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Selective sculpting

Article-Selective sculpting

Key iconKey Points

  • Although liposuction is considered a minimally invasive surgical technique, ultrasound-assisted lipoplasty (UAL) is even less invasive
  • According to one expert, the UAL technique for breast reduction helps to achieve good aesthetic results with minimal scarring

32-year-old female patient shown pre (photos 1 and 3 above) and post ultrasound-assisted liposuction (UAL) for breast contouring (photos 2 and 4 above). UAL was performed for 25 minutes on each breast yielding 550 ml of aspirate. All photos credit: Alberto Di Giuseppe, M.D.
Of the numerous contemporary techniques for breast reduction, one of the least invasive is liposuction. However, according to one plastic surgeon, ultrasound-assisted lipoplasty (UAL) is even less invasive and is one technique that can help achieve maximum aesthetic results with minimal scarring — especially when used on the right patients. The technique consists of progressive adipose emulsification through the use of the Vaser probe — a solid titanium probe cannula that transmits ultrasonic energy to target the fatty tissue of the breast. The emulsified fat is then aspirated from the lower quadrants of the breast. As the volume of breast tissue is decreased via emulsification with the Vaser probe, the breast cone elevates in counteraction to gravity. The low frequency ultrasound energy helps enhance the retraction of the breast skin and helps re-drape the breast skin to the newly shaped and reduced mammary cone.

20 MINUTES, TWO SIZES "Approximately 20 to 30 minutes of ultrasound application, while preserving the central cone of the breast — including the nipple-areola complex — is enough to reduce the breast brassiere volume by two sizes," Alberto Di Giuseppe, M.D., tells Cosmetic Surgery Times . "In America, the most common breast reduction procedure has an inverted-T incision and the scar is therefore bigger and more visible," says Dr. Di Giuseppe, a plastic surgeon in private practice in Ancona, Italy. "A major advantage of the [UAL] technique is that it leaves only a minimally visible scar—one of the main goals that every plastic surgeon strives for. There is a 1-cm scar at the inframammary crease where we introduce the ultrasound probe. The other 1-cm scar is at the axilla, which is far less scarring than those you get from other more aggressive techniques such as vertical or inverted-T scar breast reduction surgery," he adds.

Alberto Di Giuseppe, M.D.
SELECTIVE SOUND Standard liposuction procedures cause an indiscriminate, mechanical, nonbiased destruction of the subcutaneous tissue, including the vessels, nerves and supporting structures. By contrast, Dr. Di Giuseppe explains, UAL is highly selective, destroying only the fat tissue and sparing the fibrous supporting tissues and blood supply so important to a well-structured and healthy breast. "The selectivity of the ultrasound makes it a cautious and safe technique as it spares the glandular tissue, the vascular network of the gland, breast sensation and the potential for breast feeding," Dr. Di Giuseppe notes. "The ideal candidate for this procedure should have a juvenile breast that is mainly fatty with good skin tone and elasticity and should not have a difficult degree of breast ptosis," he says. According to Dr. Di Giuseppe, the limit in the degree of the ptosis that one can successfully treat with this technique is a maximum raising of 3cm to 4 cm the level of the nipple-areola complex.

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