Hybrid Breast Augmentation (Motiva Demi 235cc) + Liposuction of Upper Arms, Underarm, Accessory Breast and Under the Chin + Thread Lift, Bi-Needle & Botox | 25-Year-Old Woman, 3 Months After Surgery
A 25-year-old woman. She wanted more volume in her bust and also wished to refine the fullness from her upper arms to the underarm area and along her jawline, so we performed a hybrid breast augmentation combining a silicone implant with fat grafting, together with liposuction of the circumferential upper arms, underarm fat, accessory breast area and under the chin on the same day. The photos show her from the front before surgery and 3 months after surgery.
The short answer
This is a hybrid breast augmentation with a Motiva Demi 235cc implant and fat grafting (83ml right, 70ml left), combined with liposuction of the circumferential upper arms, underarm fat and accessory breast area. The photo 3 months after surgery shows fullness from the décolleté to the bust and a cleaner line from the upper arms to the underarms.
Case overview
| Procedure | Hybrid breast augmentation (silicone implant + fat grafting) / liposuction of the circumferential upper arms, underarm, accessory breast area and under the chin / neck Bi-Needle / cheek thread lift / Botox |
|---|---|
| Details | Motiva Demi 235cc (axillary incision, subglandular) + fat grafting 83ml right, 70ml left (subcutaneous) / 260ml of fat harvested / Bi-Needle 2 needles / thread lift (Lupinus) 4 threads / Botox 330 units in total (face and neck 130 units, shoulders 200 units) |
| Anesthesia / duration | General anaesthesia / about 2 hours |
| Photo timing | Before surgery and 3 months after surgery (front view) |
| Sessions | 1 session |
| Cost | JPY 1,620,800 (tax included, monitor price) Price list |
| Main risks | Swelling, bruising, pain, oedema, skin irregularity, asymmetry, scars, capsular contracture, rippling, lumps or calcification from fat grafting, etc. (details below) |
| Doctor | Dr. Shin Moriwaki (Director) |
Her concerns
She had little thickness in her chest, with a flat line from the décolleté to the breast. She also wanted to refine the fullness from her upper arms to the underarm area and the slackness from her jawline to her neck.
In slim patients, an implant alone can leave visible edges or steps, while fat alone is limited in how much volume can be added at once, so we proposed a hybrid breast augmentation that combines both. The fat was harvested from the areas she was concerned about: the circumferential upper arms, underarm fat and accessory breast area.
Procedures performed
Hybrid breast augmentation (Motiva Demi 235cc + fat grafting)
After checking the width of her chest wall and the stretch of her skin, we chose a Motiva Demi 235cc implant and inserted it in the subglandular plane through an axillary incision along the underarm crease.
From the harvested fat, 230ml of purified fat was centrifuged (400 rpm for 1 minute) to produce 153ml of fat for grafting, and 83ml on the right and 70ml on the left were grafted subcutaneously. By adding subcutaneous thickness from the décolleté to the upper part of the breast, we aimed for a natural slope in which the edge of the implant is less noticeable.
Liposuction of the circumferential upper arms, underarm fat and accessory breast area
We treated the area from the base of the upper arm through the underarm to the outer chest as one continuous zone, reducing the fullness that tends to collect where the arm meets the chest. A total of 260ml of fat was removed. The incisions are small ones at both elbows, the front and back of both armpits and below the nipples.
Around the face (under-chin liposuction, Bi-Needle, thread lift and Botox)
Under-chin liposuction reduced the fullness from the jawline to the neck, and 2 Bi-Needles in the neck and 4 Lupinus threads in the cheeks were placed to support the skin.
Botox was injected into the chin, nostrils, outer corners of the eyes, bridge of the nose (bunny lines), corners of the mouth, masseters and platysma (130 units in total), and 200 units into the shoulders.
Anaesthesia and operation time
The procedure was performed under general anaesthesia (propofol and midazolam) combined with nitrous oxide and sevoflurane, with 1,700ml of tumescent solution infiltrated into the upper arms and chest and 100ml into the face. The operation took about 2 hours.
Changes from before surgery to 3 months after
Before surgery, there was little forward projection of the chest, with a flat line from the décolleté to the breast. In the photo 3 months after surgery, a gentle fullness has formed from the décolleté to the bust, adding roundness to the neckline of her dress.
The upper arms look slimmer from the shoulder to the elbow, and the fullness around the underarms has decreased, giving a cleaner transition between the arm and the chest.
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.
Firmness in the liposuction areas (contracture) peaks around 1 month after surgery and usually settles in about 3 months. Swelling and firmness of the breasts also gradually settle over 1–3 months, and any unevenness or discomfort from the thread lift usually settles in about 3 months.
After surgery, she wore a compression bolero for the upper arms for 1 week, 24 hours a day, and a facial band for 24 hours. Sleeping face-down or positions that press on the chest should be avoided for 3 months, and a non-wired bra should be worn for the first 1.5 months.
These photos were taken 3 months after surgery, and the result will continue to settle gradually. The effect of Botox gradually wears off over time.
Risks and side effects
Liposuction may cause swelling, bruising, pain, oedema, skin irregularity or tightness, asymmetry, pigmentation and scars at the small incisions (elbows, armpits, below the nipples, under the chin and below the ears). Rarely, complications such as infection, haematoma, numbness or reduced sensation may occur. Skin laxity or rippling may occur on the upper arms and underarm area, and skin laxity or temporary difficulty moving the corners of the mouth may occur after under-chin liposuction.
Silicone implants carry risks of capsular contracture, rupture or malposition of the implant, rippling (the implant's folds showing on the surface), infection and changes in nipple or breast sensation. Fat grafting may cause calcification, lumps or cysts, variable fat survival and asymmetry.
Bi-Needle and the thread lift may cause redness, swelling, bruising, dimpling or puckering of the skin, palpable threads and relapse, and Botox may cause an unnatural feeling in facial expressions or temporary heaviness. General anaesthesia may temporarily cause nausea or throat discomfort.
These may occur during recovery and most ease over time, but the degree of symptoms and the length of recovery 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