The breast is central to the feminine identity and is culturally celebrated in many genres of ancient and modern art. It bears essential function relating to breastfeeding and life-sustenance, and significant sociocultural function as a highly invested aesthetic part of the human form.
Aesthetic breasts are covered by crisp and elastic skin devoid of wrinkles, occupy an optimal position on the chest wall and are of proportionate size. Weight loss may cause a broad range of breast deformities that present as functional and aesthetic problems. These changes may affect an individual’s body image, self-confidence and social functioning.
Breast enlargement (macromastia) may occur during obesity may persist even after weight loss. Macromastia may be associated with shoulder, neck and back pain, grooving of the brassiere straps and difficulty finding well-fitting clothes and undergarments. Macromastia is also often associated with droopiness (breast ptosis). Breast ptosis is descent of the breast and/or nipple areolar complex below the inframammary fold, and predisposes to accumulation of perspiration, skin irritation and occasionally fungal infections within the fold. Due to the descent of the breast, individuals often have a flat upper chest with a low-lying and small breast gland covered with significant skin excess (“rock-in-a-sock” appearance).
Obesity causes increase in size and numbers of adipocytes (fat storage cells). These adipocytes convert some of their lipids into estrogen-related hormones which are released into the circulation and stimulate the growth of breasts and subcutaneous fat. In normal breasts, fibrous strands (Cooper’s ligaments) attach the gland to the chest wall and prevent their drooping. Breast ptosis is caused by shrinkage of the breast gland and/or subcutaneous fat volume, leading to relative skin excess. The Cooper’s ligaments that previously supported breasts of larger volume do not support this skin excess well. The result is descent of both the breast gland and the overlying skin.
Breast deformity following weight loss is often more extensive and severe than in regular post-pregnancy or aging individuals. This skin excess may extend laterally (outward) to the underarm and outer chest region, requiring modifications to traditional skin reduction techniques. Special skin excision techniques are needed to ensure maximal excess skin excision while minimizing the scar burden to achieve attractive postoperative outcomes.
The skin in weight loss individuals is thinner and may require longer healing time than average individuals. Use of breast implants alone in such cases may not result in optimal aesthetic outcomes due to potential visible implant edges. Specialized wound care techniques may be required in these cases to optimize wound healing and minimize scarring. Intimate knowledge of these anatomical and physiological differences and tailoring the treatment accordingly delivers optimal and bespoke outcomes.
Careful clinical assessment is critical in differentiating between breast ptosis and atrophy (droopy and shrunken breasts), breast ptosis (droopy breasts) only, and macromastia (abnormally enlarged breasts). Intimate knowledge of the anatomical changes underlying these physical signs, and delivering treatment that is specific to these changes is the best method of achieving optimal outcomes. In almost all cases, these procedures are performed as day surgery cases under general anesthesia.
The following are good candidates for breast contouring surgery:
Individuals who have a high BMI may wish to consider other forms of weight loss interventions (e.g. diet and exercise interventions, or bariatric surgery) to achieve ideal weight prior to breast contouring for best results.
Breast contouring surgery restores the breasts to their youthful and natural position on the chest wall. It modifies breast volume to achieve a proportionate size suited to the individual, and confers a pleasing silhouette when viewed from the front and from the sides. It restores elegance, feminity and confidence.
Individuals are advised to stop herbal supplements and traditional medicine, and start special medications 7 days prior to surgery to minimize bruising and swelling. Individuals above the age of 40 will require routine breast cancer screening prior to contouring surgery.
Minor postoperative swelling and bruising is expected, and will mostly resolve after the 10th postoperative day. Many individuals are able to return to work after the 3rd postoperative day. Stitch removal is not usually required as they are usually self-dissolving.
Showering is possible on the second postoperative day in most cases. Bruising may be minimized by avoidance of strenuous activity for the first 14 days. Specific post-operative support garments may be required in the first 2 weeks to support the inner tissues during wound healing, and to guide the shrinkage of skin.
Post-weight loss breast contouring is a niche and emerging field within plastic surgery. At Picasso Plastic Surgery, we are pleased to have embraced this subspecialty very early on in Singapore. Dr Yeo is privileged to have visited and learnt from some of the foremost overseas experts in this field in the past. He is similarly privileged to have worked with outstanding bariatric general surgeons and has accumulated experience in this area. He is regularly invited to speak on post-weight loss contouring at plastic surgery conferences in the Asia Pacific region. Dr Yeo is one of the select plastic surgeons in Singapore who are able to offer both Mentor® and Motiva® implants for maximal flexibility in choice for your breast contouring 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 and keeps facility and equipment costs contained.