Shape, position and support, planned together

Augmentation adds volume to breasts that are naturally small, have deflated after pregnancy or breastfeeding, or have changed with age or weight. The goal is a balanced, natural-looking breast rather than size for its own sake.

Dr. Kao weighs breast tissue, chest width, skin quality, nipple position and the patient's goals before recommending implant type, shape, incision and pocket. He makes small adjustments in implant size or position between sides when the breasts are slightly asymmetric.

When there is meaningful sagging, implants alone may not be enough. In that case he discusses combining augmentation with a lift.

Recovery Bruising, swelling and tightness are expected, and discomfort is managed with oral medication. Most patients return to work after about one week and resume exercise after about four weeks. Swelling largely settles by about six weeks, and the breasts continue to soften over the following months. Patients may recover at the KO'AN Recovery Center.

A breast lift removes excess skin, reshapes the breast tissue and moves the nipple and areola to a higher position. It suits women whose breasts have descended after pregnancy, weight change or with age, without necessarily wanting them larger.

Dr. Kao grades the degree of sagging and chooses the technique from it. For many patients he prefers the circumareolar lift, with the incision at the edge of the areola. For very heavy breasts and advanced sagging he uses the inverted-T pattern, closed in five layers to limit scar stretching.

The areola can be reduced at the same time. For patients who dislike any scar at the areolar border, the practice offers areola tattooing to soften its appearance.

Recovery Bruising, swelling and mild discomfort are expected, and a support garment may be worn. Most patients return to work after about one week and to exercise after about four weeks. Numbness and changes in nipple sensation are usually temporary. Major swelling subsides over about six weeks. The breasts continue to age naturally after a lift.

When the breasts have descended and also lost fullness, a lift alone improves position but not volume. Adding an implant restores fullness while the lift reshapes the breast and raises the nipple.

Dr. Kao balances how much tissue is removed against the size of the implant. He generally performs the combined procedure through a circumareolar incision, which lets him position the nipple correctly rather than lowering the implant to meet it.

Recovery Recovery follows the lift and augmentation guidance: most patients return to work after about one week and resume exercise after about four weeks, with swelling settling over the following weeks.

This technique is for women who need more lift than a simple circumareolar procedure can give but do not want the anchor scar of an inverted-T lift. Through an incision around the areola, Dr. Kao separates the skin from the breast tissue and shapes the tissue internally in an inverted-T pattern.

Where appropriate, an acellular dermal matrix is placed as an internal bra. It attaches to the chest wall, reinforces the lower breast and is gradually incorporated into the patient's own tissue.

Dr. Kao developed the Alexandra Breast Lift™, named after the patient who asked for it, as a hybrid of the circumareolar and internal inverted-T methods. It can be performed with or without implants. Severe sagging, very thin skin or poor elasticity may be better served by another lift.

Recovery Swelling, bruising and tightness are expected. Many patients return to work after about one week and resume exercise at about four weeks. Major swelling improves within about six weeks, and the shape refines over several months.

Reduction relieves the weight of large breasts, which can contribute to neck, back and shoulder strain, bra-strap grooves and skin irritation. It also lifts the breast and repositions the nipple and areola.

Dr. Kao treats reduction as sculpting the tissue that remains, not only removing tissue, so the breast does not look flat or boxy. Each side can be reduced differently to improve asymmetry. Fullness toward the underarm can be refined with liposuction or direct excision.

Recovery Swelling, bruising and soreness are expected, and a surgical or soft non-underwire bra is worn. Many patients return to desk work in one to two weeks and resume fuller activity around four to six weeks with Dr. Kao's approval. Symptom relief varies from patient to patient.

Revision addresses implants that are the wrong size, have hardened, rippled, ruptured or moved. Dr. Kao first identifies the cause, then plans the repair, which may be an exchange, capsule surgery, pocket repair, a lift or fat transfer.

When capsular contracture requires a capsulectomy, he removes the scar capsule without removing breast tissue. Implants that have drifted together are held apart with sutures along the inner pocket. Implants that have dropped are supported by reconstructing the breast fold. Where possible he works through the original incisions.

Recovery Recovery depends on the extent of correction. Patients rest upright for several days. More involved revisions typically mean about two weeks away from work, with exercise resuming at four to six weeks. Some conditions, such as capsular contracture, can recur.

After implants are removed, the skin and tissue they stretched may not contract back. A lift in the same operation reshapes the remaining breast and raises the nipple and areola.

Dr. Kao decides on capsule removal, the lift pattern and any fat transfer from the condition of the capsule, the skin and the patient's goals. Patients with small implants, good elasticity and little sagging may not need a lift.

Recovery Many patients return to desk work within one to two weeks and resume fuller activity around four to six weeks with approval. The breasts will be smaller once implant volume is gone.

Fat is taken by liposuction from areas such as the abdomen, flanks, hips or thighs, purified and placed in the breast in small layers. The result is a subtle change, generally about one cup size, rather than the volume an implant provides.

Dr. Kao processes the fat by centrifugation and filtration to remove oil, blood and damaged cells, a refined graft he calls Super Fat. Fat transfer is also used to soften implant edges, smooth rippling and restore contour after implant removal.

Some transferred fat is absorbed during healing, and more than one session may be needed.

Recovery Swelling and bruising affect both breasts and donor areas, and a compression garment may be worn. Most patients return to work in one to two weeks and resume exercise at four to six weeks. Final results appear at about three to six months.

Dr. Kao prefers to be involved before mastectomy. He holds an extensive consultation, works with the surgical oncologist on the incision, and is often in the operating room to keep the incision small and preserve skin. When the nipple is free of cancer, he favors a nipple-sparing mastectomy and repositions the nipple higher, refining it later with a modified circumareolar technique.

One of his preferred approaches is implant-based reconstruction combined with fat grafting, which softens implant edges and improves contour. Options also include tissue expanders, direct-to-implant reconstruction, a latissimus dorsi flap, and nipple and areola reconstruction with tattooing. For abdominal flaps that need microsurgery, he may coordinate with another specialist.

Reconstruction is often staged. Some patients choose not to reconstruct, and that choice is respected.

Recovery Recovery depends on the method. After expander or implant reconstruction, some patients return to light activity within about two weeks. Flap reconstruction takes longer because the donor site also heals. Sensation after reconstruction varies.