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Liposculpture – An Artist’s Approach

Besides an increasing number of patients requesting breast enhancement in Australia, there is also an increasing number requesting the larger sizes reports Sydney cosmetic plastic surgeon Dr Darryl Hodgkinson.

Lifestyle decisions must be taken into account including what sports a patient plays (serious joggers and runners do not usually request a D-cup), summer past-times and mode of dressing. If lying on the beach, wearing no-support bikini tops or showing a great cleavage is important, then a D-cup will do it.

Each brassiere manufacturer has a slight variation in cup sizes, but suffice to say that if a woman wants a D-cup, then the larger breast prosthesis above 350cc is usually chosen.

A well-informed decision needs to be made about the “fill” of the implant. Both saline and silica gel implants are available in Australia while saline implants alone are available for breast augmentation in the United States. In 50% of the D-cup sizes, I use saline and in the other 50% of patients, I use the silica gel implant. The newer cohesive gel implants seem to have a lower rate of capsular contracture (firmness around the implant from scar tissue). However, caution should be mentioned as complications of any prosthetic procedure may occur years later.

If a breast enhancement patient has ptosis (droop) then a bigger implant may be necessary to fill up the loose skin. All implants vary in “fill”. The amount of saline or gel varies from implant to implant. The choices in shape whether round or teardrop needs to be explained to the prospective patient. This choice has been available for 30 years. Which implant to use is a matter of decision-making – careful communication of the “look” the patient desires is essential. The “look” is the patient’s choice. The limitations and possibilities are numerous – so a patient needs to be explicit when explaining her desires to the surgeon.

In my experience many patients relate to the larger sizes. If indeed a D cup is the aspiration, a careful evaluation of chest shape, breast volume, skin tone and texture needs to be assessed by the surgeon before he can stretch the envelope. American patients more routinely want more for their money so a D-cup is common there. It is safe to say it’s also on the rise in Australia!

Liposculpture An Artist’s Approach

Liposculpture has evolved from liposuction over the last ten years. Along with breast shaping, the aim is to improve a woman’s figure in a curvaceous way and add to the length of her legs in a more shapely way. Figurative representation is a foundation of human artistic endeavour and so with liposculpture it must be an artistic endeavour. There are three modes of liposculpture, but only one ideal design for each patient.

Initially, fat scraping and cutting of fat were carried out in an attempt to improve the figure, but the complications included scarring and deformity. When Illouz from Paris and Fischer from Rome introduced a new technique of liposculpture in the early 1980s, they used vacuum evacuators and crude large metal cannulas. One atmosphere of negative pressure was enough to suck out the fat but the introduction of blunt cannulas rather than sharp prevented damage to the surrounding tissues. So much emphasis was placed on the newer aspirators and newer cannulas which meant that the aim of the procedure – shaping – was neglected.

To refine the process of fat removal, ultrasonic liposculpture was introduced in 1995 which literally melted the fat and the pneumatic ultrasculptor was introduced in 1998 which effectively drilled out the fat. I prefer to use all three modes of liposculpture i.e. traditional, ultrasonic and pneumatic to refine the patient’s shape and suck out the fat.

Like all tools that are available they are only as effective as the surgeon using them is. Artistic figurative shaping of the body by liposculpture requires meticulous planning, taking into account the basic body skeleton, muscular development, skin laxity and fat distribution. A careful design is made prior to surgery.

At surgery, usually under general anaesthesia, we subtract the body fat, defining the most beautiful parts of the body. In women, smooth curves beginning at the waist should be shaped continuously between the breasts and hips.

The buttocks should be rounded, the legs lengthened by saddlebag removal and the inner thighs defined with subtle superior inner thigh hollowing. In men, the abdomen should be etched to reveal the “abs”, the chest shaped to define the “pecs” and the “love handles” removed.

Unfortunately traditional plastic surgical education has remained somewhat ignorant of artistic anatomy that has been considered to be largely the realm of the artist but should be appreciated by your cosmetic surgeon. You will benefit from the artist’s approach to liposculpture.