It is a commonly accepted fact that apart from the functional aspects, breasts are organs of beauty and attraction. A woman suitably endowed with attractive and good sized breasts will exhibit self confidence and posture in the social circles.
Therefore if this organ is under developed or subsequently becomes smaller, distorted or droop after pregnancy; it may have psychological affects on a woman. It would then become a cause for concern for many women if they feel that they have lost the once beautiful physical asset. How then, can we – as plastic surgeons help to restore the stature of these unfortunate ladies in the safest possible manner?
There are many methods of breast enhancement – some temporary while others are permanent. We should select the one that gives the patient the best desired size and appearance, and will last for a life time. It must also give the patient the best natural shape and softness. Here are the different methods of enhancing the breast in the order of preference and safety.

Autologous Fat Transfer to augment the breasts

This is the best means to enhance the breast as it utilises the patient’s own fat to build up the breasts. The enhanced breasts are natural
in shape and feel normal. The fat is very carefully removed by non traumatic method like waterjet, washed, filtered and then reinjected into the appropriate anatomical planes. This placement must be very precise or it would result in abnormal lumps with calcifications as these lumps can make it difficult to differentiate them from breast tumours. Also, the patient must undergo the procedure more than once to achieve one size bigger and must have sufficient fat store for the plastic surgeon to harvest it. But the wonderful satisfaction is that it is your own
body tissue and will remain permanent.

Anatomical cohesive gel implant

The current use of the anatomical cohesive gel implant is well-accepted by the patients. This
state-of-the-art implant will not leak even when cut through and will give the patient
the best natural shape. Most companies have a “life warranty” on their product. This will
require good surgical skills and experiences in the correct placement of a well selected
implant. There will be a slight incisional scar. The pre-operative selection of size and
planning of the procedure are important aspects for the success of this method and
also for the patient’ satisfaction.
Some temporary methods

Artificial materials like macrolane, hyacorbs and others are also being used to enhance the size of breasts. These are temporary and will last for about a year. About 100 ml of these materials are injected into the breasts, and being biologically degradable, the body will remove
them in about a year, requiring replenishment. The material cost is high and the procedure is not without pain and some possible complications. Some patients are sensitive to the material and may develop reactions also. Possible infections and uneven filling may add to the woes of the patient. The annual top-up is often the deterring option.

Liquid silicone prosthesis

These are being phased out as they will seep or leak when the external coverings deteriorate. The
prosthesis has to be changed after 10 years. Normal saline implants are safer and still commonly used. Sometimes they may deflate suddenly due to a defective valve. When the prosthesis gradually deflates it can cause a “rippling” effect and will make the enhanced breast rather unnatural. However it is a safe prosthesis.

Others

Like injection of semi-permanent fillers, liquid silicone or other permanent materials are not to be considered because of severe adverse consequences.

Conclusion

What then is an ideal result of breast enhancement? It should be one which is natural and preferably uses one’s own tissue. For this using one own fat is the best. It must be harvested properly with as little trauma as possible. In order to use this method the patient must have a good reserve of fat and also willing to undergo at least more than one operation. We can
only help to increase the breast one size up unless we do it a few more times. For the artificial implants these must be permanent providing good natural profile. Currently the best option is the anatomical cohesive gel prosthesis which gives a natural shape, and is also good and natural to touch. Enhanced breasts with hard and severely contracted implants would become a liability
instead of a rewarding asset to the patients. Most breasts will become droopy and lose the upper
fullness as one ages and often more rapidly after pregnancy or breast feeding. The upper portion is often the most affected and most alarming to the women. They often describe their breasts as having lost the turgid or fullness that they once had and are now concentrated in the lower portion. This droopiness must also be corrected to make the breast appear as natural and attractive as possible. For most pregnant women, another common complaint is that
the once light colour of the nipple-areolar complex had become darker. They dislike this change. This can also be improved with a reliable pigment lightening laser and suitable lightening creams. For those with developmental small breasts which has caused them severe emotional and psychological trauma they should seek correct medical assistance. The loss of self confidence due this deformity can be alleviated by the right surgical options. It is vital to seek the right source and not anyone who boasts that they will be their “saviour”. The honest helpers must be
well qualified, trained and committed to help them and not otherwise.

Dr. Yeap Choong Lieng
Plastic Surgeon
#14-13, Mount Elizabeth Medical Centre, Singapore 228510
clyeapsurgery@gmail.com
Tel: (65) 6734 0061 / 6734 0062
Fax: (65) 6738 1192
After Office Hours: (65) 6533 0088, (65) 6535 8833
Dr Yeap Choong Lieng is a graduate of from the Medical College of the University
of Singapore. He was admitted as a Fellow into the Royal College of Surgeons
of Edinburgh and subsequently as a Fellow in Plastic Surgery of the Academy of
Medicine, Singapore. He was trained in the Department of Plastic Surgery in the
Singapore General Hospital and was sent on a government scholarship for further
advanced training and exposure in plastic surgery in the United States of America.
He was Consultant Plastic Surgeon and Deputy Head of the department till he
resigned to start his private practice in the Mount Elizabeth Medical Centre/
Hospital. He actively keeps pace with the latest developments in the field of
Aesthetic Surgery and He also teaches and lectures on various topics like Vaser
Liposelection for removal of fat and laser surgeries. He goes on yearly teaching trips
to underdeveloped countries to teach surgeons on reconstructive surgeries.

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