Breast augmentation involves using breast implants to increase the size and improve the shape of the breasts. Breast augmentation is desired by women who wish to enhance their breasts because they are too small, or by women who have lost breast volume and shape after pregnancy and breast feeding. It is one of the commonest cosmetic surgery procedures, with high levels of safety and also high levels of patient satisfaction due to the strongly positive impact it has on the patient’s self esteem. Dr Huang has more than twenty five years of experience in this procedure using round, anatomical, and more recently, Motiva Ergonomix silicone breast implants. He has given invited presentations on breast augmentation in plastic surgery professional meetings across Asia, in such countries as South Korea, China and Japan, as well as in South East Asia and the Middle East. You can therefore be assured that you will be in the hands of an experienced and acknowledged specialist.
Silicone gel is the preferred type of breast implant material. There are three main types, based on shape and physical properties: round, anatomical, and Motiva Ergonomix. Round implants are dome shaped and equally full in all parts. Anatomical implants are tear drop shaped and are fuller in the lower part than the upper part. Anatomical implants are natural looking in the upright position but tend to maintain that same shape even when lying down. The current and preferred type of implant is the Motiva Ergonomix implant, which looks like an anatomical implant in the upright position, but changes its shape in a natural way when lying down because the silicone gel within the implant gravitates to the upper part of the breast in that position. More information on the Motiva Ergonomix implant is found below.
MOTIVA ERGONOMIX BREAST IMPLANTS
What are they? The Motiva Ergonomix is the current generation of silicone breast implant from Establishment labs of the U.S. (https://motivaimplants.com/). Using modern and sophisticated nanotechnology in its manufacturing process, Motiva produces high quality implants that look and feel more natural, yet are more durable, and are also safe. What are the advantages of Motiva breast implants?
- They feel soft and natural.
- They have a natural shape in all positions that changes and moves naturally with breast movements.
- They have a very low complication rate.
- Because they so soft (yet strong), they can be inserted through shorter incisions, resulting in shorter scars.
Breast augmentation is one of the commonest cosmetic operations by women who desire breast enhancement. Dr Huang uses careful, measurement based preoperative planning to select the most suitable breast implant for you based on your existing chest and breast dimensions as well as your own desires. He carries out the procedure meticulously and with great attention to technical detail using current and effective surgical techniques via the inframammary dual plane approach. Postoperative care is equally detailed, attentive and proactive to ensure a smooth, pain free and quick recovery. His ultimate goal is to deliver to his patients a high quality, natural looking aesthetic result with a high level of safety and low complication rates. The advent of the Motiva Ergonomix implant has allowed these goals to be achieved to a high standard due to the softness, natural shape and movement and enhanced safety of these implants.
The operation takes about one and a half hours under general anesthesia and is a day surgery procedure. A short incision is made in the inframammary fold (the skin crease along the lower margin of the breast). Please see FAQs below for why Dr Huang prefers this incision. A pocket of space is created to accommodate the implant snugly. This implant pocket is located partly under the chest muscle and partly under the breast tissue. Bleeding is thoroughly controlled. The implant is carefully inserted after soaking it in an antibiotic solution. The wound is closed meticulously without the need for surgical drains.
Postoperative pain is mild and well controlled with oral pain medication. Bruising and swelling are also mild, and are reduced by appropriate medications. Normal activities can usually be resumed within one or two days. Downtime from work is usually three to four days. A compression band is worn around the upper chest above the breasts for the first two to four weeks. This helps to reduce swelling and keeps the implants in the correct position. The stitches are removed after two weeks. A proactive scar management program is then commenced to ensure the best possible scar. Bras are avoided for the first one month so as not to push the implants upwards and allow them sufficient time to stabilize in the correct position. Exercise can be resumed after one month, but strenuous upper body exercise should be avoided for the first three months.
The risks of surgical complications such as bleeding and infection are extremely low. The main long term risk is capsular contracture. This refers to hardening and distortion of the implant caused by thickening and contraction of the capsule of scar tissue that normally forms around it. The Motiva implant has a very low risk of capsular contracture, well below one percent. There is also a small risk of losing some nipple sensation. This is due to the fact that the sensory nerves of the nipple can sometimes get in the way of the surgical dissection when the implant pocket is being created, especially when very large implants are used. If excessively large implants are avoided, this risk becomes negligible, and any sensory loss that occurs is usually temporary. Over the past few years, there have been clinical reports of two specific complications of highly textured breast implants: seromas and Anaplastic Large Cell Lympjhoma (ALCL). A seroma is an fluid collection of serum around the breast implant. It can occur as a result of trauma to the breast or excessive manipulation of the breast. ALCL is a rare form of lymphoma (cancer of the lymph nodes). A seroma can sometimes be the first sign of ALCL. Interestingly, all the known cases of ALCL have been reported in the West, and there have been no reports of ALCL in Asia. Importantly, there have been no cases of seroma or ALCL in patients with Motiva implants worldwide
Frequently Asked Questions
What makes Motiva implants feel so soft and natural?
The silicone gel used in these implants is made using modern and sophisticated manufacturing techniques that create an implant with different physical properties in that it is cohesive (hence non-liquid, so that it doesn’t leak even when ruptured), yet it is soft and natural feeling.
What gives them a natural shape that changes and moves naturally with breast movements?
The silicone gel in these implants has the right balance of viscosity (thickness) and elasticity (flexibility) that allows it to change and adapt its shape in response to the forces of gravity. Thus, when the patient is sitting or standing, most of the gel gravitates to the bottom half of the implant, creating a natural breast shape that is fuller below than above, just like an anatomical implant and natural breast. On the other hand, when the patient is lying down, most of the gel gravitates to the upper part of the breast, just like normal breast tissue does. An anatomical implant does not behave like this and tends to maintain its original shape even when lying down. Thus, the Motiva implant is a “smart” implant that is able to behave like normal breast tissue.
Why do they such a low complication rate?
The surface of the shell of the implant has many tiny undulations created by using nanotechnology in the manufacturing process, resulting in a finely textured surface. This fine texturing results in favorable interactions between the implant shell and the surrounding tissues so that the capsule of scar tissue produced around the implant is thin and soft. This results in a soft and natural feel. It also allows the implant to better adapt to the normal movements of the breast. In addition, the thin and soft capsule tends to stay that way, greatly reducing the risk of capsular contracture.
What’s capsular contracture?
Capsular contracture is a complication where the capsule of scar tissue surrounding the implant thickens and contracts around the implant. This squeezes the implant and increases pressure on the implant. The thick capsule and increased pressure on the implant combine to make the implant feel hard and stiff. Its shape also becomes too round and unnatural. Although it is not dangerous, capsular contracture impairs the aesthetic result of the breast augmentation procedure, and when significant, can only be corrected surgically. Therefore, anything we can do to reduce the risk of capsular contracture is high valuable.
How do we decide on the size of the implants?
Good preoperative planning and implant selection are key steps to achieving a successful outcome. In this detailed process, your chest and breasts will be carefully examined qualitatively and quantitatively. Several key dimensions of your chest and breasts will be measured. Based on these measurements as well as your own desires in terms of bra cup size, Dr Huang will select a range of the suitable designs and sizes of breast implant so that your breasts will be enhanced with a natural looking shape and an appropriate volume, and will be proportionate to the rest of your body. You will then get to try on different sizes of implant within this range by placing them in your bra and evaluating your appearance in the mirror. This helps you to decide if you are comfortable with the implant size and shape that has been selected.
Which incision is optimal?
The inframammary incision is Dr Huang’s preferred incision. It is made along the skin crease below the breast. This incision allows easy and direct access to the surgical field and facilitates the accuracy of the implant pocket creation, without violating the breast tissue. The underarm incision (the trans-axillary approach) is too distant from the breast, making it difficult to achieve this level of surgical precision. The periareolar approach (incision around the areola) provides good access, but it results in some milk ducts being cut in the process. This has two adverse consequences. First, it may compromise future breast feeding. Second, it releases bacteria that reside in the milk ducts, causing contamination of the implant. While the level of bacterial contamination is too low to cause infection, it will cause some degree of inflammation, which increases the risk of capsular contracture. For all of the above reasons, the infra-mammary incision is the preferred incision for Dr Huang.
Under the muscle or over the muscle?
The muscle in question is the pectoralis major muscle, which sits under the breast on the chest wall. Placing the breast implant under this muscle provides additional tissue padding over the implant, and helps to make the implant margins less obvious. This is especially useful in the upper inner part of the breast, where the patient’s own tissues are often thin. However, placing the implant totally under the muscle has a significant disadvantage. This muscle, which is very strong, will gradually pull the implant upwards and outwards as it contracts, causing the implant to sit too high up on the chest and too far out to the side. The breast will then look too full in its upper pole and its shape will be distorted. Therefore, Dr Huang prefers to place the implant partly under the muscle and partly under the breast. This is known as the dual plane approach: the implant sits under the muscle in the upper inner zone of the breast, and is under the breast the other zones. This provides muscle padding for the implant in the area that needs it most (the thin upper inner zone), but avoids muscle coverage elsewhere (where it is not needed anyway), so that the muscle cannot pull the implant out of position.
How often will I need check ups?
Postoperative care by Dr Huang’s nurses and will be attentive and detailed and check ups by Dr Huang will be frequent. Typically, reviews are scheduled on the second postoperative day, at the end of the first week, then weekly till the end of the first month. Thereafter, reviews are scheduled very two weeks till the end of the second month, then at three months postoperatively. Subsequently, reviews are carried out every three months till the end of the first year. The interval is then increased to six months till the end of the second year, after which reviews become yearly. If the patient is a foreigner who can only stay in Singapore for a limited time, the schedule for postoperative reviews is modified accordingly, and her recovery is monitored long distance through email communication and photos taken of the patient at appropriate intervals and sent to Dr Huang for review.
Do I need to replace the implants after many years?
While breast implants are not promoted as being lifetime devices, as long as there is no capsular contracture, it is not necessary to replace the implants after a certain number of years. Therefore, the implants can usually remain in your body indefinitely.
Can I still do breast screening examinations?
After the surgery, the breasts can still be screened with ultrasound scans, mammograms and MRI scans.
Will I still be able to breast feed after breast augmentation?
Breast feeding is still possible after breast augmentation because the milk glands and milk ducts are not damaged by the procedure.