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南国の美容クリニック

電話でのご予約・お問い合わせはTEL.098-860-9120

〒900-0016 沖縄県那覇市前島2-2-1-3F

    

BREAST CARE

                              日本語はこちら

Breast Enlargement
  Breast Enlargement (Implants)
    Silicone Implants     Saline Implants
  Fat Transfer for Breast Enlargement
  Hyaluronic Acid Filler for Breast Enlargement
Breast Lift/Reduction
Gynecomastia Correction
Areola Reduction
Nipple Reduction
Inverted Nipple Correction






Breast Enlargement

  Breast Enlargement (Implants)

   Using breast implants is still the most reliable procedure in giving the desired size and shape in performing breast enhancement. Two main types are the silicone and saline implants, but nowadays, only silicone is mainly used.


implant breast enlargement before/after
downtime: swelling&pain in 1to2 wks.,
  if bruises, needs 2-3wks. to subside



    Silicone Gel Implants

   FDA-approved smooth-typed silicone gel implant is the brand of choice in our facility. It is filled with safe cohesive silicone gel that sticks together to prevent leaking when rupture or implant breakage occurs. Because of this feature, silicone implant is sometimes called 'gummy-bear implant'. Implant sizes vary from 100 to 800 cc, around 200 to 300 cc is the estimated size to see 1-cup bra size change in American bra sizes.

image of broken cohesive implant





  Rough-surfaced silicone implant called textured-typed silicone gel implant was produced to reduce the incidence of contracture(hardening) of the capsule, the covering produced by the body when implant is inserted. But there has been a serious issue concern about the textured type. 10 or more years later after implanting, textured-type implants might cause a rare type of cancer called anaplastic large cell lymphoma(ALCL) in rare chance of 1 in a milionth of operated cases. Textured implants production may now be halted and this type might not be used anymore in medical settings.

  Anatomical type is another popular implant type designed exclusively into anatomical breast shape, but this type also is not the type of choice in our clinic. The reason is that it might change its direction afterwards when it moves inside the body where the capsule space is very spacious enough to rotate the implant, which is not a problem in regular round type ones. Another concern is that most of these anatomical ones are produced with textured coverings, the reason we think that this might become extinct in the near future.

   Our clinic has been choosing smooth-typed inplants for over 10 years, since when the occurence of lymphoma was not an issue yet. The reason we do not select textured types is that they seem to produce more rippling(wrinkling) of breast skin, and sometimes their rough surfaces are more touchable from skin surface especially in individuals with originally smaller breast and thinner skin.

   Breast enlargement surgery is performed under general anesthesia, with actual operation of 30 minutes, or 1 hour for the over all anesthetic process. After 1 night of bandage compression, it will be changed to a band compression beginning the next day until a week or a few weeks later. Stitch removal of wounds is done 1 to 2 weeks later.

   Postoperative swelling is observed 1 to 2 weeks, and if bruises are noticeable, it might take until around 3 weeks. Inserting implants under the pectoral muscle causes more pain that lasts for 1 to 2 weeks. Unexpected side effects maybe noticed, such as bleeding and infection, so refraining from active movements and wetting of the wounds for 1 week postsurgically is a must advice.

   Approaches of implant insertion are made at armpits, areola, or submammary folds, but areola procedure might sometimes show noticeable scar redness or keloid, so usually we encourage patients to select submammary folds or armpit approaches.














  Implants are placed in submuscular layer most of the time because it is assumed to be the most reliable level to insert implants.











   Subglandular(over muscle) placement is shallow enough to make implant contour or rims look so noticeable from breast skin years later, the main reason why it is not the first layer choice. But in cases with rich breast fat and skin tissues to cover the implants, to correct sagginess of loose breast skin, using 'dual plane technique' (submuscular insertion in upper breast area and subglandular in lower side) is also an option. But with thinner skin, this might not be able to hold implants after several years.


   Subfascial insertion is another method suggestion which imply placement in between muscle surface and its fascia(muscle membrane) but this is not realistic enough since pectoral muscle fascia is not that thick to differentiate this technique from subglandular placement.

   Keller Funnel is a remarkable creation of a plastic-made funnel to secure insertion of an implant through a smaller incision without unnecessary touching of the skin and instruments used in surgical setting, avoiding incidence of unwanted contamination of the implant and its space.






   The rough criteria of implant size and its outcome are the following:

180cc bef/aft
downtime: swelling&pain in 1to2 wks.,
  if bruises, needs 2-3wks. to subside




300㏄ bef/aft
downtime: swelling&pain in 1to2 wks.,
  if bruises, needs 2-3wks. to subside


400㏄ bef/aft
downtime: swelling&pain in 1to2 wks.,
  if bruises, needs 2-3wks. to subside


                 Saline-filled Implant

   Saline-filled implant is an alternative for those who were not comfortable using silicone ones. Procedures with this implant has become less since the advent of the cohesive silicone gel, but recently, because of the issues caused by silicone implants, saline ones are reviving their popularity as well as fat transfer procedure to the breast.

   Saline type is a safe option in case of rupture or breakage of implants but has higher rate of rupture incidence. However, replacement of newer saline implant is much easier and rather painless because of the same space can be used for insertion.

   Saline-filled implant procedures must be done also using smooth-surface type to prevent rare occurence of malignant lymphoma.

   The size of the approach wound for saline implants is much smaller than the one done for silicone type. Other operating and healing process are mostly the same with both implant types.


    Pricing

     without tax with tax 
 Silicone Implants Mentor's MemoryGel smoothtype up to 400cc \850000 \935000 
           above 400cc \900000  \990000
   Motiva's SilkSurface type up to 400cc \600000   \660000
           above 400cc \650000   \715000
Saline Implants  Mentor's smooth type up to 400cc  \700000   \770000
           above 400cc \750000   \825000
       General anesthesia fee included

   Fat Transfer for Breast Enlargement

  Fat Transfer or Grafting was introduced to the world over a century ago, but has only been practised seriously after the 2000s. Improvement in skills and diligent studies have made this possible, however, there are still some issues that have to be dealt with.

   While fat grafting has many advantages, a list of disadvantages also does exist. Let's see first some of its ADVANTAGES:
     ・not artificial, self-derived autologous fats are safe
     ・more natural in shape and touch
     ・permanently remain in the tissue
     ・liposuction can be performed together
There might be some more, but these 4 are the main factors in the list.

   Next are the DISADVANTAGES:
     ・most injected fats are resorbed, survival rate as bad as 20% up to 50%
     ・need treatments to achieve desired volume
     ・every session needs liposuction procedure
     ・non-surviving dead fat mass may turn into calcification or infection if not resorbed

   About same number of cons as pros is the reality of this method, however, tactics have been developed to cope with these issues. Firstly, injected fats must be rich in fat stem cells(adipose stem cells ASC). Harvested fats is purified to highten ASC's density inside the graft, anticipating stem cells to grow and multiply into mature fat cells inorder to compensate for the resorbed portion of the graft.

   Then, actual injection must be done in scattering manner by injecting fats in smaller strips along a layer and the same way at the other levels of the subcutis tissues, fat layers, and muscles, if necessary, to avoid creating a bulk.

   Tissue layer condition also affects survival rate of the fats. Specifically, loose spacious layers embrace more of the graft than the dense and firm ones. Body parts with loose layers and saggy excessive skin that has more room usually adopt well to the injected fats about 2 or 3 times of its desired capacity, which is necessary to gain the desired goal. Injecting further more than these might cause low survival rate and undesirable side effects. Only body parts that have extra room for fats can tolerate the adequate enormous graft volume.

   Fat graft is purified by the following process:


  Liposuction or Mini Lipo by Syringe Method is used for harvesting fats.





  Then syringes are centrifuged.





   Impurities are separated from purified fats.






   Directly inject fats or subdivide them to smaller syringes.



   Breast fat transfer is a method that requires certain amount of fats which are usually harvested with the full tummy or thigh liposuction, not mini lipo.

breast fat transfer before/after
downtime: suctioned area swells, get sore, & bruise for 1to2 wks., breast part is puffy, tender, & sometimes bruise a bit for days


    Volume of graft transfered is around 200cc on a side, 400cc on both sides. Of course, there might be exemption, but for regular body sizes, around 400cc is a safe amount for breast fat transfer. Fat survival rate really depends on condition of the breast tissue and skin. Loose tissue and excess skin that have plenty of room for fats can see better survival of graft while tighter breast might absorb most of the injected fats.

   More than 600cc transfer is often peformed at other facilities, but more is not mostly better. This makes the breast tighter leading to a surrounding where fat graft won't survive that much and sometimes might show unnatural touch from calcification, and , for the worst, infection might occur.

   Survival rate of the graft certainly differs in every individual, speaking from long experience, from 20 up to 50%. In American bra sizes, 200cc is a 1-cup upgrade. So 200cc of fats might turn out to be half-cup bigger. More treatments are needed if bigger size is desired. Surviving fats remain permanently.

   Pricing
     without tax with tax 
 Fat Transfer breasts  \200000+full liposuction fee   \220000+full liposuction fee
       
       
  Pricing is only for 1 treatment session.
  2nd fat injection and beyond are 50% OFF.
  Liposuction fee is required in every session. Refer to Liposuction page for pricing details.
  

  Hyaluronic Acid Filler Injection for Breast Enlargement

   Hyaluronic acid(HA) filler injection does not have the inconvenience usually experienced in fat transfer since it is a ready-to-use injectable, but the substance is absorbed within a year.

breast hyaluronic acid injection before/after
downtime: breast part turns puffy&tender for few days, if rarely bruises occur, takes a week to subside

 hyaluronic acid gel

  After a minute of local anesthesia, the filler can be conveniently injected for around 10 minutes. This is the main, or maybe the only, advantage of HA filling, then the following disadvantages might follow:
  ・can be absorbed and excreted from body 100%
  ・expensive since it's an artificially-synthesized product
  ・even soft gel might turn out hard when injected in mass
  ・extensive injection of the gel might produce some permanent uncertain lumps

  For such reasons, HA filler injection is better limited from 30㏄ to see effect, up to 100cc, which might be the upper limit to avoid unwanted efffects.

      Pricing
     with tax without tax 
 Hyaluronic Acid Breast Enlargement 10㏄  \40000   \44000
       
       

                          

Breast Enlargement: How Large is Large Enough



Breast Lift(Mastopexy)/ Reduction

   Mastopexy or breast lift is done for saggy breast, and breast tissue reduction is performed simultaneously if smaller size is desired or breast implant insertion if fuller breast is the goal. The skin on the lower part of the breast will be removed and tucked, and the areola will be transfered to a higher skin level around 20cm from sternal notch.


breast lift before/after
downtime: swelling&pain last for 1to2 wks.,
bruises take 2to3 wks. to subside




   Incision is made around areolar rim, down vertically to mammary fold inorder to remove excess skin, shaping a surgical wound that resembles a 'key hole', the reason why it is called the key-hole incision. Wound blends to skin color in time. If areolar sagging is not that severe, breast enlargement with implants only might work to see fuller lifted breast.





    If breast reduction only is the goal, incision of areola's lower half rim is big enough already to remove breast tissues.




   This procedure is performed under general anesthesia, requires physical and lab tests preoperatively.

   It takes 3 hours or more to complete this surgery, a week of bandage compression and months of band pressing follows. Stitch removal is 2 weeks later.

   Breast wounds are lengthy , so they take time on checking up, taking measures to avoid infection and splitting.

   Breast lift has to resist the pulling force of gravity that tends to spread scar's width. Taping of the wound is recommended to avoid this.

   Pricing
     without tax with tax 
 Breast Lift  both breasts  \500000  \550000
   +silicone implants  +\300000  +\330000
 Breast Reduction  both breasts  \400000  \440000
   General Anesthesia Fee \50000(with tax \55000)

             

Gynecomastia Correction

   Enlarged male breast tissue(gynecomastia)is the main concern of men in breast care especially in younger generation. Male hormone testosterone usually acts to develop a masculine chest contour. But when it does not work well, minute amount of female hormone in male body becomes a dominant trigger to create a feminine breast shape.

gynecomastia gradeⅡa correction before/after
downtime: swelling&pain for 1to2 wks.,
bruises might be observed for 2to3 wks.


   Famous grading of gynecomastia' s severity goes as follows:


gradeⅠ   hypertrophic tissue just under areola









grade Ⅱa   hypertrophy extends all over breast








grade Ⅱb   severe hypertrophy with saggy skin but nipple stays higher than fold







grade Ⅲ   severe hypertrophy with saggy skin, nipple lower than fold







   Treatment with surgery is done accordingly to grading:
grade Ⅰ   incision along areolar lower half rim, only removal of breast tissue








grade Ⅱa   same incision as gradeⅠ, removal of breast tissue,
        together with minilipo of breast from outer approach









grade Ⅱb  same remedy as grade Ⅱa

grade Ⅲ   breast lift with 'key-hole' incision(refer to breast lift mentioned above)
       transfer of areola to higher skin level
       removal of breast tissue, excess skin, & mini lipo









   Grade Ⅰup to grade Ⅱb cab be performed under local anesthesia while grade Ⅲ needs general anesthesia. A week of bandage compression, then stitch removal 2 weeks later. Swelling and bruises last around 2 or maybe 3 weeks.

   To avoid bleeding and infection, caution of keeping wound dry for a week mst be observed.
                                                   Pricing
     without tax with tax 
Gynecomastia Correction  grade Ⅰboth breasts  \180000   \198000
   grade Ⅱab both breasts \300000   \330000
   grade Ⅲ both breasts  \500000  \550000
    General Anesthesia \50000 (with tax \55000)

Areola Reduction

    Ideal areola size may vary in different breast sizes, but usually said to be around 3.5 cm in diameter. Reduction is designed to achieve this goal but areolas on bigger breasts tend to stretch out easily months later, resulting in a little more extended sizes than planned. So it is easier to create smaller areolas in smaller breasts than the bigger ones which are easily affected by the gravity.

    Areola reduction is done by removing the outer excess area and tucking the skin together creating a circular wound around the rim. By making the scar at the boundary, it will not be easily recognized when the scar heals with lighter color than the skin afterwards.










   Treatment can be done usually under local anesthesia, needs an hour to complete. A day of compression with gauze and band is needed, then stitch removal a week later. Swelling and bruises might last around 2 weeks.

   To avoid bleeding and infection postsurgically, caution of keeping wounds dry for at least 5 days is advisable.
                                                   Pricing
     with tax  without tax
 Areola Reduction both sides  \150000   \165000
       
       

Nipple Reduction

 
   In women, ideal nipple size is around 8mm in diameter, also 8mm in height, of course, these change accordingly to favorites or breast sizes.

   In men, about half of women's ideal diameter, which is 4mm is the best, and height , almost flat.



   Enlarged nipples usually resulted from breastfeeding and sometimes in men breast from natural cause.




   Nipple reduction is done by removing and tucking of skin of the lower base and partially at the lateral side of the upper part of the nipple







   30 minutes to an hour is the time needed to perform this procedure which is usually under local anesthesia. Since recovery of wounds at this area is slow, stitch removal is done after 2 weeks. Skin reduction is the main technique of this procedure, so mammary ducts will be preserved and remain intact, meaning breastfeeding is still possible afterwards.

   A day of bandage compression is necessary, swelling and bruises might last until 2 weeks.

   To avoid bleeding and infection, caution of keeping the area dry for at least 5 days is advisable.

      Pricing
     without tax with tax 
Nipple Reduction  both sides  \150000   \165000
       
       

Inverted Nipple Correction

    Inverted nipple is a cosmetic concern that can be seen from younger through older women. This issue is caused by underdeveloped mammary ducts which turn out shorter and tend to pull down the nipple.

    Because mostly younger women are eager to repair this problem, it is necessary to obtain consent in possibility of injuring the mammary ducts, meaning the disturbance of the normal breastfeeding. The incision usually goes across the whole diameter of the nipple, but in our clinic, we try our best to preserve the top portion by just cutting the side portion.
    
   Grading of severity:





gradeⅠ  nipple flat
      protrude easily with stimulating breast push








grade Ⅱ  nipple denting or sinking
     protrude when pulled with tweezers


grade Ⅲ  similar to gradeⅡ, nipple sinking
    but not pointing with tweezer pull
    requires sutured thread to be pulled




   Treatment according to grading:
grade Ⅰ  no need of surgery(breast pump or breast feeding as natural remedy)






grade Ⅱ  surgery needed. nipple lateral incisions on 2 sides, release duct adhesions,
      Z plasty sutures on neck to hold pointed nipple,
      1or2 weeks of traction device








grade Ⅲ  surgery needed. nipple incised in half after pulling out with sutures,
      release duct adhesion and cut short ones if needed
      secure neck with Z plasty stitches, 1or2 weeks of traction device








   This procedure is usually performed under local anesthesia, swelling and bruises are not that obvious. Requires an hour or more to complete, 1or2 weeks later, stitch and device removal/

   Be aware that recurrence might be observed particularly in severe cases. Also cut ducts might not be able to work for breast feeding afterwards.

   To avoid unwanted side effects such as infection and have a satisfactory result of the surgery, keep area dry while held by a traction device, by refraining from washing it but just treat it with some aseptic wipes.

     Pricing
     without tax with tax 
 Inverted Nipple Correction both sides  \160000   \176000
       
       
            

Miyagi Cosmetic Surgery宮城美容外科クリニック

〒900-0016
沖縄県那覇市前島2-2-1(3F)

2-2-1-3F Maejima, Naha City
Okinawa, Japan 900-0016

TEL 098-860-9120
FAX 098-860-9176

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e-mail  info@miyagi-clinic.info

 
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