Hybrid Breast Augmentation (Motiva Demi 270cc) + Thigh, Knee & Upper Arm Liposuction + Morpheus8 | 21-Year-Old Woman, 6 Months After Surgery
A 21-year-old woman. She wanted more volume in her breasts and also wished to slim her thighs, knees and upper arms, so on the same day we performed hybrid breast augmentation combining a silicone implant with fat grafting, and liposuction of the thighs (circumferential), knees and upper arms (circumferential); during surgery we also treated her jawline with Morpheus8. The photos show her breasts from an oblique angle before surgery and 6 months after surgery.
The short answer
This case combines hybrid breast augmentation using a Motiva Demi 270cc implant and fat grafting (right 100ml, left 70ml) with liposuction of the thighs, knees and upper arms. 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.
Case overview
| Procedure | Hybrid breast augmentation (silicone implant + fat grafting) / liposuction of the thighs (circumferential), knees and upper arms (circumferential) / Morpheus8 (jawline) |
|---|---|
| Details | Motiva Demi 270cc (axillary incision, subglandular) + fat grafting: right 100ml (80ml subcutaneous, 20ml intramuscular), left 70ml (subcutaneous) / total fat removed 2,660ml / Morpheus8 (upper and lower jawline, 3.0mm depth, 129 shots) |
| Anesthesia / duration | General anaesthesia / about 4 hours 40 minutes |
| Photo timing | Before and 6 months after surgery (oblique) |
| Sessions | 1 session |
| Cost | JPY 2,583,800 (tax included, monitor price) Price list |
| Main risks | Swelling, bruising, pain, oedema, skin irregularity, asymmetry, scars, capsular contracture, rippling, fat lumps and calcification, redness and heat from Morpheus8, 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, knees and upper arms.
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, knees and upper arms, which she wanted to slim.
The procedures
Hybrid breast augmentation (Motiva Demi 270cc + fat grafting)
After checking the width of her chest wall and the stretch of her skin, we chose a Motiva Demi 270cc 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 (600 rpm, 1 minute) to prepare 240ml of fat for grafting. We adjusted the amount on each side: 80ml subcutaneous and 20ml into the pectoral muscle on the right, and 70ml subcutaneous on the left. 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), knees and upper arms (circumferential)
The thighs were treated as one continuous area (inner, outer, front and back) connected to the knees, and the upper arms were treated together with the back, shoulders and front. 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 from the three areas was 2,660ml. The small incisions are at both elbows, the front and back of both armpits, below the nipples, the groin, below the buttocks and the knees.
Morpheus8 for the jawline
During surgery, Morpheus8 (microneedle RF) was applied to the jawline (the line from the corners of the mouth and under the chin) at a depth of 3.0mm with 129 shots. The purpose is to tighten the skin.
Anaesthesia and operating time
Surgery was performed under general anaesthesia (propofol and midazolam) with nitrous oxide and sevoflurane, and 2,000ml of tumescent solution was injected into the thighs and 1,200ml into the upper arms and chest. The operating time was about 4 hours 40 minutes.
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 from an oblique angle the breasts have a rounded shape down to the lower pole.
The timing and posture of the photos differ before and after surgery. These photos mainly compare the breasts; changes in the thighs, knees, upper arms and jawline 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.
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, below the nipples, groin, below the buttocks and knees). Rarely, complications such as infection, haematoma, numbness or reduced sensation may occur. The upper arms may show skin laxity or rippling, and the thighs and knees may have prolonged oedema, reduced sensation, or temporary firmness and irregularity due to induration.
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.
Morpheus8 may cause redness, swelling, a sensation of heat, bruising, dot-like marks and pigmentation at the treated area, and the degree of tightening varies from person to person. 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