Breast Augmentation in the Asian Patient

Introduction

Breast augmentation is one of the most popular aesthetic procedures worldwide, including in Asia. The unique Asian cultural background, which is more conservative, influences various options for Asian breast augmentation. Many Asian women prefer an axillary incision to inframammary fold (IMF) incision because they do not want others to notice any scar on their breasts when they are in a public bath, swimming pool, or any other public places. From the ethnic perspective, Asian skin is darker than Caucasian skin and has a higher risk of hypertrophic and hyperpigmentation scarring.

The axillary approach has been questioned because of the blind, inaccurate, and bloody dissection. However, with the help of endoscopy, the axillary approach can have clear visualization and precise dissection, ensuring much better results than blind dissection. It has been demonstrated that axillary approach breast augmentation is a safe technique that has no impact on sentinel lymph node detection. If the dissection is appropriately performed, there is minimal chance of damaging the nerves and vessels. The periareolar incision is infrequently used, mainly because of the risk of changes in nipple–areolar sensibility, interference with milk ducts, and therefore possible bacterial contamination of implants.

In this chapter we discuss two dominant primary implant breast augmentation techniques in an Asian population: silicone implant subpectoral breast augmentation via IMF incision and endoscopy-assisted axillary incision.

Indications and Contraindications

IMF incision is suitable for almost all cases, especially for the difficult ones such as those involving ptosis, low pole constriction, and complicated revision surgery.

Axillary incision is preferred for patients who wish to hide the scar away from the breast. There are some limitations for this incision, so the relative contraindications are as follows:

• Severe breast ptosis needing mastopexy

• Lower pole constriction/short nipple-to-fold distance and need to stabilize new IMF

• Tubular breast

• Snoopy nose deformity

• Complicated breast revision cases (IMF approach needed)

Preoperative Evaluation and Special Considerations

Patients who seek breast augmentation have an extended consideration period and have collected much information on the internet. Sometimes, the more information they have, the more unrealistic their expectation can be, and the more confused they are due to “Dr. Google.” Patients should be informed about all the surgical procedures and details, including all the possible complications and risks. The formal consent form should be signed after all consultations.

A careful history and physical examination should be applied when approaching prospective breast augmentation patients. Meticulous attention should be given to the following:

• In evaluating breast development, the surgeon should inspect both breasts for symmetry, checking contour, fullness, nipple–areola position, the relationship between the position of the areola complex and the IMF, the relative relationship between breast and chest wall, and the distance to cleavage; and examine for musculoskeletal abnormalities such as scoliosis and soft tissue abnormalities (mass or nodule).

• Either obvious or subtle, asymmetries should be noted and explained to patients, ensuring that they are aware of all the details about their breast and chest wall beneath it.

• Pregnancy and breastfeeding history and breast mammogram history should be recorded.

Preoperative Measurement and Markings

Detailed measurements are necessary for both patients’ communication and making a surgical plan. Most importantly, dimensions of the breast can give surgeons guidance to choose the right implants for optimal results. Here we classify all the essential dimensions into two groups: measurement for education (aims to help patients to know more about their breast and understand the results) and measurement for surgical planning ( Table 5.1 ).

All those measurements should be informed to patients and recorded in the medical chart. Based on the individual breast dimensions, proper implants should be selected to match the patient’s expectation and to ensure the safety of the long-term follow-up. The measurement and marking should be performed in a standing position, and all the essential measures can be placed on patients’ breasts before the surgery ( Fig. 5.1 ).

Surgical Technique