Non touch - No pain Technique

Most people believe that breast augmentation is followed by pain that can last for 2-3 weeks, compression garments or suffocating bandages, tubes inserted inside the breasts, bruising and long stays in bed. And if all this used to be true, it is now all left to the past.

So, what would you think of the idea of an almost pain-free breast augmentation technique, without tubes, suffocating compression garments around the chest and movement restrictions? Is it too good to be true?

Well, no matter how hard to believe, modern techniques allow 90% of breast augmentation patients to resume regular activities 24 hours after the procedure.  Forget narcotic analgesics, tight compression garments around the chest, drains or special bras that press against the breasts;  forget bruising and breasts that make you look like a beating victim.

How is this possible?

This is no exaggeration and of course it didn't happen overnight. The technique was developed and published in 2002 in the top plastic surgery journal by Tebbetts, a plastic surgeon in Dallas, Texas.  So, what’s the difference? The secret unveils below:

A. Before breast augmentation surgery.

Careful planning as to the type and volume of the implant, before surgery. The plastic surgeon performs 5 important measurements of the patient's breasts. The patient then tries on the silicon implants. This is very important since the patient will be able to get a good idea of what her breast will look like after surgery. Therefore, the patient's desire in combination with the measurements of her chest will define the type of implant and, most of all, its size.

B.  During breast augmentation surgery.

Less tissue injuring during surgery means less bleeding and, of course, optimum recovery. This is common sense and the simple secret of this technique.  Using specially designed tools, we prepare the pocket for the silicon implant inside the breast with a FULLY atraumatic method (almost no blood is lost during surgery). This results to minimum injury of the tissues. Minimum surgical trauma means minimum pain after surgery as well as minimum ecchymosis (bruising) after surgery. The core principle of this new technique is that the surgeon must fully avoid using his fingers to create the pocket since this may cause extended injury or tissue bleeding that will lead to intense pain or slow post-surgery recovery.

C. After breast augmentation surgery.

Thanks to the atraumatic technique, the surgeon won’t need to use breast drains (tubes), compression garments around the chest or arm movement restriction. Patients are able to raise their hands high immediately after surgery.
All this combined with perfect anaesthesia allow minimum feeling of nausea or vomiting after surgery.

So, what can we achieve with this new breast augmentation technique:

This technique is characterised by accuracy and high “respect” for the tissues. Thanks to careful planning before surgery and the fully atraumatic technique, our patients may go back home safely 6 hours after surgery.
Since there are no tubes, compression garments or surgical bras, the patient may move around freely. She may go out for dinner on that same day or drive 2-3 days after the surgery.

What is also important, if not most important, is that this technique reduces immediate as well as long-term complications of the surgery. Thereby, in a recent analysis of the results of 1250 breast augmentation procedures during the 11th Congress of ESPRAS in Rhodes, haematomas were 0.05 %, inflammations were 0 %, and capsular contracture formation was 0.4 %.

Dual plane technique

Q. In June 2007 your paper “Composite Plane Breast Augmentation: A new Concept” was awarded in Berlin, among 500 papers from around the world during the International Plastic Surgery Conference. In this paper, you present a brand-new technique for breast augmentation.
A. This technique is actually a modification of the technique first presented by Dr Tebbets, the Texas-based guru and a great teacher in breast augmentation.

Q. What exactly does this technique involve?
A. Until now we knew of two techniques in breast augmentation: the subglandular and submuscular implant placement techniques. In 2002, the subfascial technique was also introduced. Our technique is a combination of these two techniques. I.e., the silicone implant is placed both underneath the muscle and underneath the muscle fascia.

Q. This sounds quite complex.
A. Actually, it’s not. Take a look at figure 1. The upper part of the silicone implant is covered by the pectoralis major muscle and the lower part by the muscle fascia (a thin tissue that covers the muscle).

Q. Why not use the old techniques?
A. Because no technique is perfect. Every new technique is launched to offer something new.

Q. So, which are the advantages and disadvantages, if any, of the new technique?
A. There are several advantages:

1.Fewer complications, such as the capsular contracture formation, a complication that affects 1-20% of women submitted to breast augmentation surgery. By placing the implant below the muscle and the fascia, we minimise the implant’s contact with the mammary gland. This is a manoeuvre that can minimise the formation of capsular contracture.
2. The upper part of the implant is covered by the muscle. This gives a natural result, particularly in thin patients with very small breasts.
3. The possibility of implant dropping is reduced. The muscle and fascia secure the implant and keep it in the right position.
4. We avoid malformations to the implant due to the strength exercised by the pectoralis major (as is the case in the submuscular technique). The so-called “open breast” abnormality.
5. The possibility of palpable implant borders is reduced.
6. No wrinkles are formed on the upper part of the breast.

Q. What about the disadvantages:
A. There are no actual disadvantages, apart from the fact that the doctor needs to have more experience in performing this technique.

Q. Does surgery last longer compared to other techniques?
A. No. An experienced surgeon can perform the procedure in 30-45 minutes.

Q. Are there any drains placed on the breast?
A. No, no drains, no bandages, no suffocating compression garments around the breasts.

Q. Why?
A. It’s all in the name!

Q. So, what does the “no-touch, no pain” mean?
A. It literary means no touching of the breast and no pain. Let me explain this: in surgery, the way you treat tissues is of outmost importance. If you “respect” the tissues, i.e. avoiding abuse and following the advised anatomical and non-blood techniques, the problems that may appear after surgery will be minimised. In our fast-paced society, patients ask for fast recovery. Our goal is to allow the patient to go out for dinner or go to the movies on the same day, after surgery.

Q. And how can this be achieved?
A. By using 1) special tools 2) fully atraumatic techniques and 3) special exercises after surgery.
With the above combination we can achieve:

1. Speedy recovery
2. Minimum pain, in 90% of patients. They can even go out for dinner on the same night
3. No drains
4. No bandages
5. No compression garments around the breasts
6. No bruising after surgery
7. Dramatic reduction of complications such as haematomas or inflammations

Q. Can the combination of this atraumatic technique and the dual plane technique further minimise the problems that can appear after surgery?
A. Dramatically. Complications and revision surgery are currently below one percent (1%). On the other hand, among women, the level of satisfaction from this procedure reaches 98-99%, and this is what we are aiming for.

Subfascial technique

What is the SubFascial technique?
The subfascial technique is new and refers to breast augmentation. It was first presented in 2000 by Miss Craf, a Plastic Surgery Professor from Brasil. The presentation was made in the Aesthetic Plastic Surgery journal and in 2003 it was also published in the American journal of Plastic and Reconstructive Surgery.

Where is the silicone implant placed?
In the subfascial technique, the silicone implant is placed under the fascia of the pectoralis major. As you can see in the figure, the fascia is a very thin hymen that covers the pectoralis major.

What are the advantages of the procedure?

1. Minimum or no pain.
2. Much faster recovery
3. Performed with local anaesthesia and sedation
4. More natural shape of the breast, since the fascia is covering the implant and smoothes out the roundness that develops on the upper part of the breast
5. Minimisation of capsular contracture, possibly due to the fact that the implant is not in contact with the breast (the fascia separates the implant from the breast).
6. It may possibly limit the chance of implant dropping in the future since the implant is well secured as is the breast.
7. In selected patients, it minimises the chance of wrinkle formation mostly on the upper part of the breast.

As in all breast augmentation techniques, we perform the non touch, no pain technique in the operating theatre.

In this technique we create the pocket with a fully non-blood procedure.

What is your experience with this technique?
We are currently among world leading practices with more than 800 surgical cases.

Where have you presented this technique?
This technique is very popular and has been enthusiastically accepted by the most established conferences of our specialty. It has been presented in the following meetings:

1. 10^th European Societies of Plastic, Reconstructive and Aesthetic Surgery Congress, Vienna, August 30^th - September 3^rd, 2005
2. 7^th Congress of Hellenic Society of Plastic Reconstructive and Aesthetic Surgery, October 27^th – 29^th, 2005, Loutraki.
3. 9^th Congress of Pan Arab Association of Burns & Plastic Surgery, April 10^th -13^th, 2006.
4. 14^th Congress of the International Confederation of Plastic, Reconstructive and Aesthetic Surgery (IPRAS) Berlin, October 26^th - 29^th, 2007.
5. IMCAS meeting in Paris, January 2009 (International Master Course on Aging Skin).
6. At 11^th European Society of Plastic Reconstructive and Aesthetic Surgery Congress, Rhodes 2009.

We have also published our experience with this technique in the two most prominent international journals of Plastic Surgery: “Plastic and Reconstructive Surgery” and “Aesthetic Plastic Surgery”. In 2008 the procedure was broadcasted live in television for the first time.

Where?
In Mega Channel’s “Extreme Make Over” show.

Is this when the technique was first applied?
We were among the first to perform it. We first started using this technique in London, in 2003.

What are your conclusions after so many cases, publications and presentations on this technique?
1. It yields the best possible results in selected patients
2. Complications have been drastically reduced. It would be interesting to see a slide presentation with comparisons of complications as presented in the Paris Meeting in January 2009, in Rhodes in September 2009, in Berlin in 2007 and in Vienna in 2005. In Paris and Rhodes there were 800 cases, in Berlin (2007) 575 cases and in Vienna (2005) 190 cases. Complications and revision surgery reduced dramatically.

Is this reduction in complications due to the Subfascial technique?
It is due to the Subfascial technique but also the so-called non–touch, non-pain technique for pocket preparation.

What is the Subfascial technique?
Let’s just say that we can prepare the pocket without causing haemorrhage. This way we avoid the use of drains, we do not use bandages or compression garments or bras on the breasts and no special massage is necessary. Research has shown that the average quantity of blood lost during surgery was 4 cc, which is equal to 0. Surgery time was between 75 and 22 minutes, with an average of 40 minutes. Patient satisfaction was nearly 99 %.

What happens with older techniques such as the subglandular and submuscular procedures?
Personally, I perform two techniques. The subfascial and the dual plane technique. This is because these techniques have minimum complications. In particular, I am able to prevent the formation of capsular contracture and the displacement of the implant underneath the muscle.