17 May Dr. William Watfa
Breast Augmentation Beyond Aesthetics
Assistant Professor of Plastic & Reconstructive Surgery – Saint George Hospital University Medical Center, Beirut | Licensed Plastic Surgeon – Dubai, UAE | EBOPRAS Fellow | LSPRAS Board Member
Dr. Watfa, can you tell us about your background and what led you to specialize in breast surgery?
I’m a Plastic, Reconstructive, and Aesthetic Surgeon. After completing my medical degree, I pursued a six-year specialization in plastic and reconstructive surgery. Many people think of plastic surgery as purely cosmetic, but it’s far more comprehensive; it includes restoring form and function after trauma, cancer, or congenital anomalies. My training took me from Switzerland, where I completed my residency in Lausanne, to Montreux, where I had the privilege of learning not just surgical techniques, but also how to communicate effectively with patients and make them feel seen, heard, and supported.
My early experience involved working with burn victims and reconstructive breast cases, which gradually evolved into a deep passion for breast surgery as a whole; both aesthetic and reconstructive. Over the years, I realized that true breast surgery is not only about shape or size. It’s about preserving the natural function of the breast; especially sensation and the ability to breastfeed; and about providing women with safe, long-lasting outcomes.
How has the field of breast augmentation evolved over the past decade?
Traditionally, breast augmentation was centered around increasing size and volume. But today, we’re moving toward a more holistic approach: breast enhancement. This reflects a broader vision that includes shape, proportion, sensation, tissue preservation, and longevity. Women are no longer looking for exaggerated results. They want subtle, natural-looking outcomes that feel right for their body; and they want to avoid multiple surgeries down the line. Through our research and published studies, we discovered that critical factors like nipple sensation, breastfeeding capability, and implant stability are often overlooked. These are now central to my approach. My patients are increasingly asking questions about safety, implant materials, recovery time, and future revision needs. It’s not just about looking good; it’s about feeling whole and preserving the body’s function.
What are the most popular types of implants you’re using today, and what sets them apart?
There has been a clear evolution in implant design over the years. We used to choose between round implants and anatomical, teardrop-shaped ones. Now, we’re seeing biocompatible implants that combine the advantages of both. These advanced implants adapt to body positioning; appearing more anatomical when upright and round when lying down; offering both aesthetic flexibility and a natural feel. They are also designed to minimize complications like capsular contracture, which remains the most common long-term issue with implants.
How important is fat grafting in modern breast surgery?
Fat grafting has completely changed the landscape; not just in breast augmentation, but across aesthetic and reconstructive surgery. It’s now an essential tool.
In breast surgery, we often use it to contour the result, fill in irregularities, or enhance volume in combination with implants. It gives us more control and precision, helping us achieve a softer, more natural appearance. It’s rarely used as a standalone augmentation method, but in hybrid procedures, it’s incredibly valuable.
You’ve developed a unique breast augmentation technique called SSS. What does it involve?
Yes, SSS stands for Safe, Smooth, and Scarless; a technique I developed and trademarked after years of refining hybrid breast augmentation. It combines small-volume implants placed above the muscle with anatomical fat grafting. By going above the muscle, we reduce trauma to the body and significantly shorten recovery time. Fat is then added strategically to contour the breast and provide a more natural shape.
SSS responds to a growing trend among younger women who want a subtle, elegant enhancement; not exaggerated results. I began seeing more patients who were actively avoiding the overly “done” look. They wanted a procedure that aligned with modern beauty ideals: natural, understated, and minimally invasive. With SSS, we also use very small incisions, so scarring is minimal, and recovery is fast. This technique is part of what I believe is the future of aesthetic breast surgery.
What determines the long-term success of breast implants?
The two key factors are the quality of the implant and the technique used for placement. Choosing an implant with a proven low rate of complications, particularly capsular contracture, is essential. I always rely on implants backed by solid clinical data, ideally with a complication rate of under 1%. Equally important is ensuring proper implant positioning and respecting the anatomy. Oversized implants placed without adequate support can lead to sagging or the need for a breast lift much sooner than expected. That’s why I emphasize stability, proportional sizing, and tissue preservation in all my procedures.
What role does 3D imaging play in your consultation process?
3D imaging has become a vital part of how I communicate with patients. It allows them to visualize potential outcomes, making the decision-making process more interactive and informed. During consultations, I also use external bra sizers to help patients physically feel how different volumes would look on them. This two-step visual and tactile approach builds trust and allows the patient to feel confident in her choice.
But it doesn’t stop there. I always conduct a detailed physical examination and take precise chest base measurements. This helps me recommend implant sizes and projections that are both safe and aesthetically pleasing. There’s no “ideal” breast size; it’s all about balance, communication, and education.
How do you ensure long-term follow-up and patient satisfaction?
I follow a very structured post-operative monitoring schedule. After surgery, I see patients at one month, two months, five months, one year, and then every year up to five years. This ensures we detect any issues early. I also offer what I call a functional warranty; if any complications arise during this follow-up period, I take full responsibility and will often offer revision surgery if needed.
This transparency builds confidence. It’s not just about the surgery; it’s about creating a lasting partnership with each patient. I want every woman who walks into my clinic to know that her outcome matters to me long after the procedure is over.
How do you decide between placing implants above or below the muscle?
The decision is based on both the implant type and the patient’s body characteristics. Thinner patients or those with thinner breast tissue might benefit from implants under the muscle to provide better coverage. On the other hand, with the newer generation of implants and fat grafting, we can achieve beautiful results above the muscle in many cases; especially when aiming for faster recovery and less post-op discomfort. Skin thickness, tissue elasticity, and overall goals all factor into this highly individualized decision.
What are the most common complications associated with breast implants?
In the short term, complications can include hematomas or seromas; collections of blood or fluid. These are more likely to occur with more invasive procedures but are rare with minimally invasive techniques like SSS. In the long term, capsular contracture is the most well-known risk. It happens when the body forms a tight capsule around the implant, sometimes distorting the shape or causing discomfort.
The rate of contracture can vary dramatically depending on the type of implant and surgical technique. That’s why I always use scientifically supported implants and a careful, minimally disruptive approach to insertion.
Is breast augmentation reversible?
In many cases, yes; especially when we use tissue-preserving techniques and smaller implants. If no major disruption is done to the breast structure, the tissue can often return to its pre-augmentation state. However, larger implants and more aggressive techniques may lead to irreversible changes. This is why I advocate for conservative sizing and long-term planning from the very first consultation.
What signs might indicate the need for a revision surgery?
The most common reason for revision is advanced capsular contracture, particularly stages 3 or 4, where the implant becomes palpable or affects the shape and comfort of the breast. Other reasons include implant malposition, visible rippling, or natural aging changes that affect skin elasticity; especially in patients with larger implants. That’s why I encourage preservation strategies early on to delay the need for future breast lifts or revisions, ideally pushing that timeline 10–20 years further down the road.
What is your message to women considering breast augmentation today?
Do your research. Look beyond trends and focus on your health, your goals, and your long-term wellbeing. Choose a procedure that aligns with your lifestyle and values. A good plastic surgeon won’t just enhance your look; they’ll preserve your function, prioritize your safety, and be your partner through every step of the journey. Modern breast surgery is no longer about extremes; it’s about harmony, confidence, and sustainability.