Ultrasound-assisted lipoplasty (UAL) in breast surgery.

Breast surgery has evolved significantly since the increased demand for reduced scars led to the development of minimal incision techniques. Ultrasound-assisted lipoplasty (UAL) presents important advantages when compared to traditional liposuction, such as preservation of connective structures and significant skin retraction capability. Other factors such as a favorable side-effect profile, satisfactory aesthetic results, and virtually inconspicuous scars have led us to utilize UAL in virtually all of the different breast surgery modalities carried out in our practice. Important aspects of patient selection, markings, surgical technique, and postoperative care are outlined. Ultrasonic energy is applied through superficial tunnels that lie radial to the mammary cone, with preservation of elements such as the areola, mammary ducts, and the central part of the breast's base which contains the perforators that supply the gland. Deep treatment should be applied onto adipose tissue regions and should preferably be performed in the peripheral and subcutaneous layers of the breast, with conservation of the central glandular cone to ensure maintenance of anterior projection. In selected cases, UAL is a valuable adjunct to procedures such as symmetrization, reduction mammaplasty, and breast reconstruction, permitting both volume reduction and shaping through three-dimensional retraction of connective tissue and skin. The excellent preliminary results support new indications and future developments of the technique.