Breast Augmentation

A well-formed and good size breast is recognized as a feminine asset. It is aesthetically pleasing and provides for easy fitting of clothes. There are commonly 2 groups of patients who will benefit from breast enhancement or augmentation. The first group of patients are usually young girls who have smaller breast as a result of breast hypoplasia. The second group of patients are adults who develop breast flattening or droop after pregnancy and breast feeding due to breast tissue atrophy. The enlargement or enhancement of breast can be achieved reliably and safely using breast implants. Currently silicone breast implants are the most popular and commonly used implant for augmentation. It gives a more natural shape and texture as compared to saline implants which tend to be rounded and firmer. The newer breast implants have been made safer with the use of cohesive gel, commonly known as “gummy bear” type of gel. The gel is more cohesive or “viscous” and thus less likely to leak out into the surrounding tissues.A well-formed and good size breast is recognized as a feminine asset. It is aesthetically pleasing and provides for easy fitting of clothes. There are commonly 2 groups of patients who will benefit from breast enhancement or augmentation. The first group of patients are usually young girls who have smaller breast as a result of breast hypoplasia. The second group of patients are adults who develop breast flattening or droop after pregnancy and breast feeding due to breast tissue atrophy. The enlargement or enhancement of breast can be achieved reliably and safely using breast implants. Currently silicone breast implants are the most popular and commonly used implant for augmentation. It gives a more natural shape and texture as compared to saline implants which tend to be rounded and firmer. The newer breast implants have been made safer with the use of cohesive gel, commonly known as “gummy bear” type of gel. The gel is more cohesive or “viscous” and thus less likely to leak out into the surrounding tissues.

The implants may be inserted through 3 different approaches namely the axilla, periareolar and inframammary approach. The implant may be placed under the breast tissue (sub-glandular) or below the chest muscle (sub-muscular) or dual plane, where part of the implant is under the muscle and part under the breast and subcutaneous tissue. The choice of approach is dependent on the patient’s physical attributes, the size of breast and thickness of soft tissue. One of the most preferred surgical approach for Asians is through the peri-areolar incision because the scar heals well and is least visible. It is also a more direct approach, thus less dissection and less painful.

The procedure takes about 2 hours under general anesthesia. Hospitalization for 1 day is recommended for more comfortable recovery. One of the possible complication for this surgery is bleeding or haematoma and infection (<5%). In the long term, there is a 3%-10% risk of capsular contracture, rippling or palpability of implant.

For secondary breast augmentation or correction of capsular contractures, generally the inframammary approach is advised. This approach gives better exposure for capsulectomy (removal of capsule) and to control bleeding. Sometimes the peri-areolar approach is possible.

The enhanced breast will improve the body proportion and facilitate the wearing of clothes. It will increase your attractiveness and give you added self- confidence. You can enjoy more sports like swimming and outdoor activities without feeling inhibited because of the sports wear. There is no increased risk of cancer and you can continue to breast feed baby naturally.

 

Breast Reduction

The breast develops during puberty in response to hormonal changes. However at times the breast overgrows and become too large and heavy. It can cause significant problems like backache, bra straps cutting into the shoulder and fungal infection under the breast. Besides it can cause considerable inconvenience during exercise, ill fitting of clothes and psychological stress for the individual.

Breast reduction is most commonly done using a keyhole-shaped incision and inferior central pedicle technique of the breast. After making the incision, the skin flaps are raised to expose the underlying breast tissue. The excess breast tissue is trimmed down on the medial, lateral and superior quadrants leaving the inferior and central sector of the breast intact as a functioning breast unit. The preserved breast tissue is reshaped and redraped using the skin flaps. The nipple and areolar complex is raised to an optimal position.

This procedure takes about 3-5 hours under general anaesthesia. Hospitalization for 1-2 days is recommended. The recovery period is about 1-2 weeks. The surgery carries a small risk (<5%) of post-operative bleeding, skin flap and nipple and areolar nerosis.

After the surgery, there is significant improvement in the symptoms and the greatest relieve is having the heavy load taken off the chest. They become more confident, outgoing and were able to pursue a more active lifestyle.

 

Mastopexy, Breast Lift

With age or following breast-feeding, the breast tend to atrophy and droop. The position of the nipple becomes lower and points downwards as the breast sags. For mild cases of breast atropy with volume loss, the fullness and firmness of the breast can be restored with a breast implant as in breast augmentation. With the improvement in fat grafting technique, breasts with mild atrophy can be rejuvenated using fat grafting. Multiple procedures may be necessary to achieve better fat graft take.

Frequently the severity of breast droop is contributed by previously large and heavy breasts, which weighs down the breast, stretches the skin envelope, leading to nipple and areolar complex ptosis. The nipple-areolar complex can be elevated and repositioned by performing a mastopexy or breast lift procedure. An ovale shaped or keyhole-shaped incision is made around the nipple areolar complex. Excess skin is removed and the skin flaps redraped and tightened to firm up the breast.

This procedure takes about 2-4 hours and requires hospitalization of 1-2 days. The recovery period is about 1-2 weeks.

 

Nipple Surgery

With breast feeding and ageing, the nipple may enlarge or elongate, leading to a pedunculated droopy nipple. The nipple can be reduced or firmed up using wedge excision or reduction technique. The procedure may be done under local anaesthesia as day surgery. The recovery time is about 1 week.

Inverted nipple is usually due to tight bands of tissue pulling down on the tip of the nipple, thus reducing its projection. These deformity may be corrected by releasing the band and applying a retaining stitch around the base of the nipple to maintain the projection. As the mammary ducts may be cut in the process of releasing the tight band, there is a risk of losing the ability to breastfeed. There is also a risk of losing the projection over time.

The procedure can be done under local anaesthesia as day surgery. The recovery time is about 1 week.