Background: Breast augmentation in women of Asian ethnicity is far less common than that of Caucasians. But with changing fashion and clothing trends, more women of Asian descent are interested in having the procedure. The cultural concept of a smaller chest size and darker skin makes for some different considerations in breast enhancement surgery.
Case Study: This is a case of a 42 year-old female of Chinese birth who had lost some of her breast tissue after having had two children. She was very petite (5’1” 103 lbs) and had a great concern about being ‘too big’ after surgery. Her breast skin had no stretch marks and her nipple was positioned well above the lower breast crease. Her breast base diameter was 12.5 cms.
One of the critical decisions for her included what type of breast implant to use (saline vs silicone) and what size did she want to be. Given her lack of any breast tissue, the choice of silicone gel implant was chosen as she did not want any unnatural implant rippling. (whichi is likely to be apparent with so little natural breast tissue) As silicone gel breast implants must be placed through an incision on the breast, there is a scar concern given her darker skin complexion. The only way to completely avoid this issue is to use saline implants through a transaxillary (armpit) incision. Becuase of the risk of scar hyperpigmentation, I find that many Asian women will choose saline for this reason. But either way, it is a case of ‘picking your poison’…no scar on the breast and potential implant rippling vs. no implant rippling and a scar on the breast.
Like almost all women who undergo breast augmentation, a natural and not too large of a result is what they desire. This is particularly true in Asian women who rarely want to be disproportionate to their body and look obvious. This is inconsistent with much of their culture. One of the keys to breast implant size selection is the measurement of the diameter of the width of the natural breast. You do not want an implant size whose diameter is wider than your own breast base width, particularly if proportion and modesty is the goal. Given that her breast width was 12.5cms and being petite, a 300cc implant was more than adequate.
The operation was performed through a lower breast crease incision because she had chosen silicone gel implants. While placing that incision can sometimes require some guesswork, in her case, it did not. She had a well established crease but, more importantly, her nipple was positioned nicely in the center of her small breast mound. This means you can use her existing crease for the incision and have perfect scar placement. This is ideal in the darker complexioned patient where a scar anywhere even slightly off the crease can be very noticeable.
She had an excellent result with just a few days of recovery. She was very pleased with her new size as it was very body proportionate and allowed her to pursue new clothing options.
For postoperative scar management, I put all my body contouring patients on topical Scarguard beginning three weeks after surgery. They continue this daily for up to three months after surgery. While her scar was not yet completely mature, its appearance at three months as seen here shows that it will not pose any long-term concerns.
Case Highlights:
1) Asian breast augmentation patients desire very natural looking breasts with avoidance of scars on the breasts if possible. It has been my Indianapolis plastic surgery esperience that most of our Asian female patients are very private so natural looking breast implants are best.
2) Keep the size of the breast implant, regardless of silicone or saline, to within the diameter of the natural breast base. Only go bigger if the patient shows you pictures of other brest augmentation results that clearly go beyond those dimensions.
3) Incisions in the lower breast crease can be successfully used but perfect placement and topical postoperative scar management is necessary to ensure the most inconspicuous result. The funnel placement technique through the armpit is another implant delivery option to avoid any breast scars.
Dr. Barry Eppley
Indianapolis, Indiana