What makes the All Me Augmentation® possible? 

Conveniently located to serve the areas of Houston, TX

The question is often asked, “Why is the All Me Augmentation® such a revolutionary and unique procedure?” 

In other words, why are not all plastic surgeons offering the All Me Augmentation®? The answer to this question is rather multifactorial. Many things make the All Me Augmentation® difficult for the typical plastic surgeon to do. The fundamental factors are the experience and the surgeon’s skill. Therefore, to perform the All Me Augmentation®, the surgeon must be a true expert in both cosmetic and reconstructive procedures. 

Regarding the reconstructive experience, there are certain advances that have made the All Me Augmentation® possible that are not uniformly accepted in the reconstructive surgery realm. The first advance is the rib-sparing technique. Most surgeons who perform the Deep Inferior Epigastric Perforator (DIEP) flap for cancer reconstruction remove a portion of the rib to access the internal mammary vessels, which serve as recipients to the flap. To the layperson, this sounds like an incredibly painful and anatomically disruptive thing to do, and they would be correct. Removing a portion of the rib causes not only short-term pain around the surgery, but the potential for long-term pain at the removal site. It is simply not consistent with the goals and aims of the All Me Augmentation®. Dr. Boutros has published extensively1 on avoiding chest morbidity while performing DIEP flaps for both reconstructive and cosmetic purposes.  Following All Me Augmentation®, the patient experiences minimal short-term pain and virtually no chance of long-term issues, accomplished with the rib-sparing approach.

The second advance in the reconstructive surgery realm is the microfascial incision. The microfascial incision is a method by which the DIEP flap is harvested from the abdomen using an incredibly small incision in the rectus muscle sheath. Typically, when a DIEP flap is performed, extensive incisions in the anterior rectus fascia are made, with incisions up to 15 centimeters. With a microfascial incision, the incision is kept at approximately two centimeters. This difference is quite significant. For comparison, historically, when surgeons removed a gallbladder from a patient, they made an approximately nine-centimeter incision in the muscle. With that, patients were often in the hospital for up to 10 days due to the pain associated with it. When surgeons transitioned to laparoscopic approaches with incisions of approximately two centimeters in the muscle, the patients were able to have these procedures done and be discharged the same day. This is analogous to the microfascial incision approach of the All Me Augmentation®. By shortening the muscle incision, the patients have significantly less pain. Furthermore, with the longer incisions, there is a strong possibility of long-term muscle weakness and budges.  Both of these long-term issues are unheard of with the microfascial incision. 

Dr. Boutros has pioneered performing breast microsurgery as an outpatient procedure. This is due to many innovations, which include the rib-sparing approach and the microfascial incision as part of his outpatient breast surgery protocol.2 This outpatient approach makes the All Me Augmentation® possible. Simply stated, performing these procedures in a hospital setting would not only unduly add significant expense, but it also exposes the patient to potential increased risk of infections and devastating complications like blood clots in the legs that can travel to the lungs as it is well known that when procedures are performed as an outpatient or following Enhanced Recovery After Surgery (ERAS) protocols, the incidence of hospital-acquired infections and deep venous thromboses drop significantly.3,4 

As previously mentioned, the efficiency of surgery depends on two factors: the practitioner’s inherent skill and their experience. Dr. Boutros has performed more than 4,000 DIEP flaps in his career. On top of that, he possesses a baseline of technical gifts that are well recognized by his peers, allowing him to perform these procedures both quickly and efficiently with minimal blood loss, allowing for less risk to the patient.

Experience in both cosmetic and reconstructive surgery is rare.  Most experts in cosmetic surgery do only that.  Likewise, most reconstructive surgery experts only perform reconstructive surgery.  Dr. Boutros’s work in both reconstructive surgery and cosmetic surgery is well known. He truly bridges the divide to provide the innovative All Me Augmentation® to his patients.  

Putting all of this together, it is the combination of inherent skill, innovations, and experience in both cosmetic and reconstructive surgery that makes the All Me Augmentation® possible. We truly believe that this is the best way to augment the breast, and we are actively teaching other surgeons how to do these procedures. With time, more and more surgeons will pursue and imitate the advances that Dr. Boutros has made, making the All Me Augmentation® the standard of care for breast augmentation in the future.

References

  1. Martinez CA, Boutros SG. Avoiding Chest Wall Morbidity in Outpatient Microvascular Free-Flap Breast Reconstruction. J Clin Med. 2025 Jan 18;14(2):602.
  2. Martinez CA, Boutros SG. Outpatient Microsurgical Breast Reconstruction. Plast Reconstr Surg Glob Open. 2020 Sep 23;8(9):e3109.
  3. Stone AB, Grant MC, Wu CL, Wick EC. Enhanced Recovery after Surgery for Colorectal Surgery: A Review of the Economic Implications. Clin Colon Rectal Surg. 2019 Mar;32(2):129-133.
  4. Obafemi T, Mullis D, Bajaj S, Krishna P, Boyd J. Results following implementation of a cardiac surgery ERAS protocol. PLoS One. 2023 Jul 14;18(7):e0277868.