The perfect breast implant fillant material would have higher viscosity than water and would be autologous and harmless. We describe the confinement of liposuction fat in implants using the Lipovacutainer during a routine liposuction procedure. This collected fat is prepared inside the Lipovacutainer and is reinjected through a Lipomedia filling cannula into a leaf valve implant as the fillant in place of saline. The implants are used for bilateral augmentation mammoplasty and breast reconstruction procedures. Our six clinical cases have been monitored closely using mammography and MRI. These cases showed slow liquefaction without interference with mammography studies. We obtained excellent overall body contours. All complications were correctable and non-life-threatening and there was no capsule formation.

There are an increasing number of young patients seeking an ideal reduction mammoplasty. The ideal procedure must obtain a youthful-looking result, minimal scarring, preservation of lactation, erotic sensitivity, and no postoperative complications. We have done a subjective comparison of six different reduction mammoplasty procedures by using a mail questionnaire. The questionnaire comprised three categories: (I) alleviating preoperative complaints, (II) postoperative appearance, and (III) postoperative complications. In category I, greater than 95% of all preoperative complaints were alleviated in all groups of patients. In category II, McKissock's and Robbins' procedures scored the best for nipple-areola position, with highest number of patients (40.5%) in the free nipple group appreciating the overall breast symmetry. In category III, the modified Regnault group (H/B) had the lowest overall complication rate. Only 33% of the patients in H/B group experienced failure to lactate and 26% experienced loss of erotic nipple sensation for longer than six months. In our study, we show that the H/B mammoplasty procedure was rated best overall and was the best compared with the concept of an "ideal" procedure.

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Many breast reconstruction procedures have been performed with success and satisfaction. These methods can be categorized as implant reconstruction, local tissue with implant, autologous tissue, and free flaps. Implant reconstruction, immediate or delayed, has been the easiest and most fulfilling experience for the surgeon and the patient. Local tissue with implant and autologous tissue are usually available to those patients with anterior chest tissue deficiency or those who prefer autologous tissue without the fear of implant material. Free flap reconstruction is often selected when no other procedures are appropriate for the patient. Individual procedures must be familiar to the patient and the surgeon. Other factors such as time involved, cost of hospital stay, recovery time, and associated complications are discussed in this article. Refinement and nipple areolar reconstruction are an intimate part of breast reconstruction, but these are usually the decisions made by the patient that must be respected.