Plastic Surgery 2009, the annual meeting of the American Society of Plastic Surgeons, wrapped up today after five days of instruction and discourse between doctors from across the country. But, many attendees were left with as many questions as answers, particularly when it comes to controversial techniques and new technologies in breast augmentation and reconstruction.

Dr. Ron Israeli, a plastic surgeon practicing in Great Neck, New York, sees a lot of breast cancer patients in his practice, and was intrigued by the conference presentations focusing on the use of tissue implants for breast reconstruction after mastectomy.

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“I’m interested in the science behind some of the decisions we make with breast reconstruction,” he said. “For example, implant-based breast reconstruction, [and] acellular dermal matrix – the use of AlloDerm® – that’s something that’s been hot, that’s been really developing over the last several years.”

But, while recent progress on the reconstructive side left doctors optimistic, sessions focused on fat grafting for breast enhancement stirred up controversy.

“Of all the papers I heard here, the one that really hit me over the head was this paper in Hot Topics about tumor cells in mice, where they injected fat and these tumors grew more and there was greater metastasis, and what this means – what its implications are for fat injections into the breast,” said Santa Monica plastic surgeon Dr. Steve Teitelbaum, an expert on cohesive gel breast implants.

Dr. Robert Grant, a board certified plastic surgeon practicing in New York City, noted the need for more scientific studies on the long-term effects of fat transfer, and believes it may have a place in cosmetic surgery.

“I could imagine circumstances where, for a small contour deformity after breast augmentation, fat transfer is the ideal solution. Not for every patient, but in certain select circumstances,” he said. “As long as we keep our patients’ interest paramount and adhere to the [maxim], ‘At first, do no harm,’ when we implement these new advances, we’re always going to be on the right path, and our patients will benefit.”

Patient safety was a concern shared by all conference attendees, particularly in an era when patients do the bulk of their research online.

Said Dr. Teitelbaum, “Where do patients get their information? They get it from personal websites of doctors pushing their own agenda – whether or not it’s justified by any data. They get it by manufacturers pushing claims, to suit the pecuniary interests of the manufacturer.”

Added Dr. Israeli, “[Patients] are empowered now by the Internet – they are able to get a tremendous amount of information, some of it great, some of it not so great. We have to be careful when people come and ask for things that they’ve read online, and really use information and do things that are scientifically sound.”