Hybrid Breast Augmentation (Motiva Mini 200cc) | Woman, 32, 3 Months
A 32-year-old woman. She wanted more volume in her breasts, so we performed hybrid breast augmentation combining a silicone implant with fat grafting. The fat for grafting was harvested by liposuction from the waist and the entire upper arms, which also slimmed her arms. The photos show her upper body from an oblique angle before surgery and 3 months after surgery.
The short answer
This case combines hybrid breast augmentation using a Motiva Mini 200cc implant and fat grafting (105ml right, 95ml left) with liposuction of the waist and the entire upper arms. In the photos 3 months after surgery, the area from the décolleté to the breasts, which was flat before surgery, now projects forward with a rounded fullness down to the lower pole.
Case overview
| Procedure | Hybrid breast augmentation (silicone implant + fat grafting) / liposuction of the waist and entire upper arms |
|---|---|
| Details | Motiva Mini 200cc (axillary incision, subglandular) + fat grafting 105ml right, 95ml left (subcutaneous) / fat removed 600ml (waist 300ml, upper arms 300ml) |
| Anesthesia / duration | General anaesthesia / about 1 hour 45 minutes |
| Photo timing | Before and 3 months after surgery (oblique view) |
| Sessions | 1 session |
| Cost | JPY 1,496,000 (tax included, monitor price) Price list |
| Main risks | Swelling, bruising, pain, oedema, skin irregularity or laxity, asymmetry, scars, capsular contracture, rippling, fat lumps and calcification, temporary firmness due to induration, 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 when seen from the side.
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 waist and the entire upper arms.
The procedures
Hybrid breast augmentation (Motiva Mini 200cc + fat grafting)
After checking the width of her chest wall and the stretch of her skin, we chose a Motiva Mini 200cc implant and placed it in the subglandular plane through an incision along the armpit crease.
Impurities were removed from the harvested fat to prepare 200ml for grafting, and 105ml was injected subcutaneously on the right and 95ml on the left. The amounts were adjusted to the difference in size between the breasts, and the aim was to add thickness from the décolleté to the upper breast so that the implant edge is less visible and the slope looks natural.
Liposuction of the waist and entire upper arms (fat harvesting)
The fat for grafting was removed from the waist (300ml) and the entire upper arms (300ml). In the upper arms, the back, shoulder and front were treated together to reduce thickness around the whole arm.
The small incisions are in the armpits (for implant insertion and arm liposuction), at both elbows, below the nipples, above the buttocks and on the back.
Anaesthesia and operating time
Surgery was performed under general anaesthesia (propofol) with nitrous oxide and sevoflurane; 800ml of tumescent solution was injected into the waist and 1,200ml into the upper arms and chest. The operating time was about 1 hour 45 minutes.
Changes from before surgery to 3 months after
Before surgery she had little forward projection, and from an oblique angle the line from the décolleté to the chest was flat. In the photos 3 months after surgery, there is a gentle forward fullness from the décolleté to the breasts, and 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 waist and upper arms 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 waist and upper arms where fat was removed (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 bodysuit 24 hours a day for 1 week. 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 3 months after surgery.
Frequently asked questions
How much does hybrid breast augmentation with waist and full upper arm liposuction cost?
The cost in this case was JPY 1,496,000 (tax included, monitor price), covering hybrid breast augmentation (Motiva Mini 200cc + fat grafting, including liposuction of the waist to harvest the fat) and liposuction of the entire upper arms. Anaesthesia, pre-operative blood tests and compression garments are charged separately, and the final amount is confirmed at the consultation. The monitor price requires consent to photo and video documentation.
How long is the downtime?
Pain peaks 2–3 days after surgery and settles in about 10 days; swelling and bruising subside over 2–3 weeks. Firmness (induration) in the waist and upper arms peaks around 1 month and usually settles in about 3 months, and breast tightness and firmness settle gradually over 1–3 months. The upper-arm compression garment (bolero) and bodysuit are worn 24 hours a day for 1 week. Sleeping face down or pressing on the chest is avoided for 3 months, and a non-wired bra is worn for the first 1.5 months. Showers are allowed from the next day (short, lukewarm), and baths, saunas and strenuous exercise can resume 2 weeks after surgery.
Where are the scars?
The incisions are in the armpits (for the implants and arm liposuction), at both elbows, below the nipples, above the buttocks and on the back, all small. The silicone implants were inserted through an axillary incision along the armpit crease. The scars become less noticeable over time, although how long redness or pigmentation lasts varies from person to person.
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, above the buttocks, etc.). Rarely, complications such as infection, haematoma, numbness or reduced sensation may occur. In the upper arms, skin laxity, rippling or a pulling sensation may occur, and in the waist 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.
Related treatment and cases
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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).
Certifications
・VASER Lipo certified physician
・ECFMG Certificate
Memberships
・Member, Japan Society of Aesthetic Surgery (JSAS)
・Full member, Japanese Society for Regenerative Medicine
・Member, American Academy of Aesthetic Medicine