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Procedures

Breast Surgery Introduction

Also known as breast enlargement, breast implants, and popularly referred to as a “boob job”, Breast Augmentation is a surgical procedure that involves the enlargement of the breasts. The surgery may be performed to either treat breast ptosis (i.e., droopiness) or to acquire a more aesthetically pleasing upper body contour.

The three main causes of breast droopiness are breast gland shrinkage (resulting in a decrease in volume), breast gland enlargement (resulting in the breast itself drooping), and breast gland enlargement (leading to a loss in elasticity or stretching of the breast skin).

The 3 main ways to treat breast ptosis and droopiness are breast enlargement, excision of any droopy breast tissue and/or skin, and breast reduction performed in conjunction with a breast lift.

Breast enlargement procedures involve the insertion of breast implants that push the breast tissue superiorly and fill the overall breast area. On the other hand, during a breast tissue and/or skin excision procedure, the breast size is maintained, but the droopy breast tissue and skin are surgically removed. This procedure may also involve either a periareolar breast lift or reduction where the tissue around the areola is removed to lift the breast. It is also applicable in minor breast droopiness, or a breast tissue lift and autoaugmentation, where the lower breast tissue is re-located to the central aspect of the breast in order to “autoaugment” or naturally lift the breast tissue. Meanwhile, breast reduction procedures are performed at the lower and outer aspects of the breast in order to decrease the breast volume while elevating the position of the areola.

Common Indications

Some common indications (i.e., something that is considered advisable or necessary to undergo a particular test, medication, or procedure) for this procedure include the following:

  1. Flat chests
  2. Small breasts
  3. Droopy breasts
  4. Sagging breasts
  5. Asymmetrical breasts

Ideal Breast Shape

While the ideal shape of the breast may vary based on personal opinion, there are objective categories to determine the ideal breast shape.
The beautiful shape of Asian breasts is a teardrop shape, where the side-view outline from the neck to the areolar has to flow without sharp turns.

When lying down with the body facing upward, the breasts should lean slightly outward with the areolas pointing outward as well. In addition, the breast should not maintain its teardrop shape but rather the outer portion of the breast should appear thicker and slightly flatter.

The average length of the two areolars is 18-22 cm, while the average length from the areolar to the folding line underneath the breast is 5-6 cm.

The size of the breast will vary depending on the weight, length of the shoulders, natural breast size, and the patient’s desire. Usually, the desired size of the breast is 20-25cm larger than the waist size.

Breast Augmentation in Asians differs from breast augmentation in Caucasians due to the fact that Asians tend to scar more and Asians tend to have thicker skin than Caucasians.

In Asians, determining how the scar will appear after surgery is based on where the surgical incision is made and how much tension exists on the scar. Thus, a surgeon must have experience in deciding where the surgical incision site should be as well as an understanding of how to minimize tension during closure since tension is unavoidable with breast augmentation – due to the fact that the implant itself stretches the skin.

Thicker Asian skin does not allow breast implants to be positioned at the center of the breast. The thick lower breast skin and breast crease region do not stretch as much as that of Caucasians. By utilizing a traditional technique that is applicable for Caucasians, Asian breast augmentation tends to result in an implant that is placed more on the upper region of the breast. The result is a high upper breast fullness and insufficient lower breast. Thus, a natural-looking tear shape breast cannot be formed.

In Asians, a lower breast region pocket must be adequately dissected in two separate planes to allow the implant to fill the lower breast region. This helps create a natural-looking tear-shape breast in Asians. Thorough understanding of Asian skin elasticity and its effect on breast implant is required to produce a beautiful breast in Asians.

Anatomy of the Breast

The breast is mainly composed of adipose (fatty) tissue and glandular tissue (milk glands). The milk glands are interspersed throughout the breast, while the fatty tissue embraces them underneath to protect. The fatty tissue determines the shape and size of the breast. Underneath the breasts are pectorialis muscles, which function in movement of the chest, shoulder joint, and arms.

The size of the breast may change due to pregnancy, sudden weight loss, and aging process (skin stretching, ptosis due to gravity). This may result in droopy breasts. In addition, some patients have asymmetrical breast size, meaning the volume or shape of the breasts are different.