Breast Augmentation
Breast augmentation is also commonly known as a “boob job”. It is one of the most popular cosmetic surgery procedures done to increase the volume of the breast. This can be done either with breast implants or with fat grafting or a combination of both the techniques called hybrid breast augmentation. These options have long-lasting results and high success rates.
What are the types of breast augmentation?
Implant
Breast augmentation using silicone implants is a surgery performed to enhance the volume and projection of the breast, while creating a natural looking but well defined cleavage. The type of implants available include Motiva and Mentor.
Fat Grafting
Breast fat grafting can be a primary mean of increasing the volume of your breast. It is a natural way of breast enhancement using your own fat cells from another part of your body. It feels and looks more natural when compared to breast augmentation using implants. Furthermore, the scars for extracting the fat cells and injecting the fat cells into your breast are so tiny, they are barely visible once healed. It also has the additional advantage of removing fat from areas like your abdomen and thighs.
Which type of augmentation is best for you?
An in-depth discussion will be done at the initial consultation, to understand your general health, desired breast goals and sizes, together with a thorough examination and evaluation. During this visit, a 3D simulation of the appearance of your desired implant size will also be created using Quantificare 3D imaging. Potential areas for fat graft harvest will be identified together with you. With this 3D image, you can better visualize the possible final appearance. This will aid with your final decision on the procedure type, size, and placement.
It would be helpful to bring along any previous mammogram or ultrasound reports.
Implant
How is the breast implant surgery done?
This is done under general anaesthesia in a day surgery setting. The procedure will take less than 2 hours. There will be a short incision placed in the lower fold (infra-mammary fold) of the breast, which will ultimately leave you with a well-hidden scar once it has healed. The implants can be placed in 2 different planes of your breasts, either subglandular (under the breast tissue) or subpectoral (under the pectoral muscles). Often, they are also placed in a dual-plane method to achieve the benefits of each of the 2 different locations. This will be further discussed during the consultation based on your clinical examination.
What type of implants are available?
In our clinic, we have a range of implants for you to select from, both Mentor as well as Motiva implants are available. Implants come in various fill, sizes, shape and outer covering. Breast implant can be filled with cohesive silicone gel or saline. Cohesive silicone gel implants are also called gummy bear implants because they keep their shape, even when the implant shell breaks.
Breast implant shapes can either be anatomical or round. Anatomical or teardrop shaped implants have texturing on the surface. The textured surface allows increased friction between the implant and the surrounding breast tissue, ensuring that the anatomical implants are less likely to move around inside your breast and better stay in place. Anatomical implants are shaped to appear more naturally like a breast. It has a slope in the upper part which increases to a fuller rounder base.
Round shaped implants have a smooth outer texture. Round implants will make your breast look fuller over the top and cleavage area. They do slide more easily when compared to textured implants. These also feel softer.
Motiva implants are “next generation” ergonomix implant which are round in shape, while their texture is made of nanosurface texture, this marries the benefit of textured implant with round shaped implants. They have a round shape when you are lying down but form a natural slope when standing up as the silicone settles down at the base. This design allows the Motiva implants to follow the movements of your body.
The type of implants and the nature will be discussed with you during the consultation to aid with your decision.
What are the benefits of breast augmentation
with breast implants?
Breast implants will provide you with an immediate and significant degree of volume enhancement when compared to fat grafting. Depending on your desired volume of improvement, appropriate breast implant can be chosen to achieve your goals. It can range from a more naturally appearing ‘mini boob job’ with smaller implants to an obviously voluptuous augmentation with larger implants. The augmented breast will appear well defined, particularly over the cleavage. Depending on the volume of the breast implant, it may also help to lift slightly droopy breasts up.
What are the limitations of breast implant?
Implant breast augmentation will not be able to correct severely droopy breast (breast ptosis). For some of these cases, a combination of breast lift (mastopexy) may be required to reposition the nipples and the areola to a more ideal position. This can be done at the same time as the breast augmentation. An assessment will be made during the consultation and management options provided.
What is the recovery like after implant breast augmentation?
This is done as a day surgery procedure and you are able to go home on the same day. You will be placed in a supportive bra following the surgery. Ideally the supportive bra should be worn for 4-6 weeks to help with reduction in swelling and optimize the position of the implants.
Everyone heals differently, but generally there is minimal downtime. You should be able to return to work after at least 3 days. Swelling and bruising is expected after surgery, this will mostly settle down over the next two weeks and continue to improve with time. On average, full recovery takes about six weeks.
You should avoid doing sporting activities or lifting of heavy objects for at least six weeks following surgery, this is to ensure that the implants are given time to settle into place.
Fat Grafting
How is the breast fat transfer surgery done?
The procedure is generally done under sedation or general anaesthesia in a day surgery setting. It will take about 2 hours depending on the areas of liposuction required. Tiny incisions less than 1cm will be used for extracting the fat and for injecting and transferring the fat into your breasts.
What are the limitations of fat grafting?
If you have very little fat available for harvest, this could be an issue. We may suggest for breast augmentation using an implant like Motiva® or Mentor® instead.
Each fat grafting procedure can increase your breast volume by about half to one cup size. Should you desire larger volumes, the procedure may need to be repeated again. This can be done as early as 3 months following the first surgery.
Breast fat grafting will not be able to correct severely droopy breast (breast ptosis). For some of these cases, a combination of breast lift (mastopexy) and breast fat transfer may be required at the same time. An assessment will be made during the consultation and management options provided where required.
Can breast implants and breast fat grafting be combined (hybrid augmentation)?
Yes, this is a fantastic approach. There are several benefits of fat grafting concurrently, particularly for skinny woman. Fat grafts will further improve the medial cleavage and yet still appear soft and supple. Over the other edges of the implant, placement of some fat graft will soften the edges and thus reduce palpability and a visible edge. Generally, a small amount of fat (usually between 60-80mls) is sufficient, and it can easily be harvested from the inner thigh during the same procedure.
Frequently Asked Questions about Breast Augmentation
Breasts that have been augmented with implants generally feel slightly firmer than your natural breasts. Particularly for women with smaller natural breasts and thinner skin, you may be able to feel the outline of the implant through your skin and breast tissue. Otherwise, once the implants are placed beneath your pectoral (chest wall) muscles, there are sufficient tissue covering the implant to reduce its palpability.
The type of implant chosen will also affect how the breast feels like after augmentation. Generally, Mentor round implants and Motiva ergonomix implants are much softer in feel than anatomical (teardrop) shaped textured implants.
This is a breakdown about the differences between each type of implant.
| Benefits |
- No association with BIA-ALCL - Feels softer and more natural - Greater upper pole fullness - Smaller incision in the inframammary fold |
- Less risk of malposition - More natural slope of the upper pole - Lower risk of capsular contracture - Less risk of gel leak due to the cohesive nature of the silicone gel |
- Radiofrequency identification device that stores the implant information - Implant adjusts to your body movement, more natural slope when standing and fuller upper pole when lying down - Feels softer and more natural |
| Limitations |
- Higher risk of capsular contracture - Implants can rotate or flip - Increase risk of malposition / lower pole stretching out ‘bottoming out’ especially with larger implants |
- Very low risk of association with BIA-ALCL - May require a slightly longer inframammary incision - May feel slightly firmer due to more highly cohesive gel fill |
- Shorter period in the market with - Approved for use in Singapore (HSA) & other countries since 2016 - It is not FDA approved and not used in USA. - Slightly more costly than the other available implants |
| Selection Considerations |
- If you desire greater upper pole volume - If you are worried about BIA-ALCL |
- If you desire a more natural breast shape - If you have had recurrent capsular contracture - If you desire more stable outcome |
- If you desire a more natural breast shape and softer feel |
The scar will be placed in the inframammary fold region and is generally between 3-5cm long depending on the size of the implant chosen. Once the wound has healed, scar management will be instituted to allow the quality of the scar to improve to a fine, flat and pale scar.
Breast implants are largely safe, they have been used for over 50 years. However, breast implants are not lifetime devices, the life expectancy of the breast implant cannot be estimated, some woman can have their implant intact for over 10 years.
Here are some of the potential risks that can occur with implants:
- Changes to the sensation of the breast or nipple
- Palpability / rippling
- Capsular contracture is caused by hardening of the capsule around the breast implant. This hardening and shrinkage of the scar tissue causes the shape of the implant to distort
- Implant silicone gel leak
- Rupture
- Implant malposition
- Breast tissue thinning and stretching out with time
- Infection
- Seroma
- Breast implant associated anaplastic large-cell lymphoma (BIA-ALCL)
It generally takes about 3-4 months for the swelling to completely settle down. This is when you will be able to appreciate the final appearance of your breasts.
Any woman below the age of 21 will need to have parental consent for breast augmentation.
Breast implants are medical devices that does not last for a lifetime. The average lifespan of a breast implant can range between 10 to 20 years. The older the implants are, the risk of complications sequentially increases. However, breast implants only need to be replaced if any complications arises or if you are dissatisfied with them.
Sometimes after breast augmentation, the sensation of the nipples/areola may increase or become temporarily dulled. However, most of the time, the sensation gradually returns to normal after about 3 months.
Sometimes the direction of the nipples can alter after surgery, the final appearance will generally stabilize after about 3 months.
Some woman with mildly inverted nipples may find that following breast augmentation, their nipples may pop out with the stretching of the skin and pushing effect of the implant. Alternatively, you can also consider correcting the inverted nipples at the same time as your breast augmentation. Surgery is only recommended if you have completed your family and are no longer planning to breastfeed your child.
Breast implants are placed under the glandular tissue or under your pectoral muscles. This avoids interfering with the breast ducts and glands from which milk are produced and excreted. There are also other factors that can contribute to low milk supply.
If breastfeeding is important to you, it would be advisable not to have the breast augmentation done via the peri-areolar approach as there is some interference with the glandular tissue during the surgery. Instead, an inframammary approach should be performed.
During mammogram, additional views are required to allow better imaging of the breasts if there are implants in place. It is very rare for the mammogram process to rupture your implants.
Sometimes additional imaging may be necessary and includes ultrasound as well as MRI.
Mammograms should be done yearly starting from the age of 40.
Fat grafting definitely looks and feels more natural than implant. The advantage of fat grafting is such that the volume of breast is increased without having a “done” appearance. It does not have the distinct outlines of breast implants. Furthermore, it also feels much softer than any type of breast implants.
It generally takes about 3 months for most of the swelling to settle down. By this period of time, we will also be able to assess for the final volume of fat graft that have taken in the breast pocket and the final size of your newly enhanced breast.
The most ideal areas of fat for harvesting are the abdomen as well as the inner thighs. These are two areas that have the most abundant stores of fat. Furthermore, the quality of fat from these regions are also the best to enhance survival of the fat graft.
Other areas that can be considered are the back, arms, calves and the banana roll areas. However, the quality and quantity of fat in these regions are often less ideal as a primary location.
The incision made for the fat harvest as well as the fat grafting as less than 1cm. Also, they are strategically placed in well-hidden areas like the umbilicus or groin for harvest from the abdomen, groin for harvest from the thighs and in the inframammary fold region for grafting into the breast. A combination of tiny scars and well-placed scars will make them barely visible.
Generally, no specific preparation is required. You do not need to purposely gain weight for the procedure. The fasting time for the procedure is 8 hours, if it is performed under sedation or general anaesthesia.
We will often ensure that a baseline mammogram of the breast or ultrasound of the breast is done before your surgery, this is to ensure that we have images that we can compare to in the future for reference.
Anyone who desires an increased breast volume or increase in volume in specific areas of the breast are suitable candidates for fat grafting. However, the volume increase is generally between half to one cup size.
Woman who desires an immediate increase in breast volume above one cup size should consider breast implant augmentation instead. Unless undergoing more rounds of fat grafting is acceptable to you.
Most woman have some stores of fat in the abdominal or thigh region, even in the people who exercise on a regular basis. However, it is best to have a formal evaluation of your suitability.
Breast fat grafting surgery involves 2 separate procedures. First is liposuction of the areas involved for harvesting of the fat graft. Second is preparing of the fat and grafting them into the breast. The duration of these 2 procedures generally takes around 2 hours.
Liposuction and fat grafting are best performed under either sedation or general anaesthesia as it involves a sizable area of your body and staying still and comfortable is important to ensure a smooth surgery. The anaesthetist will provide you with adequate analgesia throughout the procedure.
After surgery, you will also be provided with adequate amount of analgesia, anti-swelling medications and antibiotics to return home with.
A portion of the fat graft that does not survive may initially feel lumpy as it undergoes necrosis or cyst formation. However, over the next 3-6 months, these fat grafts will gradually be broken down by the body and resorbed. There is also a very low risk of infection of the fat graft. There may also be asymmetry of breast due to unpredictable fat graft survival.
Generally, about 60-70% of fat graft that is transferred to the breast will survive and remain permanently in your breast. The fat that is now permanently in your breast will still undergo metabolic changes of weight gain and loss.
You will initially feel sore and bruised after the procedure. This discomfort will improve over the next few days. There will also be swelling involved, and compression garment after the procedure will help limit the swelling and also relieve the discomfort.
You should avoid putting pressure over your breast region. Sporting activities or going to the gym should also be stopped for the next 4 weeks to allow the wounds to settle down.
The procedure is usually done as a day surgery procedure, and you are able to return home on the same day. You will feel sore for the first few days, but this should not limit your daily activities. It would be ideal to take at least one week off work if possible as this is the period when you will experience some swelling and discomfort. Significant amount of the swelling and bruising would have settled by about 6 weeks. Sporting activities or going to the gym should also be stopped for the next 4 weeks to allow the wounds to settle down.
With fat grafting to the breast, you can expect about half to one cup size increase in your breast depending on the amount of fat graft that has retained.