Anatomical Considerations for Hyaluronic Acid Filler Injection for Breast Augmentation in Young Female Patients

Abstract

Hyaluronic acid (HA) fillers offer a minimally invasive alternative for breast augmentation, appealing to young female patients seeking natural results and minimal recovery time. However, achieving optimal outcomes requires a thorough understanding of breast anatomy, filler properties, and safe injection techniques. This study provides a comprehensive analysis of the anatomical considerations, techniques, and filler properties necessary for optimal breast augmentation using HA filler. It also explores patient selection, long-term safety and efficacy, and the management of complications. A review of key anatomical structures, including glandular tissue, fascial layers, vascular anatomy, and Cooper's ligaments was conducted. Injection techniques, such as dual-plane and submuscular approaches, were analysed with a focus on pre-procedural imaging. Four cases of young female patients undergoing breast augmentation using HA filler (e.p.t.q. eve X, Jetema Inc., Seoul, Republic of Korea) were analysed. The efficacy of HA fillers in achieving natural breast enhancement was demonstrated in all four cases. Ultrasound played a crucial role in ensuring accurate filler placement, reducing risks like vascular occlusion and filler migration. Patients reported high satisfaction and minimal complications, though periodic treatments were required for maintenance. HA filler-based breast augmentation is a safe and effective option for young female patients, delivering natural results with rapid recovery. Although the results can be temporary and maintenance treatment is required, HA fillers may offer a non-invasive alternative to silicone implants. Optimal outcomes can be achieved through a thorough understanding of anatomy, the use of highly cohesive fillers, and ultrasound-guided injection techniques.

Keywords: anatomy; breast augmentation; cross-sectional; hyaluronic acid; injections; interventional; subcutaneous; ultrasonography.

Figure 1

(A). Pre-procedure image of a 29-year-old female patient seeking subtle breast augmentation using the dual-plane technique. The patient desired a proportional increase in breast volume without undergoing surgery. (B). Immediate post-procedure image taken after the injection of 300 cc of HA filler (e.p.t.q. eve X, Jetema Inc., Seoul, Republic of Korea) into each breast, showing a subtle but noticeable increase in breast volume with a natural contour and smooth integration of the filler. (C). Ultrasound images from 9 o’clock of the breast before (left) and after (right) HA filler injection in the retromammary space, over the pectoralis fascia. An overall increase in the thickness of the breast is observed. (D). Ultrasound images from 6 o’clock of the breast.

Figure 2

(A). Pre-procedure image of a 35-year-old patient with thin breast tissue, seeking a more noticeable increase in breast volume through a non-surgical approach. (B). Immediate post-procedure image taken after receiving 350 cc of HA filler (e.p.t.q. eve X, Jetema Inc., Seoul, Republic of Korea) into each breast using the submuscular injection technique. The image shows significant volume enhancement with no visible lumps or irregularities, demonstrating the successful placement of filler beneath the pectoralis major muscle.

Figure 3

(A). Pre-procedure image of a 32-year-old fitness model who opted for a subtle enhancement to maintain a natural balance with her athletic physique. (B). Immediate post-procedure image taken after the injection of 250 cc of HA filler (e.p.t.q. eve X, Jetema Inc., Seoul, Republic of Korea) into each breast. The image illustrates a maintained natural breast contour that complements her frame, with no visible scars or complications.

Figure 4

(A). Pre-treatment image of a 36-year-old mother of two, seeking volume restoration following breastfeeding-related changes. (B). Immediate post-procedure image taken after receiving 300 cc of HA filler (e.p.t.q. eve X, Jetema Inc., Seoul, Republic of Korea) in each breast, primarily targeting the upper pole. The image shows restored breast fullness and a slight lift, with a rejuvenated shape and no visible signs of surgery.