Augmentation mammaplasty in asian women

Abstract

With the rapid economic development of Southeast Asia, the demand for cosmetic surgery has increased rapidly. Breast augmentation is among the most frequently performed cosmetic procedures. However, breast augmentation still has "bad press" in Southeast Asia because of not so distant catastrophes caused by direct liquid silicone injection and "Amazing Gel" augmentations. Asian patients have special characteristics that need to be taken into consideration when performing breast augmentation. The patients are usually thin and small with proportionally smaller breasts. The areola is often small with a large nipple. Because of poor scar healing, incisions need to be hidden. The transaxillary approach is therefore favored. A frequently performed adjunctive procedure is nipple reduction. In this article, the authors present their preferred technique for augmentation mammaplasty: endoscopically assisted subpectoral placement of smooth saline-filled implants via a transaxillary approach. Simultaneously, nipple reduction with the "modified top-hat flap" procedure is presented. Complications and their management are also discussed.

Keywords: Asian; Breast augmentation; aesthetic surgery; endoscopically assisted.

Figure 1

Complication of liquid silicone injections. (A) Preoperative picture presenting a patient with bilateral severe breast deformations secondary to injection of liquid silicone. Siliconomas have been removed partially at another hospital via an IMF approach. (B) Excised siliconomas.

Figure 2

Complication from Amazing Gel injections. (A) Note bilateral breast distortion secondary to a foreign body reaction to the Amazing Gel (polyacrylamide hydrogel). (B, C) Foreign body removed en bloc from right and left breasts. Breast tissue as well as muscle had to be removed.

Figure 3

Endoscopic pocket dissection area. The origins of pectoralis major at the fourth, fifth, and sixth ribs are released. The inferior quadrants of the breast are freed from the 3 o'clock to 9 o'clock positions.

Figure 4

Modified top-hat flap technique. (A) The incision done for the modified top-hat flap. (B) Nipple reduction after closure. (C) 1 and 2: The incision line of the modified top-hat flap for nipple reduction. 3: The modified top-hat flap elevated. 4: The shape of the nipple after reduction.

Figure 5

Breast augmentation with simultaneous nipple reduction with the modified top-hat flap technique. (A) Preoperative view. (B) Follow-up at 15 months.

Figure 6

A 28-year-old, thin woman with hypoplasic breasts. (A) Preoperative anteroposterior view. (B) Preoperative oblique view. (C) Postoperative anteroposterior view at 3 months. The augmented breast mounds look natural and pleasing. (D) Postoperative oblique view.

Figure 7

Use of the inframammary approach for correction of complication and secondary deformities. (A) A 25-year-old patient presenting with bilateral inferior displacement of implants, symmastia, and capsular contractures. Displacement of the implants and symmastia was thought to be due to inappropriate massaging. (B) Thirty-five days postoperatively. An inframammary approach was used to correct the deformities and release the capsular contracture. A new inframammary fold was created by fixing the dermis to the rib cage.

Figure 8

A hypertrophic, hypopigmented scar after a periareolar incision in this Asian patient.