TORONTO – Given the dearth of literature, Asian breast augmentation is largely driven by anatomical differences and patient preferences, according to a presentation at the Toronto Breast Surgery Symposium in Toronto.

The degree of augmentation requested varies according to cultures, explains Colin Hong, MD, FRCSC, a surgeon in private practice in Toronto, and chief of plastic surgery at Rouge Valley Health System in Toronto. For example, Chinese patients tend to request smaller-sized implants. “They sometimes request less than 150cc (sized implants),” he says.

Hong routinely selects gel-based, round, smooth implants for Asian patients who request breast augmentation. “I find these easier to place, and I don’t find much advantage (of the textured implant),” he adds.

“[Asian patients] tend to have a very thin chest wall,” he says. “The soft-tissue envelope can be very thin and very visible.” Dual-plane breast augmentation is Hong’s preferred approach to placement in Asian breast augmentation patients. “With the soft-tissue envelope being so thin, I rarely put in the implant (completely) under the glandular tissue.”

Hong’s incision of choice is the areolar incision, in part, because this type of incision will not leave as obvious a scar as would an inframammary fold incision. In his experience, the transaxillary approach makes revision, if required, more challenging.

Patients may turn to remedies like bleaching agents and steroid injections if hypertrophic scarring occurs after an inframammary incision.

“The inframammary fold incision is the most popular, according to the ASAPS (American Society for Aesthetic Plastic Surgery),” Hong says. “In my practice, it is the alveolar incision.”

The alveolar incision does not preclude the potential for revision surgery if it is required, nor does it produce inflated rates of capsular contracture. Moreover, it allows for a partial capsulectomy if necessary.

A disadvantage of alveolar incision is that patients report sensory changes to the nipple, Hong explains. However, the nipples of Asian patients tend to be larger than those of Caucasian patients, and Hong will often perform a nipple reduction subsequent to an augmentation.

Plastic surgeons are not always aware of differences in anatomy between races as well as differences in patient expectations based on culture, adds Wayne Carman, MD, FRCSC, director and founder of the Cosmetic Surgery Institute in Toronto and chief of plastic surgery at The Scarborough Hospital outside Toronto. “We appreciate the tips that are more specific to this ethnic group (Asian patients),” he says, noting Asians represent about a quarter of the Toronto-area population.

Asian breast augmentation is the second most common surgery in Hong’s practice.