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Breast augmentation is one of the most popular aesthetic surgery procedures. Aesthetic breasts are covered by crisp and elastic skin devoid of wrinkles, occupy an optimal position on the chest wall, are of proportionate size relative to the individual, have good volume distribution between the upper and lower poles, and confer a pleasing silhouette when viewed from the front and the sides. When viewed from the side, the upper pole of the breast is a gentle slope arising from the upper chest wall, and the lower pole is convex ending in the inframammary fold (IMF).
The ideal breast size is one that is proportionate to the width of the individual’s chest and overall height, and varies between individuals. Beautiful breasts project the image of youth, confidence, elegance and femininity.
Breast hypoplasia affects many slim-built females. Common clinical findings include abnormally wide distances between the breasts in the midline of the chest and high inframammary folds. The nipple-areola complexes often lie in the appropriate position between the 4th and 5th intercostal space. Some individuals with breast hypoplasia may also have tuberous breast deformities (specific underdevelopment of the lower half of the breasts, enlarged nipple-areola complexes, herniation of the breast glands and abnormally high inframammary folds). Breast hypoplasia results in underdevelopment of the adult feminine silhouette and is less able to complement the beautiful waist and abdominal contour.
Breast hypoplasia may carry significant psychological burden, especially in the adolescent and young adult population. Individuals may experience diminished self-esteem, social anxiety, impairment of social development and restriction in their choice of certain fashion styles.
Most cases of breast hypoplasia are developmental; the glands are normal but do not enlarge to a significant degree during puberty. A small proportion of individuals may have congenital chest wall deformities, such as Poland syndrome (unilateral breast hypoplasia, undeveloped chest muscle and short, webbed fingers), or other hormonal disorders or burn injuries that result in underdevelopment of the breasts.
Breast augmentation is a safe procedure for trained and experienced hands. There are three methods of augmentation mammaplasty: implant augmentation, structural fat grafting breast augmentation, and hybrid breast augmentation which is a combination of both techniques. The technique chosen is tailored according to the individual anatomy and the individual’s expectations. Successful outcomes restore individuals’ femininity, self-confidence and social functioning.
Breast augmentation is an outpatient procedure performed under intravenous sedation or general anaesthesia.
The following may consider breast augmentation:
There are some important considerations before proceeding with implant breast augmentation. These are discussed in detail during the clinic consultation and the approach is individualized to ensure bespoke and optimal outcomes.
There are two main shapes: round implants and anatomical (teardrop-shaped) implants.
Round implants are hemispherical when viewed from the side, and the majority of the breast implant volume is at the middle of the implant. Anatomical implants have a teardrop shape when viewed from the side because a greater proportion of the implant volume lies in the lower half.
Round implants are suitable in individuals with no or minimal excess skin, and individuals who prefer the appearance of a fuller upper breast. Anatomical implants are suitable in individuals who desire a natural look that is fuller at the lower half of the breast, and in those with mild chest skin laxity. Teardrop implants preferentially lift the lower breast and are ideal for individuals with mild skin excess.
Implants may be filled with silicone gel, saline or a combination of both.
Silicone gel implants provide better shape and lift. They look and feel natural. If there is breakage of the implant shell, silicone gel implants retain their shape.
Saline-filled implants are associated with a lower incidence of capsular contracture (abnormal scar formation around the implant periphery).
Individuals who are very slim may observe visible surface rippling because saline implants are often filled to a lesser degree than silicone gel implants. In the event of implant rupture, the saline implant deflates and there will be a loss of shape. Saline is completely absorbed by the body.
Implants may be classified by their surface types: smooth or textured (“rough”).
Smooth implants have thinner shells and are less visible and palpable, and are suitable for implantation in slim individuals.
Textured implants have a rough surface and greater surface friction with the surrounding tissue. They are associated with lower incidence of implant rotation and capsular contracture.
A common misconception is the use of an “ideal” or desired implant volume as the starting point for implant selection.
The ideal implant is determined by the individual’s chest width, the desired breast projection, the implant type and the degree of skin laxity. These parameters determine the ideal implant volume. The human eye observes lengths and proportions and not volume measurements.
This method of assessment is the best method of ensuring an elegant, natural and aesthetic result.
There are three common incisions used for breast augmentation. The inframammary fold (IMF, which is the crease below the breast) incision is the commonest. It is the most direct approach and permits the most accurate placement of the implant. It is well-concealed within the bikini top. Short-incision techniques are possible with the use of modern breast implants and proprietary insertion techniques. The IMF incision is also useful for revision surgery of previously placed implants.
The periareolar incision is made at the junction of the areola and breast skin and may be used in individuals with larger areolas, typically females who have previously breastfed.
The axillary (underarm) incision is performed at the apex of the underarm and is well-concealed. This approach is possible for individuals with good skin quality and desiring placement of round implants.
Implant breast augmentation without chest or axilla scars during tummy tuck surgery is possible by using special proprietary techniques available at Picasso Plastic Surgery.
The breast implant may be placed beneath the breast (subglandular) or beneath the pectoralis muscle (submuscular) and affects its final appearance.
Subglandular placement gives better filling and lifting of the breast, especially the breast upper pole, and has a slightly shorter recovery period. Subglandular implants are not distorted or affected by pectoralis muscle action.
Submuscular placement delivers a more natural-looking upper pole appearance in slim individuals and is associated with a lower long-term risk of development of capsular contracture.
Individuals who desire a significant breast size volume increase in a single stage surgery may consider implant breast augmentation.
Implant breast augmentation delivers a single-stage breast augmentation through well-concealed incisions. The implants are placed in anatomically precise locations and will improve the breast aesthetic, the body proportion, and accentuate the waist and abdomen.
This procedure achieves attractive and bespoke outcomes and improves the individual’s confidence and social functioning.
Individuals are advised to stop herbal supplements and traditional medicine, and start special medications 7 days prior to surgery to minimize bruising and swelling.
Preoperative markings are performed to determine the ideal implant placement position. The incision is performed according to the individual’s choice and a precise anatomical pocket is dissected at the appropriate depth. This pocket is designed to be a snug fit for the implant and prevents postoperative implant migration or rotation. The implant pocket is irrigated with antibiotic solution to avoid infection and capsular contracture. Proprietary techniques are used to minimize the incision length to optimize the final aesthetic.
Implant breast augmentation is a fine art that balances the individual’s aesthetic desires, the implant characteristics and the inherent anatomy. Accurate assessment and precise technical execution by an experienced surgeon is the best way of ensuring optimal postoperative results.
Many individuals are able to return to work between the 3rd and 5th postoperative day. Mild swelling and bruising is expected, and will mostly recede by the 10th postoperative day. migration or rotation. The implant pocket is irrigated with antibiotic solution to avoid infection and capsular contracture. Proprietary techniques are used to minimize the incision length to optimize the final aesthetic. Implant breast augmentation is a fine art that balances the individual’s aesthetic desires, the implant characteristics and the inherent anatomy. Accurate assessment and precise technical execution by an experienced surgeon is the best way of ensuring optimal postoperative result.
Stitch removal is usually not required as they are self-dissolving. Showering is possible from the 2nd postoperative day onwards. Compression garments may be used in a minority of cases for maintenance of the position of the implant and to reduce incidence of implant migration.
Individuals above the age of 40 without prior mammograms are recommended to do so for cancer screening prior to breast augmentation. Following implant breast augmentation, mammography screening is possible by performing the Eklund displacement technique. In some individuals, MRI scan is also an acceptable screening modality.
Breast augmentation has been shown to have no significant impact on an individual’s lifetime risk of breast cancer. In fact, a published study using data from Swedish registries showed that the risk of breast cancer development in post-augmentation individuals may actually be very slightly lower than that of the general (unaugmented) population. an acceptable screening modality.
In recent years, some reports have emerged of breast implant associated-anaplastic large cell lymphoma (BIA-ALCL) occurring many years after breast implant insertion. At this current time, this appears to be an uncommon event. The risk appears to be mainly with the use of older-generation textured implants, some of which have been withdrawn from the market and are no longer available for clinical use. In most cases of BIA-ALCL, implant removal alone appears to be curative.
Dr Matthew Yeo was instrumental in the development of the Singapore Association of Plastic Surgeons public advisory on this topic, and also the professional advisory for plastic surgeons published by the Chapter of Plastic, Reconstructive and Aesthetic Surgeons, College of Surgeons, Singapore.
Breastfeeding is a physiological process possible in most (but not all) women. Studies have shown that the proportion of females who successfully breastfeed following breast augmentation surgery is not significantly different from the general (unaugmented) population. Breastfeeding in individuals with breast implants has not been shown to adversely affect infants.
Structural fat grafting for breast augmentation is a combination of two procedures: liposuction of the abdomen, thighs or hips, and fat graft breast augmentation. Each procedure has positive effects on the feminine silhouette and acts synergistically to create a beautiful, shapely body form. This is an outpatient procedure performed under intravenous sedation or general anaesthesia.
Individuals who desire to have the most natural appearance and feel while achieving modest breast size volume increase may consider structural fat graft breast augmentation. Some individuals may require additional stages of fat grafting to achieve their desired volume. Structural fat grafting may be considered in most individuals with a BMI of 19 and above.
Structural fat graft breast augmentation involves liposuction of areas of excess fat and augmenting the breasts with this fat. These procedures are synergistic and complementary in enhancing the feminine chest and abdominal silhouette. Fat graft breast augmentation produces the most natural look and feel. Both liposuction and fat grafting are performed through small, well-concealed scars. The grafted fat that survives provides elegant, attractive and long-lasting breast augmentation.
Individuals are advised to stop herbal supplements and traditional medicine and start special medications 7 days prior to surgery to minimize bruising and swelling.
Common sites for fat harvest include the inner thighs, hips, flanks and lower abdomen. Small incisions are made near the areas of intended liposuction, and local anesthetic is infused for optimal intra- and post- operative pain relief. The fat is broken up and aspirated under negative pressure. It is purified before being grafted into the breasts using purpose-made fat grafting cannulas for optimal survival. Grafting is performed through 2-mm incisions that are well-concealed within the inframammary fold.
Many individuals are able to return to work between the 5th and 7th postoperative day. Depending on the extent of liposuction performed, the swelling and bruising will mostly resolve by the 14th postoperative day.
Showering is possible from the 2nd postoperative day onwards. Stitch removal is usually performed on the 10th postoperative day. Specific post-operative compression garments may be required in the first 2 weeks to minimize postoperative bruising and swelling, and to guide the shrinkage of the skin and prevention of irregular skin folds. Bruising may be minimized by avoidance of strenuous activity for the first 2 weeks. Individuals may return to their original exercise and gym routines after about 3 weeks.
After structural fat grafting is performed, blood vessels grow into the fat grafted area (neovascularization). The degree of neovascularization determines the proportion of fat graft survival. In general, 60 to 80% of the grafted fat will survive, and the appearance at 2 months postoperatively is normally representative of the long-term result. The non surviving fat is absorbed by the body during the first two months. The fat grafts that survive persist for many years.
Structural fat grafting does not affect the breasts themselves. It is performed in the subcutaneous tissue, and in the chest wall muscle avoiding the breast gland. In postoperative individuals, the accuracy of screening mammography in detecting cancer is similar to individuals without fat grafting. In most cases, individuals undergo a mammography between the 3rd and 6th postoperative month for this mammogram to be used as a baseline comparison with future mammograms.
Long-term studies have shown fat grafting to be a safe procedure and not associated with a higher incidence of breast cancer. Earlier concerns that adiposed-derived stem cells (ADSCs) present in fat grafts may stimulate cancer growth have been conclusively refuted.
Breastfeeding is a physiological process possible in most (but not all) women. Studies have shown that the proportion of females who successfully breastfeed following structural fat graft augmentation is not significantly different from the general (unaugmented) population. Breastfeeding has not been shown to adversely affect infants.
Hybrid breast augmentation combines the benefits of both implant and fat graft breast augmentation. It delivers sizeable breast volume increase while camouflaging the implant borders with structural fat grafting to provide a natural-looking result. Liposuction and implant breast augmentation enhance the feminine silhouette. This is an outpatient procedure performed under intravenous sedation or general anesthesia.
Hybrid breast augmentation may be considered in most individuals with a BMI of 19 and above.
Hybrid breast augmentation delivers a significant single stage augmentation in which the majority of the volume is contributed by the implant, and the fat is grafted in specific locations for optimal implant camouflage and additional volume augmentation. This permits individuals to attain significant breast size increase whilst using slightly smaller implants for natural-looking results. It delivers elegant and long-lasting breast augmentation and accentuates the chest and abdominal contour.
Individuals are advised to stop herbal supplements and traditional medicine, and start special medications 7 days prior to surgery to minimize bruising and swelling.
Common sites for fat harvest include the inner thighs, hips, flanks and lower abdomen. Small incisions are made near the areas of intended liposuction, and local anesthetic is infused for optimal postoperative pain relief. Using specialized cannulas and equipment available at Picasso Plastic Surgery, the fat is broken up and aspirated under negative pressure. The breast implants are inserted via the usual surgical incisions (inframammary fold, periareolar, or in the underarm) and fat grafting is performed, usually to the upper, lower and inner borders of the implant, using purpose built cannulas that optimize fat graft survival.
Many individuals are able to return to work between the 5th and 7th postoperative day. Depending on the extent of liposuction performed, the swelling and bruising will mostly resolve by the 14th postoperative day. preservation of the hair follicles, so that hair will eventually grow through and camouflage the scar. A special wound closure technique is used to optimize the final postoperative scar appearance. Our clinic has an en suite operating facility, which assures your maximal privacy and convenience, and keeps facility and equipment costs contained. Our operating room carries a full range of equipment tailored for brow lifts.
Showering is possible from the 2nd postoperative day onwards. Stitch removal is usually performed on the 10th postoperative day. Specific post-operative compression garments may be required in the first 2 weeks to minimize postoperative bruising and swelling, and to guide the shrinkage of the skin and prevention of irregular skin folds. Bruising may be minimized by avoidance of strenuous activity for the first 2 weeks. Individuals may return to their original exercise and gym routines after about 3 weeks. Stitches are removed on the 10th postoperative day and most individuals are able to return to work by then.
After structural fat grafting is performed, blood vessels grow into the fat grafted area (neovascularization). The degree of neovascularization determines the proportion of fat graft survival. In general, 60 to 80% of the grafted fat will survive, and the appearance at 2 months postoperatively is normally representative of the long-term result. The non-surviving fat is absorbed by the body during the first two months. The fat grafts that survive persist for many years.
Dr Yeo is one of the select plastic surgeons in Singapore who is be able to offer augmentation using the latest generation of nanotextured Motiva breast implants, as well as all other brands and types of implants. He is also experienced in structural fat grafting breast augmentation, and is able to offer you the full range of breast augmentation procedures available. Implant breast augmentation without chest or axilla scars during tummy tuck surgery is possible by using special, proprietary techniques available at Picasso Plastic Surgery.
Our clinic has an en suite operating facility that has MOH certification as an Ambulatory Surgical Center (ASC). This assures your maximal privacy and convenience while keeping facility and equipment costs contained. Our operating room carries a full range of specialized equipment for breast augmentation, liposuction and structural fat grafting aimed at delivering optimal results.
Complementary procedures enhance the result of hybrid breast augmentation and may be performed at the same sitting. These include:
