Singapore’s top cosmetic surgeon Dr. Woffles Wu says his WW Stealth Incision technique renders breast implant scars more invisible than ever before. Dan Childs reports.
When it comes to any cosmetic surgery procedure, one of the main goals is a natural appearance. But for breast enhancement, this is more than a goal – it is a necessity.
For many women, the demand for a completely natural look from their breast implants is just as important as greater volume, a more feminine appearance or improved symmetry. Responding to this demand, doctors have come closer and closer to offering their patients a totally natural look – from new designs that more closely approximate the shape and feel of breast tissue to revised techniques for inserting the implants.
However, the scars from breast enhancement surgery remain as a telltale, often stigmatising sign that a woman has fake breasts.
“There is a stigma because that’s what people look out for nowadays,” says Dr. Woffles Wu, a Singapore-based plastic surgeon. “So I developed a technique that would consistently and predictably give me beautiful scars that would be virtually – and that’s an important word, virtually – invisible.”
The technique is called the WW Stealth Incision – and though it’s a new method, it is already gaining attention from women around the world who want an enhanced bust without the scars.
The growing popularity of breast enhancement surgery is, in many ways, a double-edged sword. On one hand, women nowadays are comforted in the knowledge that a well-chosen implant and an expertly performed procedure will give them a natural appearance. However, the characteristic scar in the armpit that regularly accompanies breast enhancement is also common knowledge – and a simple raise of the arm is enough to give away the surgical secret.
Dr. Wu says many women have learned the hard way that even the most natural-looking breast enhancement can be quickly labelled as a “bad boob job” by those who are able to catch a glance of this unfortunate scar.
“We had a girl who came into our office in tears,” he says. “She had had a breast augmentation through the armpits four years ago. The surgeon had told her that the scars would disappear, but after four years they still hadn’t.
“So one day she was unwittingly wearing a spaghetti strap top in the office and reached up on a bookshelf to retrieve some files. While she was doing this, a colleague of hers saw the scar in her armpit and told everyone in the office, ‘she’s had a boob job.’ So she was so humiliated that she resigned from the job.”
Dr. Wu notes that experiences like this one can have a drastic effect on a woman’s self-confidence – ironically, the very thing they had hoped to augment along with their cup size.
“All you need is one patient with a bad scar in their armpit, and you have a very unhappy client,” says Dr. Wu. “That lady will never ever wear a spaghetti strap top out in public again. She will never be able to go to a disco and raise her arms when she’s dancing, or do the YMCA. Because she knows that as soon as she does, everyone will know her breasts are not natural.”
The stigma of an unnatural appearance even extends beyond the public eye – it has even been known to affect romantic relationships. “It’s terrible, but I have seen many relationships break up because of this scar,” he says. “You wouldn’t think that a scar would make this much of a difference, but it does.
“If a woman has a visible scar in her armpit or breast crease, it is a terrible turnoff both for the spouse as well as for the patient. For the patient it makes her feel like she’s not real. And for the husband or boyfriend, they are often turned off by a dark, noticeable scar.”
Dr Wu adds, ” I had a distraught patient who had a breast augmentation procedure 5 years ago to please her boyfriend but he awful scars not only turned him off, he also broke up with her and she was devastated. She has now found a new boyfriend but is so psychologically damaged by the past humiliation that she cannot bear to be naked in front of him and consequently has not had any relations with him.”
Unfortunately, scars often go hand in hand with traditional incisions made to allow the insertion of implants. For many women, these scars in the armpit or at the breast crease are more than they bargained for from their breast enhancement operations.
“Surgeons, when talking to their patients, tend to be very dismissive,” Dr. Wu says. “They tell their patients that there will be a thin line in the armpit and that it will disappear with time. This is giving patients false hopes and false confidence.
“When the patient ends up with a brown line – or worse, a keloid – and when it turns out this scar doesn’t disappear, that’s when they suddenly realise, ‘my plastic surgeon didn’t tell me about this.’ I get patients telling me this all the time. These are very real psychological issues that affect our patients and their spouses.”
In 1995, Dr. Wu developed the WW Stealth Incision method in an effort to confront the problem of visible scars from breast augmentation procedures.
“The reason we call this the ‘stealth’ incision is because, like a stealth bomber, it’s there, but you can’t see it,” he says. “WW happens to be my initials, but it’s also the design of the incision.”
The technique itself, as well as the idea behind it, is elegantly simple. Instead of making a straight cut, the surgeon makes a zigzag incision. To hide this line, the surgeon performs the cut in an area of the breast that possesses natural irregularities and pigmentation – the areola.
“The areola, if you look carefully, is not round,” Dr. Wu notes. “In a drawing, of course, the areola is represented as a circle, but the border of a real areola is very jagged and irregular.”
Like carving the top off of a tiny jack-o-lantern, the surgeon traces his way halfway around the nipple by making a jagged, semicircular series of W-shaped cuts around the bottom edge of the areola. This relatively small incision gives the surgeon easy access into the prepectoral pocket – the space under the breast into which the implant is inserted.
Dr. Wu says the WW Stealth method accomplishes a number of things – not the least of which is a camouflaging of even darker scars within the naturally uneven border of the areola.
“When you’re talking about the areola, if the scar comes out less than perfect, who is going to see the areola?” Dr. Wu notes. “Also, a scar on the areola is not as obvious as, say, a scar on the breast crease. The skin of the breast crease has a sort of creamy, smooth appearance, so it stands to reason that even the best scar on the breast crease is going to look awful.”
Another characteristic of the WW incision is that it makes it easy for the surgeon to match up the two sides of the cut following the insertion of the implant – virtually eliminating the chance that the incision will be improperly closed.
“It’s like a lock and key. It can only go one way,” says Dr. Wu. “If these edges don’t match up, you get a distortion of the nipple shape. This can’t happen with my technique because it locks back into place.”
Finally, despite the fact that the entire incision spans a very small area of the breast, the incision is deceptively long. This is because the zigzag edges of the incision allow the opening to stretch and expand – permitting the insertion of a much larger implant than one would imagine at first glance.
“That zigzag edge is like an accordion – it can stretch out to become very long,” Dr. Wu says. “So there’s a special trick – not only does it improve the scar, but it also lengthens the incision.”
Dr. Wu says that though the WW Stealth incision can be used with nearly any breast augmentation procedure, an exception to the rule occurs if the patient opts for a particularly large implant.
“Only if the patient wants to have a huge implant beyond 350cc or 400cc would it be a problem,” Dr. Wu says. “But most patients who desire implants up to 350cc can take advantage of WW Stealth. With these larger implants I go through the breast crease but still perform a WW Stealth Incision there.”
Another consideration that patients must bear in mind is that the WW Stealth incision is a much more intricate technique than other methods, as it replaces one long cut with dozens of tiny ones. Naturally, this method takes longer to perform. “We’re talking two to three hours for the WW Stealth method as opposed to one to one and a half hours done the traditional way,” says Dr. Wu, adding that the additional operation time and anaesthesia charges make any WW Stealth procedure more expensive than its traditional, through-the-armpit counterpart.
“For me, though, I would rather sacrifice my time than have a patient who has a scar for a lifetime,” adds Dr. Wu.
In addition to the elimination of the scar in the armpit, a number of other scarring problems commonly associated with breast augmentation procedures appear to be diminished or eliminated through the use of this technique. In a study of the method involving 200 patients, not one subject suffered from noticeable dark scarring or keloids. Dr. Wu says there is no increase in recovery time or pain with the new technique, and, contrary to the opinions of some doctors, the proximity of the incision to the nipple does not create an additional risk for loss of sensitivity.
“One little myth that some surgeons have propagated is that if there is an incision at the areola you lose nipple or breast sensation. That is not true,” says Dr. Wu. “The nerves for breast and nipple sensation come from the side of the body and spread inwards.
It is possible for these nerves to be damaged or stretched in the creation of the pocket, but the creation of the pocket is a step that is common to all breast enhancement operations.
“Therefore, you can get numbness of a decrease in sensation in the nipple through any technique, not just with WW Stealth.”
Dr. Wu says he plans to publish the results of studies on the WW Stealth incision in the Journal of Aesthetic Surgery either by the end of this year or the beginning of 2005. However, the technique is already garnering international attention as an effective way to avoid visible scarring from breast enhancement operations.
“To me, WW Stealth is a superior technique providing a superior scar,” Dr. Wu says. “The only drawback is that it takes longer to perform, which means an increased expense for anaesthesia.”
Though on the high end of the cost spectrum for breast enhancement operations, the figure is comparable to what women worldwide currently pay for conventional breast enhancement operations.
As for whether the technique will eventually replace the conventional underarm and breast crease incisions, Dr. Wu says the WW Stealth incision will most likely end up being an option offered by a only a fraction of doctors who take the time to learn the technique.
“I think it should become the industry standard, but at the same time I think that it probably won’t,” he says. “Most surgeons are by nature impatient, so they will want to do something quickly. As for me, I can’t take that risk because I’m a perfectionist. But I’m sure some surgeons will embrace it.”
Dr. Wu says he has already taught the technique to doctors from the Philippines, Australia, India, Great Britain and from Canada. As the WW Stealth method is technically simple to perform, he says most plastic surgeons will be able to get good results after two to three procedures. And he says he is optimistic that the popularity of WW Stealth will increase in the years to come – evidenced by the significant number of patients who have already come to him from around the globe to take advantage of this virtually scar-free technique.
“I’m happy that we in Asia are now beginning to contribute to the growing body of creative plastic surgery techniques,” Dr. Wu says