Response to “The Continuing Appeal but Lack of Evidence for Autoaugmentation in Reduction Mammaplasty”

Abstract

After the publication of our article describing the power-assisted liposuction mammaplasty (PALM),1 Dr Swanson raised concerns about our operative strategy and lack of effect.2 Similar to his commentary on previously published articles,3,4 Dr Swanson has yet again presented arguments derived from his publications about photographic analysis3 and the comparison between breast reduction and breast reduction plus implants5 to conclude that all breast reduction techniques are “ineffective in significantly boosting upper pole projection.” The intent of our article was to share results from a reliable new option for breast reduction. We did not intend to compare our technique with Dr Swanson's theories of autoaugmentation, and we did not intend to perform a photographic analysis study. Patients presented in our study underwent a preauthorization process, governed under European law, designed to assess the severity of their condition and to determine whether or not breast reduction would be indicated. Dr Swanson has taken an unwarranted liberty in his comments alluding to nonmedical reasons that may influence a surgeon's decision to add liposuction, which were especially unjustified given his lack of knowledge about European regulations. The senior author (M.A.) has a breadth of experience in breast liposuction and breast reduction techniques.6-9 He not only integrated the power-assisted technology for breast liposuction to enable more precise and refined breast liposuction, but also offered an easier option for the liposuction of fibrous breasts. Liposuction is the main volume-reducing tool of the breast in the PALM technique and is coupled with parenchymal reshaping to lift and restore the natural form of the breast, while simultaneously preserving the lateral, central, and superior pedicles of the breast to ensure robust neurovascular supply to the breast parenchyma and the nipple-areola complex (NAC). Breast liposuction has been a useful tool to …