Hybrid Breast Augmentation (PERLE 280cc) + Thigh, Calf, Knee, Upper Arm & Accessory Breast Liposuction | 28-Year-Old Woman, 6 Months After Surgery
A 28-year-old woman. She wanted more volume in her breasts and also wished to slim her thighs, calves, knees, upper arms and accessory breast tissue, so on the same day we performed hybrid breast augmentation combining a silicone implant with fat grafting, and liposuction of the thighs (circumferential), calves, knees, upper arms (circumferential) and accessory breasts. The photos show her upper body from a slightly oblique front angle before surgery and 6 months after surgery.
The short answer
This case combines hybrid breast augmentation using a PERLE 280cc implant and fat grafting (80ml on each side) with liposuction of the thighs, calves, knees, upper arms and accessory breasts. In the photos 6 months after surgery, the area from the décolleté to the breasts, which was flat before surgery, now has a rounded fullness, and the line from the upper arms to the armpits is slimmer.
Case overview
| Procedure | Hybrid breast augmentation (silicone implant + fat grafting) / liposuction of the thighs (circumferential), calves, knees, upper arms (circumferential) and accessory breasts |
|---|---|
| Details | PERLE 280cc (axillary incision, subglandular) + fat grafting 80ml on each side (subcutaneous) / total fat removed 3,200ml (back of thighs and calves 1,400ml, front of thighs 1,100ml, upper arms 700ml) |
| Anesthesia / duration | General anaesthesia / about 5 hours |
| Photo timing | Before and 6 months after surgery (slightly oblique front view) |
| Sessions | 1 session |
| Cost | JPY 2,874,000 (tax included, monitor price) Price list |
| Main risks | Swelling, bruising, pain, oedema, skin irregularity, asymmetry, scars, capsular contracture, rippling, fat lumps and calcification, prolonged oedema and pigmentation in the calves, etc. (see below) |
| Doctor | Dr. Shin Moriwaki (Director) |
Her concerns
She had little breast projection and was bothered by the flat line from her décolleté to her chest. She also wanted to slim her thighs, calves, knees and upper arms, as well as the accessory breast tissue bulging in front of her armpits.
In slim patients, an implant alone tends to show its outline or a step, while fat alone is limited in how much volume can be added at once, so we suggested hybrid breast augmentation combining both. The fat for grafting was harvested from the thighs, calves and upper arms, which she wanted to slim.
The procedures
Hybrid breast augmentation (PERLE 280cc + fat grafting)
After checking the width of her chest wall and the stretch of her skin, we chose a PERLE 280cc implant and placed it in the subglandular plane through an incision along the armpit crease.
From the harvested fat we obtained 400ml of purified fat and centrifuged it (1,000 rpm, 1 minute) to prepare 250ml of fat for grafting, of which 80ml was injected subcutaneously on each side. The aim was to add thickness under the skin from the décolleté to the upper breast so that the implant edge is less visible and the slope looks natural.
Liposuction of the thighs (circumferential), calves, knees, upper arms (circumferential) and accessory breasts
The thighs were treated as one continuous area (inner, outer, front and back) connected through the knees down to the calves, and the upper arms were treated together with the back, shoulders and front, along with the accessory breast tissue in front of the armpits. Treating only part of an area tends to leave a step at the border, so we connected the areas and reduced the thickness evenly.
The total fat removed was 3,200ml (back of thighs and calves 1,400ml, front of thighs 1,100ml, upper arms 700ml). The small incisions are at both elbows, the front and back of both armpits, the groin, below the buttocks and the front and back of the knees; the implant was inserted through the incision in the armpit crease.
Anaesthesia and operating time
Surgery was performed under general anaesthesia (propofol) with nitrous oxide and sevoflurane, and tumescent solution was injected: 3,700ml into the thighs and calves, 800ml into the upper arms and 200ml into each breast. The operating time was about 5 hours.
Changes from before surgery to 6 months after
Before surgery she had little forward projection, with a flat line from the décolleté to the chest. In the photos 6 months after surgery, there is a gentle fullness from the décolleté to the breasts, and the breasts have a rounded shape down to the lower pole. The thickness from the top of the upper arms to the armpits has also decreased, giving a slimmer arm line.
The timing and posture of the photos differ before and after surgery. These photos mainly compare the breasts and upper arms; changes in the thighs, calves and knees are not compared in these photos.
Recovery and aftercare
Pain peaks 2–3 days after surgery and settles in about 10 days. Swelling and bruising gradually subside over 2–3 weeks. Oedema tends to last longer in the calves and knees.
Firmness in the liposuction areas (induration) peaks around 1 month after surgery and usually settles in about 3 months. Tightness and firmness of the breasts also gradually soften over 1–3 months.
After surgery she wore an upper arm compression garment (bolero) and a thigh girdle 24 hours a day for 1 week, and the breasts were secured with tape. Sleeping face down or postures that press on the chest should be avoided for 3 months, and a non-wired bra should be worn until 1.5 months after surgery. Short, lukewarm showers are allowed from the next day; baths, saunas and strenuous exercise from 2 weeks after surgery.
These photos were taken 6 months after surgery.
Risks and side effects
Liposuction may cause swelling, bruising, pain, oedema, skin irregularity or tightness, asymmetry, pigmentation and scars at the small incisions (both elbows, both armpits, groin, below the buttocks and the front and back of the knees). Rarely, complications such as infection, haematoma, numbness or reduced sensation may occur. The upper arms and accessory breast area may show skin laxity or rippling; the thighs and knees may have prolonged oedema or reduced sensation; the calves are prone to swelling and pigmentation; and temporary firmness and irregularity due to induration may occur.
With silicone implants, capsular contracture, implant rupture or malposition, rippling (the implant's wrinkles showing on the surface), infection and changes in nipple or breast sensation may occur. With fat grafting, calcification, lumps or cysts, individual differences in fat survival and asymmetry may occur. General anaesthesia may temporarily cause nausea or throat discomfort.
These symptoms may occur during recovery and most improve over time, but their severity and the time to recover vary from person to person. If any symptom concerns you, please consult your surgeon rather than judging by yourself.
Free consultation available
1 min walk from Exit 6, Ginza-itchome Station / Open 10:00–19:00
The doctor in charge of this case
Shin Moriwaki, MD
Director, AVAN TOKYO Ginza Liposuction Clinic
Graduated from Tokushima University School of Medicine. Worked at Tokushima University Hospital, Tokyo Chuo Cosmetic Surgery and Gracia Clinic before taking up the current position. Over 5,000 liposuction procedures performed (including previous positions).
Member, Japan Society of Aesthetic Surgery (JSAS) / Member, American Academy of Aesthetic Medicine / ECFMG Certificate