says, women who get the best results have a body mass index (BMI) of 28 or higher. Under 25 is termed a healthy BMI.
"If the BMI is under 26, a woman probably doesn't have enough fatty tissue to do this," Hurwitz tells WebMD.
Deciding who might be a candidate for the spiral flap technique must be done on a case-by-case basis, says Scott Spear, MD, chief of plastic surgery at Georgetown University Hospital in Washington, D.C., who is familiar with the technique.
"If patients have enough tissue [to be transferred], it is a good option," he says. Most patients do like the "two-fer'' advantage, he says, in that they also get some body contouring.
SOURCES:Dennis Hurwitz, MD, plastic surgeon; clinical professor of plastic surgery,
University of Pittsburgh.Scott Spear, MD, chief of plastic surgery, Georgetown University Hospital,
Washington, D.C.Annual meeting of the American Society of Plastic Surgeons, Chicago, Oct.
31-Nov. 5, 2008.Hurwitz, D. Annals of Plastic Surgery, May 2006; vol 56: pp
481-486.American Society of Plastic Surgeons: "American Society of Plastic
Surgeons 2007 Average Surgeon/Physician Fees.
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