Natural Breast Augmentation (PureGraft) – BEAUTY BY DESIGN, Las Vegas

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Dear Prospective Patient,

Thank you very much for your inquiry regarding breast augmentation surgery. There are two techniques of
breast augmentation: natural breast augmentation, harvesting one’s own fat elsewhere in the body and grafting
to the breast, and breast implant surgery using either a saline or silicone implants. I have 16 years experience
performing liposuction and fat grafting surgery and will review the benefits and limitations as well as surgical
techniques of each of these methods.

I completed a residency and fellowship at Stanford University Medical Center and remained there as a clinical
professor for seven years. I am quadruple board certified. I am founder of the Center for Advanced Liposuction. I
have a practice in Las Vegas, Nevada as well as Laguna Beach, California. In January 2012, Dr Troell completed
his tenth live surgical seminar, teaching other cosmetic surgeons the art of liposuction, face and body fat
grafting and non-invasive body contouring devices.

Harvested body fat can be used to provide breast augmentation or enhancement using one’s own fat, the
outcome is a natural appearing breast that is soft without the artificial appearance of implants. Usually 150-220
cc of fat is placed in each breast, which augments the size by one or two sizes. The fat can also reshape
asymmetries in the breast. I am a national trainer for both the Body-Jet and VASER liposuction and fat grafting
techniques for the face, breast, body including the Brazilian Butt Lift.

This method is currently the best technique for fat grafting, increases the fat survival up to 80% of the grafted
fat, compared to only 40-60% with other conventional techniques. This was confirmed by an MRI study
published in December 2010 revealing 76% fat survival by volume using a similar technique (Ueberreiter,K et al.
BEAULI- A new and easy method for large-volume fat grafts. Handchir Mikrochir 2010;42(6): 379-385).
Additionally, to improve fat graft survival, Cytori’s PureGraft technique or Palomars Adivive system aids to purify
and wash fat cells and stem cells.

Dr Troell presented two manuscripts at the American Academy of Cosmetic Surgery in January 2011. One of the
presentations was the first of its kind comparing suction assisted, water-jet assisted and ultrasound assisted
(VASER) liposuction for body contouring and the other another first of its kind comparing the same methods:
suction assisted, water-jet assisted and ultrasound assisted (VASER), in terms of fat harvesting and fat grafting
survival and cosmetic appearance outcome.

The decision to use a saline implant versus a silicone implant is related to patient preference and the amount of
fatty and breast tissue currently present as well if the patient requests below or above the chest (pectoralis)
muscle. Most patients today prefer the silicone more naturally feeling implant. Incision locations include: around
the nipple (Infra-areolar), in anterior axilla fold (trans-axillary), superior aspect of the belly button and below
each breast (inframammary). Some patients also have breast droopiness (breast ptosis) that requires a
simultaneous breast lift (mammopexy) to optimize the final appearance. Occasionally, altering the size of the
areola or height of the nipple can be performed.

During your initial free consultation, we will discuss your esthetic concerns and discuss your treatment options.
Please visit my website at www.drtroell.com.

Sincerely & Respectfully,

Robert J Troell,MD, FACS