Breast augmentation

Indications
Patients with small breasts, patients with breasts that has shrank after pregnancy or breast feeding or patients who simply wants bigger breasts. Until recently, breast augmentations are done exclusively with breast implants. While breast implants remains the most popular choice for patients seeking breast augmentations and delivers great results and high patients’ satisfaction, alternatives in the form for breast augmentation with fat grafting or fat transfer is currently available for women who would like to enlarge their breast but are not keen to have implants.

Current available options for breast augmentations include the following:

1. Breast Augmentation with implants
2. Breast Augmentation with fat grafts
3. Composite Breast Augmentation with implant and fat grafts

Breast Augmentation with Breast Implants.

Procedure
Breast augmentation involves placement of implants behind the breast to enlarge the breast. This procedure is the most established method of enlarging the breast and is reliable and predictable in achieving the desired goals of breast augmentations. In the consultation process, several key decisions need to be made jointly between the patient and the surgeon.

Type of Implants
Breast implants are filled with either Silicone or Saline. Silicone implants are safe have recently been FDA approved for use in breast augmentations. Silicone IMPLANTS are very popular because it feels more natural than saline implants. The new generation silicone implants are safer and last longer.

Shape of the implants
Breast augmentation can be done with round or tear shaped implants. The round implants are popular with patients who want more fullness in the upper part of the breast (more fullness in the cleavage or the de colletage area). The tear shape implants, so named because it looks like a tear drop from the sides, are increasingly popular for patients who are looking for a more natural looking breast. Because of its shape, more of the implant volume is distributed in the lower part of the breast and less in the upper part, giving a more natural and softer look to the breast.

Incisions for Breast Augmentations
An incision needs to be made to place the implant under the breast. The incision are carefully designed and precisely made so that they are as inconspicuous as possible, hidden in natural creases of the body so that its visibility is minimized. The incision can be placed in the lower fold of the breast (called the inframammary fold incision), around the nipple (called periaereolar incision) or in the armpit. Each of these incisions has their advantages and disadvantages and the selection of the incision placement is made together with the patient.

Location or Plane to Place the Implant
The Implant can be place either under the breast or under the chest wall muscle (the pectoralis major). The location in which to site the implant is selected based on the patient’s unique tissue characteristics, the degree of droopiness (if present) of the breast and the amount of breast tissue available to cover the implant. This is because the implant needs to be covered with adequate chest wall and breast soft tissues to feel and look natural. In patients with adequate amount of breast tissues, the implant can be placed under the breast. Placement here is also more effective in correcting minor drooping of the breast, gives patients a more natural result and allows the implant to move more naturally with different body postures such as when she is lying down. In patients with very little breast tissues in contrast, the implant may be placed under the pectoralis major, to provide more soft tissues to cover the implant so that the breast will look softer and feel more natural. The decision as to where to site implant will be made together with the patients at the consultation.

THE CONSULTATION & SELECTION OF THE IMPLANTS
During the consultation, a detailed history will be taken. The patient will be examined to determine the tissue characteristics of the patient. The decisions as to the type of implant, shape, placement of the implant as well as the location of the incisions are then made jointly with the patient. To select the size of the implant desired, the patient can try on sizer implants available in the clinic and this important decision made. A second consult can be scheduled if the patient wishes to do so.

THE PROCEDURE
Surgery is usually done under general anesthesia. The procedure takes about 1 hour. The incisions are then meticulously closed and a firm dressings applied.

Recovery
The procedure can be performed as a day surgery procedure for most patients. Of course, if patient wishes, she may stay overnight in the hospital. A tight dressing would be applied to the breast for comfort and this can be removed after 1 day. Gentle range of motion and stretching exercises will be started after the surgery and this speeds recovery and minimizes pain from the procedure. Patients need a comfortable soft bra for gentle support after the operation and generally can start light exercises after 2 weeks, and be back to their usual exercises after about 3 – 4 weeks. Regular check ups are important after the procedures and these will accordingly be scheduled.

Please note that Silicone Breast Implants do not increase the risk of Breast Cancer or autoimmune diseases. Mammogram can still be taken. Please inform the radiologist that breast implants are present so that specialized views are taken, specifically for patients with breast implants.

FAT GRAFTING of the BREAST

INDICATION For patients who want bigger breast but are not keen to have an implant in their breast, FAT GRAFTING offers an alternative for breast augmentation.

THE PROCEDURE

In this procedure, fat is harvested from the abdomen and/or the thighs, processed and meticulously re-injected into the breast to enlarge the breast. Typically 200 to 400 cc of processed fat is injected into each breast. Importantly, the fat is not injected directly into the breast but into the soft tissues around and behind the breast tissues. This minimized the effect of the procedure on the breast tissues. Fat grafting to the breast, when done properly therefore do not interfere with screening mammograms for the breast and an experienced radiologist with be able to accurately read the mammogram.

WHAT is the EXPECTED OUTCOME of FAT GRAFTING to the BREASTS?
The survival rate of the transferred fat, using our current refined technique for grafting the breast is about 60-80%. Fat grating is a highly technique dependent procedure. That is to say, the survival rate varies greatly depending on the technique that the surgeon used in performing the procedure.

The advantage of this technique is that, as the fat is part of your own tissues, once the transfer or grafting is successful, the results are permanent. As the fat tissues are your own tissues, hardening or capsular contractures that may occur with implant, is not a problem fat grafting of the breast.
The amount of fat that can be injected into the breast depends on several factors including the size of your breast and the availability of fat in the abdomen and thighs for harvesting. Very thin patients may need to put on some weight before the procedure.

Composite Breast Augmentation with implant and fat grafts

Whats New?
A new development recently is what is called COMPOSITE breast augmentation. This technique is ideal for very thin and flat-chested patients who desire a significant breast enlargement. This technique combines the use of both breast implants with structural fat grafting. Before, the use of large implants with these thin patients would inevitably result in suboptimal result because the thin soft tissues of the breast would result in visibility around the implants, particularly in the cleavage area. With the COMPOSITE technique then, fat is injected around the implant, particularly in the upper part around the cleavage, this gives an overall softer look and more natural result.