http://www.asiaone.com/Health/Women%27s+Matters/Story/A1Story20090807-159745.html
Mon, Aug 10, 2009
The Straits Times
Breast reshapers
By: June Cheong
For figure-conscious women, the desire for that boob job can be fulfilled - if they are willing to pay for it.
Today, breast augmentation has expanded beyond the surgical option of implants. Fat injections and breast fillers are now available to pad one's bra - and one's ego.
Breast fillers are being touted as one of the newest advancements in medical aesthetics.
The fillers, which promise to reshape the breasts, come in the form of gels said to be safe and bio-compatible with the body.
Macrolane was launched in Singapore in July last year and is the most established brand here. Its filler uses hyaluronic acid, a naturally occurring substance in human skin. Other brands of breast fillers available here include Hyacorp and Aqualift.
The procedure is considered minimally invasive. The filler is injected by a plastic surgeon or a trained doctor into the fat beneath glandular tissues in the breast.
Fat injections operate on the same principle by adding the patient's own fat to her breast.
Fat is first harvested from a patient's abdomen, thighs or buttocks through liposuction.
Impurities and blood are removed and what is left is then concentrated before being injected into the breasts.
As for breast implant surgery, which has a history of more than 100 years, a plastic surgeon makes an incision and inserts a silicone or saline implant either under the breast or under the breast and chest muscle.
The procedure, done under general anaesthesia, usually takes less than two hours. Patients generally do not require overnight observation and can return home to rest two or three hours after the procedure.
'The aim in all these methods is the same, which is to increase the volume of the breast.
'If the increase in volume required is small, then fillers or fat injections are good options. Otherwise, an implant is another option,' said Dr Andrew Khoo, a specialist plastic surgeon at Aesthetic & Reconstructive Centre.
While breast augmentation promises a bigger bust with minimum fuss, those keen on upgrading their cup sizes should do their homework and be aware of the medical risks.
Implant risks
Dr Martin Huang, a director and consultant plastic surgeon at The Cosmetic Surgery Clinic, warned that like all surgery, breast implant procedures carry some risks.
He said: 'Overall, they're very safe. The risks that are present are low. There is a small risk of losing some nipple sensation and capsular contracture.'
Capsular contracture refers to the shrinking and tightening of the mass of scar tissue around an implant which may result in pain and unnatural firmness and distortion of the breast.
Other possible complications include bleeding, infection, asymmetry of the breasts, malposition of the implants and implant failure (leakage or rupture).
Breast implant manufacturer Allergan conducted a seven-year study of more than 400 women who had had breast implant surgery. It found that the most common complications experienced by patients who had breast implants for the first time were the need for further operations and capsular contracture.
In the early 1990s, the use of silicone implants was banned or limited in many countries, including the United States, when researchers were concerned about health risks.
A Ministry of Health spokesman said that silicone implants are not banned in Singapore and only implants that are approved by the United States Food and Drug Administration may be used.
Plastic surgeons Mind Your Body spoke to said the new generation of silicone gel implants are 'extremely safe'.
Dr Leslie Kuek, the director of Leslie Kuek Plastic Surgery, said: 'The new generation of implants is made of cohesive gel, which retains memory of its shape. Even if the implant shell breaks, the gel stays where it is and will not flow out.'
Dr Huang added: 'Implants are not promoted as lifetime devices. But if there's no capsular contracture and no infection, you can effectively keep them in you for many years.'
Breast filler risks
While fillers are not permanent - they last from 12 to 18 months - and are non-surgical, they still carry risks such as infection, encapsulation and migration of the filler.
Infections can be treated with antibiotics while other adverse consequences may be dealt with by surgically removing the filler.
Dr Khoo said: 'If the filler is injected in a large amount into one area, then a lake of filler can be created which can become encapsulated or migrate.'
Dr Kuek added: 'Anytime you inject a foreign substance in, your body will react with a capsule. Most of the time, the capsule that forms is very thin and you don't know it exists. Sometimes, however, it can grow thicker and then it may be felt.'
That happened to Ms Alice Hart Davis, a British beauty journalist. She had Macrolane injections done in March last year and expressed her disappointment with the product in a column in British daily The Times this March.
She said one of her breasts had become rock hard while the other had shrunk to half its size.
When asked to comment on Ms Davis' case, a spokesman for Q-Med, which distributes Macrolane, said: 'Clinical studies show that transient local reactions such as swelling, redness and tenderness occur following treatment with Macrolane.
'Some patients might experience lumpiness. Encapsulation due to Macrolane can be fixed by massage or injecting hyaluronidase (an enzyme which breaks down hyaluronic acid).
'There is a small population of patients, around 2 per cent, in whom Macrolane biodegrades rapidly. The reasons for this are being investigated but research indicates that lifestyle factors can play a part.'
Doctors Mind Your Body spoke to said such side effects were rare. They have not come across any patients with such symptoms here.
Dr Kevin Teh, the medical director at Singapore Lipo, Body & Face Centre, said: 'The vast majority of these issues are technique-related. If the doctor performing the procedure has enough experience and takes his time, such issues can be avoided.'
Asked if hyaluronic acid-based fillers can affect the body adversely in the long run, he said hyaluronic acid will be broken down in the body by hyaluronidase.
He said: 'This already happens in the skin naturally. Your cells have to renew and change.'
While doctors know that hyaluronic acid is broken down and re-absorbed into the body, they are not sure what it ends up as or where.
When asked if the sheer volume of filler pumped into a breast (100cc on average) can cause problems in the body, Dr Huang said: 'Hyaluronic acid has been used in facial fillers for more than 10 years. It's not new to the human body.
'The volume of the filler injected is not so important when it comes to long-term effects; it's more the nature of the material and hyaluronic acid has been shown to be safe.'
Fat injection risks
Fat injections may be safest when it comes to issues of rejection but they also carry risks like infection and migration. Furthermore, there is the concern that the fat may not survive in the long run.
Dr Khoo said: 'In an ideal scenario, the fat graft acquires blood supply from the surrounding breast tissue and survives.
'If this process does not take place, the fat is re-absorbed, causing loss of volume. If one breast re-absorbs fat more than the other, there is a risk of asymmetry.'
Dr Kuek added: 'The fat that does not survive may calcify and may cause lumps which can be confused with breast cancer. A good radiologist should be able to tell the difference though.'
So with all these choices today to bump up bust size, does the cup now look half-full or half-empty?
Dr Huang summed up: 'At the end of the day, the plastic surgeon has to present information objectively. There's always some trade-off. There's no perfect treatment.
'I always look at the issue of size first with the patient. If she wants a modest increase in size that can be achieved by an implant or filler, then the issue becomes more about permanent versus non-permanent surgery versus no surgery.'
This article was first published in Mind Your Body, The Straits Times.
Mon, Aug 10, 2009
The Straits Times
Breast reshapers
By: June Cheong
For figure-conscious women, the desire for that boob job can be fulfilled - if they are willing to pay for it.
Today, breast augmentation has expanded beyond the surgical option of implants. Fat injections and breast fillers are now available to pad one's bra - and one's ego.
Breast fillers are being touted as one of the newest advancements in medical aesthetics.
The fillers, which promise to reshape the breasts, come in the form of gels said to be safe and bio-compatible with the body.
Macrolane was launched in Singapore in July last year and is the most established brand here. Its filler uses hyaluronic acid, a naturally occurring substance in human skin. Other brands of breast fillers available here include Hyacorp and Aqualift.
The procedure is considered minimally invasive. The filler is injected by a plastic surgeon or a trained doctor into the fat beneath glandular tissues in the breast.
Fat injections operate on the same principle by adding the patient's own fat to her breast.
Fat is first harvested from a patient's abdomen, thighs or buttocks through liposuction.
Impurities and blood are removed and what is left is then concentrated before being injected into the breasts.
As for breast implant surgery, which has a history of more than 100 years, a plastic surgeon makes an incision and inserts a silicone or saline implant either under the breast or under the breast and chest muscle.
The procedure, done under general anaesthesia, usually takes less than two hours. Patients generally do not require overnight observation and can return home to rest two or three hours after the procedure.
'The aim in all these methods is the same, which is to increase the volume of the breast.
'If the increase in volume required is small, then fillers or fat injections are good options. Otherwise, an implant is another option,' said Dr Andrew Khoo, a specialist plastic surgeon at Aesthetic & Reconstructive Centre.
While breast augmentation promises a bigger bust with minimum fuss, those keen on upgrading their cup sizes should do their homework and be aware of the medical risks.
Implant risks
Dr Martin Huang, a director and consultant plastic surgeon at The Cosmetic Surgery Clinic, warned that like all surgery, breast implant procedures carry some risks.
He said: 'Overall, they're very safe. The risks that are present are low. There is a small risk of losing some nipple sensation and capsular contracture.'
Capsular contracture refers to the shrinking and tightening of the mass of scar tissue around an implant which may result in pain and unnatural firmness and distortion of the breast.
Other possible complications include bleeding, infection, asymmetry of the breasts, malposition of the implants and implant failure (leakage or rupture).
Breast implant manufacturer Allergan conducted a seven-year study of more than 400 women who had had breast implant surgery. It found that the most common complications experienced by patients who had breast implants for the first time were the need for further operations and capsular contracture.
In the early 1990s, the use of silicone implants was banned or limited in many countries, including the United States, when researchers were concerned about health risks.
A Ministry of Health spokesman said that silicone implants are not banned in Singapore and only implants that are approved by the United States Food and Drug Administration may be used.
Plastic surgeons Mind Your Body spoke to said the new generation of silicone gel implants are 'extremely safe'.
Dr Leslie Kuek, the director of Leslie Kuek Plastic Surgery, said: 'The new generation of implants is made of cohesive gel, which retains memory of its shape. Even if the implant shell breaks, the gel stays where it is and will not flow out.'
Dr Huang added: 'Implants are not promoted as lifetime devices. But if there's no capsular contracture and no infection, you can effectively keep them in you for many years.'
Breast filler risks
While fillers are not permanent - they last from 12 to 18 months - and are non-surgical, they still carry risks such as infection, encapsulation and migration of the filler.
Infections can be treated with antibiotics while other adverse consequences may be dealt with by surgically removing the filler.
Dr Khoo said: 'If the filler is injected in a large amount into one area, then a lake of filler can be created which can become encapsulated or migrate.'
Dr Kuek added: 'Anytime you inject a foreign substance in, your body will react with a capsule. Most of the time, the capsule that forms is very thin and you don't know it exists. Sometimes, however, it can grow thicker and then it may be felt.'
That happened to Ms Alice Hart Davis, a British beauty journalist. She had Macrolane injections done in March last year and expressed her disappointment with the product in a column in British daily The Times this March.
She said one of her breasts had become rock hard while the other had shrunk to half its size.
When asked to comment on Ms Davis' case, a spokesman for Q-Med, which distributes Macrolane, said: 'Clinical studies show that transient local reactions such as swelling, redness and tenderness occur following treatment with Macrolane.
'Some patients might experience lumpiness. Encapsulation due to Macrolane can be fixed by massage or injecting hyaluronidase (an enzyme which breaks down hyaluronic acid).
'There is a small population of patients, around 2 per cent, in whom Macrolane biodegrades rapidly. The reasons for this are being investigated but research indicates that lifestyle factors can play a part.'
Doctors Mind Your Body spoke to said such side effects were rare. They have not come across any patients with such symptoms here.
Dr Kevin Teh, the medical director at Singapore Lipo, Body & Face Centre, said: 'The vast majority of these issues are technique-related. If the doctor performing the procedure has enough experience and takes his time, such issues can be avoided.'
Asked if hyaluronic acid-based fillers can affect the body adversely in the long run, he said hyaluronic acid will be broken down in the body by hyaluronidase.
He said: 'This already happens in the skin naturally. Your cells have to renew and change.'
While doctors know that hyaluronic acid is broken down and re-absorbed into the body, they are not sure what it ends up as or where.
When asked if the sheer volume of filler pumped into a breast (100cc on average) can cause problems in the body, Dr Huang said: 'Hyaluronic acid has been used in facial fillers for more than 10 years. It's not new to the human body.
'The volume of the filler injected is not so important when it comes to long-term effects; it's more the nature of the material and hyaluronic acid has been shown to be safe.'
Fat injection risks
Fat injections may be safest when it comes to issues of rejection but they also carry risks like infection and migration. Furthermore, there is the concern that the fat may not survive in the long run.
Dr Khoo said: 'In an ideal scenario, the fat graft acquires blood supply from the surrounding breast tissue and survives.
'If this process does not take place, the fat is re-absorbed, causing loss of volume. If one breast re-absorbs fat more than the other, there is a risk of asymmetry.'
Dr Kuek added: 'The fat that does not survive may calcify and may cause lumps which can be confused with breast cancer. A good radiologist should be able to tell the difference though.'
So with all these choices today to bump up bust size, does the cup now look half-full or half-empty?
Dr Huang summed up: 'At the end of the day, the plastic surgeon has to present information objectively. There's always some trade-off. There's no perfect treatment.
'I always look at the issue of size first with the patient. If she wants a modest increase in size that can be achieved by an implant or filler, then the issue becomes more about permanent versus non-permanent surgery versus no surgery.'
This article was first published in Mind Your Body, The Straits Times.
