Breast Liposuction (Female vs. Male).pptx

Liposuction of Specific Regions:
Evidence Based Practice.
2002-2022
11/4/2022 email: askprof@moawadskininstitute.com 1

Dedication
The Journey of Liposuction
• This presentation is dedicated to the memory of my parents, Prof. M. Moawad,
and My mother, Iqbal S. They made me what I am today with encouragement and
sacrifices.
• To my family, my wife Salam. B., and my pride in life, my son Mo and my daughter
Noor with their unflagging support, turned the second part of my life journey into
success.

Acknowledgment
• Special acknowledgment is given
to Dr. Ibrahim El Dousky (M.D.,
IMRCS), not only because he is an
outstanding student but also
because he doomed me into the
life of plastic surgery with his
excellent work and experience.
• Dr. El Dousky is the general
secretary of ESCSL.

Acknowledgment
• Special acknowledgment is given
to Dr. M. Ramadan (MS., Ph.D.), a
brilliant scientist, chief of staff at
MSI and my right hand in all what I
do.
• Dr. Ramadan is on the board of
directors of ESCSL.

Appreciation
• The author would like to express his appreciation to the medical team at
L'institute (Riyadh, KSA) and Moawad Skin Institute (MSI) in Cairo, Egypt, for
taking care of the patient during the procedures.

Appreciation • To “PATIENTS” You’ve always believed in me
KEYWORDS: LIPOSUCTION., LIPOSCULPTURE., FAT GRAFTING, ADIPOSE FATTY TISSUES., BODY
CONTOURING

Introduction
email:
askprof@moawadskininstitute.com
• Concepts of beauty have
been continuously evolving
throughout the history of
humankind.
• Slimmer forms have
substituted the voluptuous
figure idealized by artists in
the past.
• With fashion promoting
body-revealing attire,
outdoor exposure, and the
emphasis on fitness and
good health, people have
sought to reflect these
trends by demonstrating
youthfulness and vitality in
their bodies.
11/4/2022 7

Introduction
email:
• On the other hand, a
sedentary lifestyle and
dietary excesses associated
with factors such as
genetic determination,
pregnancy, and the aging
process contribute to body
alterations that result in
the loss of the individual’s
body image, creating a
solid psychological
motivation for surgical
correction.
11/4/2022 8

Introduction
email:
• Localized fat deposits
may involve one
anatomical region and
extend to multiple body
regions.
• Therefore, it is
understandable that body
contouring surgery
includes most body
regions, including the
face, neck, and breast, in
all populations, be treated
by a one-stage operation
or require more complex
combined procedures.
11/4/2022 9

Introduction
• The current evidence-building
process in the healthcare industry is
riddled with conflicts of interest
regarding education, research, and the
practice of medicine.
• Medical specialists worldwide are
flooded with data they must collect,
process, and analyze.
• Medical images make up around 90%
of the data in healthcare.
• Experts across the globe point to the
harms of pervasive industry influence
on research, practice, and education in
healthcare, noting that it compromises
patient care.

Introduction
• The ESCSL, as an academic, non-profit
organization, is responsible for disseminating
unbiased findings to the industry, medical
health providers, and the public about
liposuction, among others.
• At the same time, it is entirely free of ties with
the industry.
• As the president of ESCSL, I retrospectively
reviewed patients' charts and photos
(thousands) who underwent body contouring
and fat grafting procedures in K.S.A. and Egypt
between 2002 and 2022.
• The unbiased evidence in this study is a way to
ensure that the benefits and harms of
liposuction are accurately reported.

Introduction
• It will guide members of ESCSL in delivering high-quality, evidence-based
practice and cost-effective surgery.
• During the journey, I developed my technique as any other medical provider;
trial and error, reading and seeing experts' techniques, and picking and choosing
what suited me based on science and skills.

Introduction
• As new techniques are introduced, we must temper
our enthusiasm and base treatment on solid scientific
evidence. The journey is ongoing. It is like riding a
bicycle; to keep balance, you should keep moving.
2021
2022

Introduction
• The data collected are given to those who want
to deliver the best care to their patients armed with
the most innovative techniques and the latest
technology in the battle of aging, rejuvenation, and
body contouring, in a reproducible and safe
outcome-driven manner.
• It also is given to novice(s) in professional and
educational standards.
• A compendium of the author’s practice, journal
publications, and books read will put the entire
liposuction process in a volume that surgeons
interested in this topic need to read.

Female Breast Liposuction

Female
Breast
Liposuction
• Breast reduction
liposuction has gradually
evolved into a primary or
secondary modality for
treating breast
hyperplasia.

Female
Breast
Liposuction
• The outer contours are drawn
along the breast's inframammary
crease and the upper side.
• A zone between the beginning of
the breast tissue and the clavicle
superiorly is marked (danger
zone).
• Markings are drawn
perpendicular to the axis of the
breast in a circular pattern.
• If the axillary extension of the
breast is to be treated, this area
is also marked. .
• Note breast asymmetry
Stab incisions are made in the medial and lateral portions of the
inframammary fold—additional incisions at the areolar border
or high in the axilla
Abdomen Revision

Female Breast
Liposuction
• The skin is first anesthetized by
creating multiple intradermal blebs
and incision sites.
• Tumescent volume is
approximately 150% to 200% of
the breast volume.

Female Breast
Liposuction
• I use external ultrasound energy to liquefy fibro-fatty tissue of the breast
• Postoperatively, it helps smooth minor irregularities and speed recovery
• Ultrasound transducer is slowly moved on the marked area in circular motions
• The breast looks blanched and firm.
• Now the anesthesia has reached its peak.
While Waiting for the Anesthesia

Female
Breast
Liposuction
• The procedure usually begins
with the larger breast
• Volume reduction is made using
a 3-mm multi-holes or spatula
powered cannula.
• Fat removal is done evenly and
starts first at deep breast tissue.
• Frequent cessations to check
contour and symmetry are of
paramount importance.
1
2
3
4
U-PAL

Female Breast
Liposuction
• The operation is complete upon reaching
symmetry, sufficient reduction
• Access sites are left open for drainage
• An absorbent pad, a bra and abdominal binder are
applied
First post-operative visit

Female Breast
Liposuction
• Liposuction breast reduction gives patients and surgeons a compelling
choice in managing breast hypertrophy, with little downtime, minimal
scarring, and high patient satisfaction i.e., significant volume removal
(average of 53 %) with a ptosis reduction (average of 3.0 cm).
Riyadh, 2002 One-month Post-operative
Suction-assisted Liposuction (SAL)

Female Breast
Liposuction
• Liposuction breast reduction gives patients and surgeons a compelling
choice in managing breast hypertrophy, with little downtime, minimal
scarring, and high patient satisfaction
• Significant volume removal of an average of 53 % with a ptosis
reduction of an average of 3.0 cm.
Tail
of
the
breast
Tail
of
the
breast

Male Breast Liposuction

Male Breast
Liposuction
• Enlargement of the breast as the result of localized deposits of
subcutaneous fat primarily with normal or slightly increased glandular breast
tissue is known as pseudo-gynecomastia
• The surgeon is responsible for ruling out true gynecomastia (an excessive
amount of glandular tissue) and neoplasm.

Male Breast
Liposuction
• I use topographic markings to indicate the thickest distribution of fat and
the point on the breast with the highest elevation from the chest wall
• Male breast liposuction is done with tumescent infiltration and IV
sedation.

Male Breast
Liposuction
• I always increase the lidocaine and
epinephrine concentration in the
wetting solution.
• While waiting for the anesthetic
solution to reach its peak effect, I
use an external ultrasound massage.

Male Breast
Liposuction
• Liposuction is begun with a 2.0–2.5 mm spatula-powered cannula for pretunneling.
• I switch to a small multiholes powered cannula.
• Liposuction starts deeply moving upward.
• Blending is critical.
• Superficial liposuction is necessary.
First Post-operative visits

Male Breast
Liposuction
• Using U-PAL excellent results can be obtained
in pseudo-gynecomastia and a significant
reduction of glandular tissue in other types of
gynecomastia.
• All the incisions open for drainage.
• Foam padding and compression garment are
mandatory in this area to prevent excessive
ecchymosis.
First Post-operative visits

Male Breast
Liposuction
• Some patients want a flat chest;
others aesthetically would prefer a
slight amount of breast tissue left
behind.
• The patient should be warned
that occasionally not all breast
tissue can be removed, and a
glandular tissue excision may be
required in association with the
liposuction procedure.
One-month Post-operative

THE END
• This chapter, a unique educational manual, is dedicated to dermatologists
and cosmetic surgeons who want to excel in delivering the best care and
liposuction results to their patients with the most innovative techniques
and latest technology in a safe outcome-driven manner.
• I have assembled my experience and global experts to inform you how
liposuction is done in a simplified, efficient, and reproducible manner.
• Liposuction is more of an art than a surgical procedure.
• It entails a practical application of scientific knowledge with precision and
craftsmanship and is a skill attained with clinical experience.
• It brings as much contentment and joy to the person undergoing it as to
the surgeon practicing.

From Adding (1997) to Removing Fat (2022):
Evidence Based Practice
By
Prof. Osama B. Moawad, M.Sc. M.D.

Breast Liposuction (Female vs. Male).pptx

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