Auto Augmentation

Created on 27th October 2008

A breakthrough in breast surgery: Professor Laurence Kirwan's ‘Auto Augmentation' technique eliminates the need for implants

Despite continual reassurances about the safety of certain breast implants - especially silicone, which has been used for over 30 years - ‘scare stories' mean that women often feel uncertain about any type of implant. For some, however, there are alternatives that offer the prospect of avoiding an implant altogether. In about 20 per cent of cases, it is possible to use the patient's own breast tissue to provide the ‘lift' and fuller contours that many women seek.

Already well known for pioneering several groundbreaking surgical procedures, British cosmetic surgeon Professor Laurence Kirwan has further developed the techniques of two of his peers - Giovanni Botti in Italy and Ruth Maria Graf in Brazil - so that women with adequate breast tissue can have breast surgery without an implant. Kirwan calls this procedure Auto-Augmentation.

The causes of breast ‘ptosis‘, as pendulous breasts are called by medics, are either developmental or caused by weight loss - or, more
commonly, by pregnancy and breast feeding. In the last three cases, ptosis occurs due to distention of the internal ligaments and the skin envelope.

When women lose elasticity in their skin, it stretches. Most women also lose a significant amount of breast volume by shrinkage of glandular structures. This is why those whose breasts have drooped often need a breast lift to eliminate excess skin, plus an implant to provide volume.

Breast lifts without implants generally stretch over time. The old-fashioned technique of re-arranging the breast tissue used a support for the nipple and areola blood supply from the lower part of the breast, and left an ‘anchor' shaped scar. Often, this procedure eventually resulted in ‘bottoming-out' in the lower part of the breast and the nipple would then point skyward. If a breast lift depends on tightening the skin ‘brassiere' alone (by removing excess skin), and without any rearrangement of the internal breast tissue, the breasts usually droop again after a while.

However, if the woman has adequate breast tissue, Giovani Botti's technique uses the lower part of the breast as an ‘auto implant', combining it with a tightening of the skin which results in a scar around the areola and a vertical scar. Together, these scars create a ‘lollipop' configuration. Ruth Maria Graf's procedure is similar, but involves an s-shaped scar with the lower part of the ‘s' in the outer half of the crease beneath the breast.

Laurence Kirwan moves the gland from the lower part of the breast to the upper area to provide fullness where it is needed - above the nipple. The gland is kept attached at its lower end to preserve the blood supply. He then improves on the techniques of Botti and Graf by reducing incisions - which results in minimal scarring. He uses the concept of keepingthe lower part of the breast as an ‘auto implant' and uses the ‘lollipop' closure which involves a single scar running vertically under the breast with a naturallooking ‘purse-string' gathering of the skin around the areola. Once the skin is tightened, thefinished contours look like a breast with an implant.

To allow a patient to see where her postoperative areola will be, she stands with her arms to her side and the breast is positioned so that the areola is transposed to the middle of the breast mound, and the skin of the lower part of the breast is taut. A mark is then made on the upper skin of the breast to show where the areola will be after surgery.

Kirwan says this new procedure is suitable for 20 to 30 per cent of the women who see him for a breast lift consultation at his Harley Street consulting rooms, and for perhaps as many as 20 per cent of all women in the UK who are contemplating breast surgery.

Laurence Kirwan started working on his own techniques for breast surgery in the late 1990s and has become internationally recognised for hisbreast lifting procedures.

As with most breast surgery, recovery from Auto- Augmentation necessitates undertaking only light chores in the first week and limited activities for another two weeks, with a return to normal lifestyle after four to six weeks. Kirwan advises against swimming, andother strenuous sports such as tennis, for at least three weeks, or until the scars are completely healed.

He recommends two creams for his scars after surgery. The first is Extra Mild Protection Cream (from La Roche-Posay) and is a micronized product containing silicone which is applied in the morning to soften the scar. The second is called Kelo-cote (from Advanced Bio-Technologies, Inc). It also contains silicone and is applied in a thin layer at night to reduce the possibility of scar thickening. Both are applied for three months after surgery.

The most common risks of this surgery are delayed wound healing, bleeding, asymmetry, a poor scar and loss of blood supply to the nipple - which is a risk of any breast lifting procedure. No tubes are used to drain blood after surgery, a light dressing is applied for 48 hours and the patient then wears a sports bra.

Patients are instructed not to smoke or drink caffeine and to abstain from taking Vitamin E supplements, St John's Wort, ibuprofen-related drugs and aspirin for three weeks before and after surgery. Patients must shower with an antiseptic wash the night before, and the morning of, surgery. Any woman with a history of breast cancer in the family should have a mammogram before the procedure to rule out any suspicious lesions. CSMUK