Liposuction is also known as "fat plastic surgery", "fat shaping", "liposuction", refers to the removal plastic surgery of various parts fat of the human body.
Fat is below the skin and above the muscle, can be divided into shallow, middle, deep fat, there are some fiber and microvascular tissue in the fat middle, liposuction too deep will injury muscle and easy to bleeding, too shallow easy lead to uneven.
 
The origin of liposuction surgery
Since the 1960s, some European physicians have used scraping surgery to remove some fat, but because the results will be bleeding and uneven, so this fat removal surgery was soon eliminated; 1974, two Italian gynecologists (Dr. Arpad and Giorgio Fischer) developed a "blunt tunnel" approach, In 1982, the French surgeon (Dr. Yves-Gerard Illouz) invented the "suction assisted lipolysis", combined the concept of the blunt tunnel and negative pressure aspirations, to achieve the commonly known liposuction surgery we know today; there is a French physician (Dr. Pierre Fournier) the use of local anesthetic and postoperative elastic clothing wearing, making the surgical results improved. Then under the joint assistance of many American orthopedic surgeons, today, " super-wet liposuction " and "swelling of the local anesthesia liposuction" is the most widely used and accepted liposuction surgery skills.
 
The lower part of the body is easy to accumulate fat parts, including butterfly sleeves, face, neck, chest, waist, back and other excess fat can be liposuction surgery, to achieve the perfect body sculpture.

 
A two - stage description of liposuction surgery
The first stage
Inject the local anesthetic into the treatment area, the local anesthetic drug injection dose, each treatment site into the amount of local narcotic drugs, impact the physician liposuction surgery final suck out amount of fat, can be divided into four categories:

• Dry - No local anesthetic drug
• Wet - 200-300cc diluted anesthetic drugs of each area
• Super Wet - Average inject 1 cc of diluted anesthetic and extract 1 cc of fat
• Swollen Tumescent – inject 2-3cc diluted anesthetic, extract 1cc of fat

 
The second stage will be fat withdrawal from the treatment area, different liposuction surgery options:

• Traditional liposuction - liposuction with manpower.
• Computer power assisted liposuction - The use of computer-assisted liposuction machine to carry out liposuction
• Waterjet power assisted liposuction -The use of high-pressure fan-shaped water column, loosening the structure of adipose tissue. at the same time can continuous extract fat and inject water to lose fat. Water knife liposuction do not need to inject too much swelling liquid, postoperative edema situation will be reduced, of course, save time and effort is also the focus.
• Ultrasound Power Liposuction - Use ultrasound-assisted power liposuction machine to carry out liposuction.
• Laser liposuction - Dissolves fat with laser energy then proceed liposuction.

Since the beginning of the 1990s, orthopedic surgeons have autologous fat transplant surgery, a great amount use on the face, breast, hands and hips cosmetic surgery, in recent years has been developed from the body fat for the healing of difficult wounds, scar repair even after radiotherapy defects (such as breast after the breast cancer radiotherapy), all have a very significant and effective help!
 
Fat transplantation, also known as fat injection, the process of surgery is a part of the body fat transplanted to another part of the body, including three steps:

1. Lipid surgery - fat extraction
2. Fat essence - fat purification essence
3. Fat implantation - the essence of the body fat injects back into specific parts of the body

 
The first stage: Fat extraction
Try to use thinner and porous liposuction tube to extract fat, laser solution fat or ultrasonic liposuction, generally considered to be more likely to hurt fat cells, so it is not recommended.
 
The second stage: Fat essence
After stand still, and then centrifuged by the centrifuge machine, the excess liquid will be excluded, some doctors will use physiological saline to clean out the fat particles. This step is very important, because those poor-quality fat cells not only cannot survive after transplantation, and may even affect those good fat cells.
 
The third stage: Fat implantation
The most important step, because the need to carefully pay attention to the essential fat particles, well implanted into the area that need to implant, not only the location is important but the number and size of fat is also very important. The "fine autologous fat gun", invented by Dr. Lin's, is an important tool for dealing with this critical step, because according to the study, it is noted that the tiny fat is transplanted, the higher the survival rate, relatively to large fat particles after implantation only will be more likely to produce the phenomenon of central necrosis.

 

In 2001, the University of Pittsburgh orthopedic surgeon, first published on the study of adipose-derived stem cells, in which found that adipose tissue in the middle of the texture cells (mesenchymal stem cells (MSCs)) is 300-500 times the bone marrow tissue, therefore, fat transplantation not only can be used in cosmetic surgery, also can further used in radiation therapy of defective tissue, such as breasts, or difficult wounds, such as diabetic foot wounds.
 
Autologous fat is completely belonged to self, lipstick essence of the implant process is completely sterile, and therefore can reduce the risk of infection and rejection to a minimum. The key of constitute a successful operation interlocking, such as: preoperative assessment, anesthesia method, liposuction surgery, the essence of fat, and then use the fine autologous fat gun, to transplant these precious fats to the parts we want:
 

• Face (10cc-100cc)
  Transplant the fat into the subcutaneous tissue location: the eye, the eye concave, tears, apple muscle, husband and wife palace, forehead, smile lines, marionette lines, bridge of nose, tip of nose, chin, upper and lower lips, neck, almost all parts of the face can use fat transplantation fill surgery to restore the appearance of youth. In addition to the increase in volume, adipose stem cells in the growth factor can also allow implantation of subcutaneous collagen regeneration, can effectively reduce the fine lines!
   
• Breast (25cc-400cc)
  Each fat transplant can increase the breast about half to two cups, depending on the condition:
  1. The amount of fat to be transplanted
  2. The size of the area where the breast itself is available for transplantation
  In addition to beauty, for breast cancer surgery because of local or total removal of the breast caused asymmetry, or because of surgical scars caused by depression and the atrophy of the breast after radiation, also have excellent treatment results.
   
• Buttocks (100-1000cc): peach buttocks, buttocks.
  the back of the hand, the instep: correct chicken hands, chicken feet.

 

精微自體脂肪槍 MAFT-GUN® (Micro-Autologous Fat Transplantation Gun)

1. Trace output
   The use of fine autologous fat gun, fat particles can be the smallest to achieve 1/240 ml, fat survival rate will be greatly improved!
   According to the theory of Carpaneda physician, during the fat transplantation each time the fat ball transfer into the body, its’ radius preferably less than 2 mm (1 mm ≦ r ≦ 2 mm), in order to have the best survival rate. According to this theory, each milliliter syringe filled with fat, if the injection of a radius of 1 mm fat ball, each milliliter must be injected 240 times to achieve this goal! Fine autologous fat gun can accurate and precision reach 240 times per milliliter output.
    
   Many after the fat transplant surgery, due to the implanted ball volume is too large, resulting in adjacent tissue cannot transmitted nutrition to the central part of the ball, and metabolic waste cannot be successfully discharged from the periphery, causing the so-called central necrosis, through fine autologous fat gun, necrotic situation significantly reduced, survival rate effectively improved.
    
2. 360-degree multi-directional output
   When the doctor is doing the implementation of fat transplantation operation, often because the injection needle tip fixed opening side cannot change the direction, must always rotate the wrist angle to change the output position, effort and inaccurate! The patented syringe chuck structure of the fine autologous lip gun is not only free to adjust the direction of more than three hundred and sixty degrees, but also have the indication of the clear direction, which can provide the doctor with judgment basis to change the direction of the output, improving the efficiency of surgery, even can accurately transfer the fat to the location to be implanted!
    
3. Impenetrability controlling reduces possible air contact and relative contamination opportunities
   Most commercially available fat grafts use their own metal push rods to replace the putters with 1 ml syringes, often causing the filled adipose tissue exposed to the air. The impenetrability controlling of the fine autologous fat gun will not cause the fat inside the syringe to be exposed, reduce the chance of fat exposure to air, and reduce the chance of contamination and infection.
    
4. Multi-stage control
   Adipose transplantation should be with the difference of surgical site anatomical location and the individual differences of the organizational structure, to elastic adjust the amount of fat injection volume, fine control of the operation movement of each injection volume, is the key step of fat transplantation to the success or failure. The patented "multi-stage controlled injection system" of the fine autologous fat gun provides physician the choice of multi-stage adjustment of the injection volume from 1/60 ml to 1 / 90,1 / 120,1 / 150,1 / 180,1 / 240 ml, according to different needs, anatomical location and tissue structure, elastic select of the required injection of each output volume, accurate and fine injection of fat particles. 
    
5. Stable and accurate output volume
   In some parts of the body injection site, due to the more tough subcutaneous connective tissue structure, must according to this repeated back and forth to push and pull needle action, to pound loose the tissue, so can inject microinjection of fat, injection needle repeated action (repeated back and forth to push and pull the needle) too much damage and impact, resulting in postoperative difficult to avoid the bruises and swelling. Fine autologous fat gun patented action system, with the pre-determined precision output volume and each accurate push, regardless of the size of the power of the physician, the speed of injection or not, can be deducted by each trigger action operation, each push the output volume is stable, consistent and accurate and accurate fat ball, a large number of reduced the planting area back and forth rubbing of ​​the drill hole type, so that the recovery period is greatly shortened, the patient swollen blood stasis appearance is also far less than other traditional surgical methods.

Breast augmentation surgery is divided into:
1. Autologous fat transplantation (The higher the BMI, the body has enough fat to carry out autologous fat transplantation.)
2. Falsies implantation
Every falsies material has their own advantages and disadvantages:
The latest water droplets jelly silicone (fifth generation)
Smooth surface jelly silicone (fourth generation)
Salt water bag
 
Every falsies material has their own advantages and disadvantages:
A. The latest water droplets jelly silicone (fifth generation) (hair surface water droplets jelly silicone)
Touch: elastic, feel natural
Whether the need for massage after surgery: no, because the villi surface structure is relatively not easy to form a capsule contracture.
Surgical wound size: about 4 to 5 cm
Recommended surgical method: the lower edge of the breast> armpit> areola
Case of rupture: chest shape will not shrink, but may feel the shape change, it is recommended to do MRI inspection
 
B. Smooth surface jelly silicone (fourth generation)
Touch in case of rupture: 1.5: elastic, the most natural touch
Whether or not massage is required after surgery: Yes, because the smooth surface structure has a little chance to form a capsule contracture.
Surgical wound size: about 4 to 5 cm
Recommended surgical approach: the lower edge of the breast> armpit> areola
Case of rupture: chest shape will not shrink, but may feel the shape change, it is recommended to do MRI inspection.
C. salt water bag
Touch: a little lack of elastic feeling, sometimes squeeze the water will have a sense of volatility, may touch the edge of the fold.
need a massage after surgery: Yes.
Surgical wound size: about 3 to 4 cm
Recommended surgical approach: the lower edge of the breast> armpit> areola >navel
Case of rupture: chest shrink, salt water absorbed by the body.

On the choice of breast augmentation surgery, as well as the advantages and disadvantages of various locations:
 

1. the lower edge of the breast
   Method: surgical entrance is located at the lower edge of the breast, that is, when usually wear underwear, underwear steel ring will block the place. The incision of the location, can look directly very clear at the organization and full of stripping, not easy to cause additional damage to the nearby tissue, the pain will be the lowest.
   
   Location: The breast after the breast augmentation, just can cover the scar, is not easy to discover from the front and side, do not have to worry about the armpit exposed when wearing a thin shoulder strap, sleeveless shirt, and bikini is just cover as well. Widely accepted in Europe and the United States, in recent years, the Asian region, including South Korea, Taiwan, the ratio of selecting this surgery is also getting higher and higher.
   
   Recovery: the lower edge of the chest most of the wound recovered very well.
    
2. Armpit
   Way: choose the most depression place under the armpit for incision, and then use endoscopic for assistance, stripped the organization, put the falsies in. Because the armpit is far from the breast tissue, so it is recommended to use endoscopic assistance in order to accurately isolate the correct space to implant the falsies.
   
   Location: Although at the most depressed place of the armpit, but if the care is not perfect after surgery, occasionally also see the scar turning wide, scar appear pigmentation or scar depression, in the case of choose dressing, such as thin shoulder strap, sleeveless shirts or bikini are subject to the scars condition.
   
   Recovery: As the wound at the armpit, after surgery massage will not affect the wound healing, most of the armpit wounds are recovered well. If you have a scar body, usually used to wear the cloth easy to expose the armpit, then the surgical approach of the incision may need to be assessed.
    
3. AreolaMethod: from the lower edge of the areola proceed operation, the location of the incision close to the organization to be stripped, can clearly look directly at the organization, and can be fully peeled. Unfortunately, due to the incision through breast tissue, if the physician is lack of experience, may hurt part of the breast, may also affect the feeling of the nipple, the infection rate is slightly higher. The chance of capsule contracture is also a little higher.
   
   Location: the lower edge of the areola, and occasionally there will be wound depression or some micro-wrinkles fold and shrink. And the color of the scar is usually lighter than the areola itself.
   
   Recovery: Most of the cases, the areola wound is usually healing well.
    
4. Navel
   Method: through the location around the navel to open a cut, implant the falsies, but because the distance from the breast surgery path is far, the incision is too small, and therefore can only be placed salt water bag material falsies for surgery, cannot choose jelly silicone falsies.
   
   Location: navel upper edge.
   
   Recovery: the navel parts are easier to filth, so the risk of infection is slightly higher, and the surgical incision location is away from the place of falsies implantation location away, so the shape of the breast is not easy to control.

Breast reconstruction surgery is an orthopedic surgeon who reconstructs all or part of a breast that has been removed by surgery and can be reconstructed by using a breast implant or another part of the body. The purpose of breast reconstruction surgery is to make patients because of breast cancer cut the breasts, after wearing clothes the breast appears natural and balanced.
 
With the progress of breast cancer treatment, there are many options of breast reconstruction surgery, plastic surgeon can be in the mastectomy or after the mastectomy re-establishment of a breast, but also to correct breast deformity after breast surgery, suitable for breast reconstruction patients:
• Diagnosis of breast cancer, will carry out breast cancer and mastectomy (surgical resection of the tumor and all breasts)
• Diagnosis of breast cancer, breast cancer resection and breast preservation surgery, such as partial mastectomy or breast tumor resection (surgical resection of the tumor and part of the breast)
• Discovery genetic mutations in , will have preventive mastectomy (resection of non-cancerous breasts for breast cancer prevention)
 
Immediate and delayed reconstruction: In most cases, breast reconstruction can be done at the same time with mastectomy and is called "immediate reconstruction", if proceed in weeks, months or years later, this is the so-called "delayed reconstruction". The decision on immediate and delayed reconstruction depends on many factors, including:
• Breast cancer stage
• your condition
• Your preferences and lifestyle
• whether other treatments are needed (for example radiotherapy)
 

Benefits of immediately rebuilt: Can reduce social or emotional problems Beauty effect is good May reduce the number of operations and the cost of surgery Unrelated to cancer recurrence and development speed Unrelated to detect local cancer recurrence Will not delay cancer treatment	Benefits of delayed reconstruction: Additional cancer treatments (such as radiation therapy) do not affect reconstruction So that patients have more time to consider the breast reconstruction program
Disadvantages of immediate reconstruction: It is more difficult to detect if the skin of the breast has a problem during surgery Longer hospitalization and recovery time More scars	Disadvantages of delayed reconstruction: Chest mastectomy scar Need to re-operation and recovery time Sometimes it's hard to rebuild scars

 
Breast reconstruction surgery can be divided into three categories:
1. Implant (tissue dilator, saline falsies, jelly silicone falsies, water droplets jelly silicone falsies)
See article: Breast Reconstruction (II) Reconstruction with Implants
2. Your body tissue (rectus abdominis flap, back muscle flap)
See article: Breast Reconstruction (III) Abdominal tissue reconstruction
3. Implant combine with their own body tissue (falsies+ back muscle flap)
 
In October 1998, the US Congress passed the Women's Health and Cancer Rights Act, which required group medical and personal health insurance to cover the mastectomy after breast reconstruction surgery. Under normal circumstances, the law states that these should include:
• Breast reconstruction after breast surgery
• The operation of the side breast makes it a symmetrical appearance with the reconstructed breast
• All stages after implants (falsies) and mastectomy include rehabilitation
 
Dr. Xie Chenghan: In Taiwan, the current health insurance does not pay, and part of the commercial insurance will pay full or partial payment. Please contact your insurance company to ensure that your operating costs are provided by the insurance company.

Q1. Do I need a breast reconstruction surgery?
Ans: Some breast cancer patients decide that they do not rebuild, or do not want to undergo any further surgery. However, breast cancer patients can still choose to wear prosthesis (artificial breast), or the use of clothing shelter.
 
Q2. What breast reconstruction options do I have if I will receive a mastectomy?
Ans: Reconstruction surgery can be divided into three categories:

1. Implant (tissue dilator, saline falsies, jelly silicone falsies, water droplets jelly silicone falsies)
2. Your body tissue (rectus abdominis flap, back muscle flap)
3. Implant combine with their own body tissue (falsies+ back muscle flap) 

All reconstruction operations may require one or more surgeries and take some time to complete.

Q3. How long do you need to prepare for breast reconstruction?
Ans: The time required for breast reconstruction varies from person to person, depending on how much surgery is needed and need to cooperate with the treatment of cancer. The reconstruction process generally takes 6 months to one year, especially early cancer without further treatment. There is a common rebuild schedule:

1. The first operation to rebuild the breast shape, waiting for about three months to heal, if you need chemotherapy or radiation therapy the time will increase.
2. Surgical modification or balance the already been do the first reconstruction operation breast, waiting for about 2 to 3 months to heal, if necessary, the steps can be repeated.
3. Surgery reconstruction of nipples and areola.

 
Q4. What if my rebuild breast and my original natural breast asymmetry? How to do?
Ans: The ultimate goal of breast reconstruction is to create a symmetrical breast, especially when wearing clothing cannot found the difference, but the reconstruction and the original natural breast to be exactly the same is very difficult. For some patients, the following can be used to improve the asymmetric situation:

1. Implant the implant into a natural breast to make it larger (breast augmentation surgery)
2. Reduction of natural breast tissue (shrinkage surgery)
3. Improve breast position (breast fixation)

Q5. If I need chemotherapy?
Ans: Breast reconstruction should not delay the chemotherapy, usually your oncologist will wait for your mastectomy and rebuild the wound after healing before starting, if there are complications such as wound healing problems or infection, chemotherapy may be delayed. If you are receiving tissue expansion (tissue dilator), chemotherapy can be done on time, until the chemotherapy is completed, your plastic surgeon usually wait at least a month later, and then consider further reconstruction surgery.
 
Q6. What if i need radiotherapy (electrotherapy)?
Ans: You may have to complete the radiotherapy until you have to undergo a delayed breast reconstruction because radiotherapy may damage your rebuild and affect the final cosmetic effect. If you need radiotherapy, your plastic surgeon may advise you to use your organization for delayed breast reconstruction. If the "implant" is used for breast reconstruction, the risk of reconstruction will be higher because radiotherapy often leads to incidental complications include:

• Infection
• Severe capsular contracture (Hardened scar tissue around the implant)
• Hydrops
• Poor cosmetic performance

If you need radiotherapy, mastectomy can still be placed tissue dilator after mastectomy, tissue dilator can keep the skin "area", it provides a breast shape, 6 to 8 weeks after radiotherapy treatment, you and your doctor can plan the next reconstruction, you can use the choice of autologous tissue or falsies to implant, but this still needs detailed planning and discussion.
 
Q7. The risk of breast reconstruction surgery?
Ans: Pain, bleeding, infection, wound healing problems, sensory changes, fluid accumulation (such as hematoma and serum swollen), scarring, hernia, flap partial or complete loss, implant loss, asymmetry, limited cosmetic effect and so on.

In October 1998, the US Congress passed the Women's Health and Cancer Rights Act, which required group medical and personal health insurance to cover the mastectomy after breast reconstruction surgery. Under normal circumstances, the law states that these should include:
• Breast reconstruction after breast surgery
• The operation of the side breast makes it a symmetrical appearance with the reconstructed breast
• All stages after implants (falsies) and mastectomy include rehabilitation
 
Dr. Xie Chenghan: In Taiwan, the current health insurance does not pay, and part of the commercial insurance will pay full or partial payment. Please contact your insurance company to ensure that your operating costs are provided by the insurance company.
 

Reconstruction of the breasts with implants (tissue dilator and falsies) is usually a two-stage operation:
Implant-based breast reconstruction is a more widely accepted surgical procedure, without the use of another part of the body and get acceptable aesthetic results. In addition to the first stage of the reconstructed tissue dilator, the second stage of breast reconstruction has two types of implants: physiological saline falsies and jelly silicate yogurt falsies (including round jelly silicate falsies and water droplets jelly silicate falsies).
 
These two kinds of implants have a large number of shapes, sizes and, contour and the FDA has been confessed to the safety of silicone falsies, and your surgeon will help you determine which implant is best for you, The implant is usually not sagging, but in the upper part of the breast will be more obvious.
 
Depending on the lifestyle and preferences, the patient can choose implant(falsies) based reconstruction, use implant (falsies) to reconstruct which is more suitable is that the patient has enough skin "area" to implant (keep the skin for breast resection), it is not suitable for patients who do not have enough tissue to do self-tissue breast reconstruction, or do not want to use own tissue to rebuild, or even have a history of radiation therapy.
 

Advantages of implant (falsies) breast reconstruction Reduce surgery and recovery time Less scars Good shape

Disadvantage of implant (falsies) breast reconstruction The tissue expansion process requires more frequent retreat Two-stage process: After the expansion of the tissue then replace the permanent implant (falsies) Because the skin is thin, it is more difficult to rebuild the nipple More difficult to have symmetrical and natural breasts More than at least one operation (two stages)

 
About the mastectomy, orthopedic surgeons will be placed in a tissue dilator (balloon filled with saline) under the muscle and skin to form a pocket with the chest wall, after wound healing, and then gradually add the physiological saline solution into the tissue dilator, Stretching the muscles and skin to the desired size to create a suitable skin area that will shrink slightly when the tissue dilator is removed and replaced with permanent falsies.
 
The process of tissue expansion usually takes 2-3 months, but if other cancer treatments patients are needed, such as chemotherapy, the expansion process may take longer. Once the "skin area" has reached the desired size, the tissue dilator will remain in the same place to keep the same size, continue stretching the skin for about 1-3 months, then arrange for the outpatient surgery, remove tissue dilator and implant permanent Implant (falsies). Permanent implants will use brine falsies, jelly silicone or water droplets jelly silicate falsies.
 

Abdominal wall flap (transverse rectus flap): Exclusive blood supply includes skin, fat and muscle tissue.
Use the abdomen to re-create a breast to provide the most natural results, the specific results depend on your abdomen's tissue size, health level and your plastic surgeon skills and experience.
 
Your belly wall is composed of multiple layers, the skin is the outermost layer, under the skin is a layer of fat. This is followed by another layer of tissue, called fascia, which is firm and helps to prevent your intestines from protruding, the fascia has a layer of muscle called the rectus abdominis, the tissue taken from your abdomen includes a few of these several layers, so surgery will not enter the abdominal cavity, after surgery can immediately drink water, will not be affected, your intestines are completely undisturbed, strictly speaking, this is more easy surgery compare to the caesarean section area surgery.
 

Advantages of abdominal wall flap breast reconstruction: Natural chest type, texture consistent (completely self-tissue) Improve the abdomen shape (reduced abdomen) No implant

Disadvantage of abdominal flap breast reconstruction: Longer operation time Need plastic surgeons with experience and technology There are scars on the stomach Longer hospitalization and recovery time

After getting your satisfaction from the shape and size of the breasts, you may consider taking the reconstruction of nipples and areola. The first thing to remind that is the nipples created by your plastic surgeon will not be like your natural nipples, it will not be flattened or changed by temperature, touch, and will not feel, so many people get satisfied breast shape and size, even if there is no reconstruction of the nipple is still quite satisfactory.
 
Nipple reconstruction method:

1. The skin used for your breast reconstruction
2. Take a part of the natural nipple from the other side of the breast (if it is large enough) and transplant it to the reconstructed breast. This does not require hospitalization, just arrange outpatient surgery.

Areola reconstruction method:

1. The most common reconstruction method for areola is tattooing. (There are a variety of colors available to create a natural areola, the areola tattoo is usually painless, and can be carried out in the outpatient environment, the tattoo will fade with time, so it may need to re-pattern after a few years.
2. Skin graft, usually take the skin from inside your lips or waist skin, re-implanted to the reconstruction of the nipple.