ORIGINAL ORIGINAL Non-surgical periodontal therapy for the treatment of chronic periodontitis Terapia periodontal não-cirúrgica no tratamento da periodontite crônica Mari Raquel Botlender TROJAHN1 Robert Carvalho da SILVA2 Júlio César JOLY2 The aim of this split-mouth controlled study was to compare the clinical benefits of administering subgingival 10% Doxycycline (test group)
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THE CENTRE FOR HEALTH IN THE HEART OF RODNEY
Breast reconstruction following a mastectomy
using Brava and autologous fat transfer (AFT)
Rodney Surgical Centre is leading You adjust the pressure, starting at a comfortable level and gradually the way with a scientifically-proven increasing it, depending on your tolerance. Most patients ramp it up and more natural alternative to breast in the week prior to surgery to achieve the maximum expansion so we reconstruction for women following can maximize the amount of grafted fat in your new breast.
breast cancer surgery. The same no Ideally, just prior to surgery, we want the Brava bra to have made your knife procedure can be used for breast breast size about one third more than the desired final size.
augmentation, defect corrections and congenital asymmetries. With reconstruction, a second step is usually needed and the Brava system can be used again.
The technique has been developed Mr David Crabbby the highly respected and much See page 3 for further detail and illustrations of the procedure.
published Dr. Roger Khouri, plastic surgeon at the Miami Breast Centre. David Crabb (plastic surgeon), who has trained with Dr Khouri, is the Fat transfer process only surgeon in New Zealand trained in this procedure. The procedure David Crabb removes fat from one area of your body and meticulously is less invasive, less stressful on your body than traditional methods, injects it back into the prepared area as hundreds of tiny individual and recovery time is quick. Patients go home on the day of surgery.
droplets in the breast site. These micro-fat transfers are harvested by For many patients, this technique is a huge leap forward from the gentle liposuction from the thighs, buttocks and stomach – wherever traditional TRAM flaps, or Lat dorsi flap, and other reconstruction there is fat to spare. Even slender patients do well with this procedure procedures of the past, which require major surgery and come with as we usually find enough fat cells. The fat then "takes" like a graft the disadvantages of implants in many cases. Using Brava and AFT, with gradual replacement by cells that grow in.
David Crabb can rebuild your breast from your own fat. It will feel Fat cell survival is between 50% and 95% with an average of two normal and real.
thirds survival. The use of the Brava is very helpful as it increases The technique is minimally invasive and has the side benefit of utilising blood supply and lymph flow which sustains the grafts.
liposuction to harvest the fat from areas of your body with unwanted fat, e.g. thighs, buttocks, stomach. Suitable indications for AFT reconstruction Final breast size will be discussed between you and David Crabb, and 1. Following breast cancer surgery
factors such as your body shape, available fat and the condition of your Most patients who have had a mastectomy will do well with this skin will be considered.
Loose abdominal tissue can be recruited and slid upwards to assist in your breast creation.
For a few weeks prior to the procedure, while you sleep, you will need to wear an external expander called Brava. This soft gel-like brassière Collapsed skin with tethered scars may need some preliminary work gently suctions the breast area in order to create an adequate matrix to prepare for the Brava device so it seals well. Tethered scars can for the fat injections.
also be released during the fat grafting procedure.
At first, the breast is conditioned with a low suction sports pack which Radiotherapy damaged skin does very well with fat grafting and the is battery powered and fits into the palm of your hand. After a few technique is now in use in the UK and the USA to treat radiation burns. days, you switch to use a squeezy bulb manual vacuum pump which It works by allowing the damaged blood supply to recover.
is like a blood pressure bulb. Finally, in the last two weeks, you are In severe cases of scarring and tethering, scar revisions may be switched to a motorized pump which you carry in a shoulder bag. needed as a preliminary step.
77 Morrison Drive, Warkworth,Tel +64 9 425 1190 or 0800 425 007 • email@example.com • www.rodneysurgicalcentre.co.nz 2. Salvage cases
3. Aspirin, over-the-counter food supplements and
Implant failure or flap failure can be a good indication for AFT.
vitamins that may impair blood clotting
It is imperative that the patient stops aspirin, all vitamins, and all
Implants are removed and fat grafting can then be done into the skin herbal supplements at least two weeks before the procedure.
flaps and underlying muscle to complete the first stage in preparation for the Brava use. This produces a surprisingly effective breast mound 4. Poor understanding of the procedure and inability to
for most people. Fat grafting can only be placed into tissue when the comply with the Brava expansion treatment
cavity from the implant has healed/closed.
A GP referral letter with your history would be the preferred first contact prior to consultation. Alternatively, David Crabb is happy to liaise with the oncology team The procedure is done as an outpatient (no overnight stay required), or the oncological surgeon to ensure timing for the procedure is under general anaesthesia and sedation. Your first contact with David Crabb may be by e-mail. He may request photos and medical details of your treatment to date. These e-mails Average recovery time is 2-4 days, a lot quicker than all other forms are treated as confidential medical records.
of breast reconstruction.
Additional planning may be required and approval will be sought from The benefits of our procedure your insurance company.
1. No foreign object in body At your appointment, your history and medications will be reviewed 2. Quick recovery and your smoking status taken. Your breast or mastectomy site will be examined and photographed. The distribution of fat is examined and 3. No cuts, no incisions unwanted areas of fat are identified.
A general discussion will ensue. Patients wishing to proceed will 5. No implant problems then have a fitting for the Brava bra, together with instructions for its use, and information sheets will be provided for future reference. 6. Minimally invasive An estimate of the costs will be provided at this time and, if you are Am I a candidate? insured, approval is then sought from your insurance provider. Most women are candidates for our Brava and AFT breast regeneration A nurse contact number will be provided for ongoing support.
procedure. There are only four disqualifiers: Where to from here? 1. Smoking
Contact the Rodney Surgical Centre on 0800 425 007 or 0800 NEW Smokers have a poor capacity to regenerate tissue. We recommend BREAST to arrange an appointment with David Crabb.
that a patient stops smoking at least two months before the procedure and abstain completely throughout the process, and for three months Rodney Surgical Centre is located in Warkworth, a rural seaside town after. If she cannot comply, we cannot help her.
on the periphery of Auckland and close to the motorway. Warkworth is approximately one hour's drive from Auckland airport.
2. Herceptin® chemotherapy and other angiogenesis
See our website www.rodneysurgicalcentre.co.nz if you need help arranging accommodation.
These prevent the revascularization of the fat graft and lead to a poor outcome. We recommend the process be started about one month after a patient completes her course of Herceptin treatment.
77 Morrison Drive, Warkworth,Tel +64 9 425 1190 or 0800 425 007 • firstname.lastname@example.org • www.rodneysurgicalcentre.co.nz growth of new tissue and blood vessels. This expansion allows room The Brava system is placed over the breast area when you sleep. for mega volume micro-fat grafts.
Typical patients wear the Brava for 30 days before surgery. It is fundamental and the key for a high ratio of fat survival.
Creating the vascularized scaffold Your fat is harvested from several areas of your body through liposuction and strategically injected into your breasts. No cuts or External expansion of the breast occurs via slight but consistent Incisions are made. New blood vessels form around the new fat vacuum pressure created by Brava. Brava expands and generates deposits allowing for fat integration and a high ratio of fat survival.
Photos are courtesy of Dr Khouri of the Miami Breast Centre 77 Morrison Drive, Warkworth,Tel +64 9 425 1190 or 0800 425 007 • email@example.com • www.rodneysurgicalcentre.co.nz
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