Breast augmentation is often and mistakenly regarded as procedure that will result to oversized breasts. However, the primary purpose of a breast augmentation is to create an elegant and beautiful breast, which contributes positively to the overall body proportions and fully meets the expectations of each woman. The selection of the appropriate silicone implants, based on body measurements, extensive comprehension and simulation of the result, always offers a fully balanced solution that fully corresponds to each body type and creates very high satisfaction rates for patients undergoing this operation.
Indications for breast augmentation
The placement of silicone implants, therefore, does not only aim at breast augmentation, but also corrects many other aesthetic problems of the breasts. Let’s see in which cases breast implants is indicated:
- When the breast is not sufficiently developed
- In cases where we simply want a larger breast size
- In cases where there is asymmetry of the breasts in terms of size
- In breast malformations, such as tubular breast
- When the breast atrophies and loses in size due to weight loss, pregnancy or other factors
- Combined with breast lift, the so-called augmentation mastopexy
- For breast reconstruction after breast malignancies
In all the above cases, the purpose of the operation remains the same: to create a beautiful breast. Many times, we use the term breast augmentation to describe this operation and the reason is that it is not an operation that is applied in the same way in all cases, but is fully individualized in order to treat any aesthetic imperfection of the breasts. Depending on the case, we may apply a different technique, choose a different type of silicone implant and combine it with other techniques.
Whatever the reason why a woman decides to proceed with breast implants, it is of utmost importance to be thoroughly and multifaceted informed about the implants to be used, the technique and what result we will expect from the operation.
Breast augmentation techniques
In our new social media governed world, imaginative names are used in order to present breast augmentation surgery as something innovative and different. Given that breast plastic surgery has been applied for more than 40 years and millions of women worldwide have undergone this procedure, there are countless scientific data from studies that have been conducted and we can, based on these studies, offer techniques and solutions that are globally accepted, time-tested, offer stable and predictable results and a very low complication rate.
Let’s examine some of the most common breast implants techniques applied and the advantages/disadvantages of each method. Regarding access, i.e. the point from which we choose to place a implants, we have the following options:
- From the sub mammary fold
- Under the nipple
- From the armpit
Why is access from the sub mammary fold the first choice?
Placement from the submammary fold is the most common statistically, while the other two approaches have been developed with the basic aim of reducing visible scars. However, according to studies, both nipple and armpit insertion of the implants can have a higher microbial load compared to the submammary fold, thus statistically increasing the risk of capsular contraction. Also, access from the armpit is usually done with endoscopic assistance, which increases the time and cost of the operation, gives limited options in terms of implant positioning and is usually possible only with smaller silicone implants. Regarding the access from the nipple, it allows the implants to be placed both above and below the muscle, but without the possibility of dual plane and the main disadvantage is that a large area under the nipple to the submammary fold needs to be undermined, which creates a relative instability of the tissues that over the years can lead to bottoming out. Very superficial placement of the implants that gives a hard feel to the lower pole or even folds that are visible or palpable (rippling).
For these reasons, our first preference for incision is in the submammary fold, i.e. the crease below the breast. This access provides the ideal access for the no touch-dual plane technique, and has been found by studies to be the safest, in terms of possible contamination of implants, capsular contraction and ALCL. The scar, measuring 2,5-4,5cm, is located right on the new submammary fold, after the first 6 months it reaches the point where it barely stands out. This approach is considered the safest, in terms of placement as well as with the lowest complication rates.
How do we choose the right implant?
A big role in the success of the operation is played by choosing the right implant. All the implants we use contain the latest generation silicone, have global certifications and offer a lifetime warranty for the durability of the material. For each woman, depending on her body type, there is a range of ideal implants, which are better suited to the body and breast. The ideal implant results after measuring the chest using a standardized algorithm we can choose the ideal dimensions.
Regarding the shape of the implants, we have the following options:
- Round implants
- Anatomical implants
- Ergonomic implants
In general, round implants offer greater filling in the décolleté area and the upper pole. Anatomical implants offer a more natural drop shape with a less toned upper pole, with greater projection at nipple height, as in natural breasts. Ergonomical implants are basically round implants with softer silicone gel inside, which mimic the shape of anatomical implants at some extent.
Regarding the shell, we distinguish the following types:
- Rough surface
- Smooth surface
- Polyurethane surface
Both rough and smooth surface implants provide great security and are selected on a case-by-case basis. Polyurethane shell implants are not widely used in Europe and the USA.
Regarding the type of silicone, we distinguish the following:
- Implants with soft silicone (cohesive I, progressive gel, etc.)
- Implants with memory silicone (cohesive II, cohesive III)
- Silicone implants with air microspheres (B-Lite)
- Silicone-free implants with serum (Saline).
The silicone contained within the implants is always in gel form, i.e. not in liquid form. What changes is how hard or soft this gel is. We usually refer to a harder gel with a fuller implant with the term Gummy bear implants. B-lite implants are a special category that involves implants 30% lighter than the rest. Finally, saline implants are primarily used in the US.
Placement above or below the muscle
Technically, breast implants surgery differs from placement above or below the pectoral major mascle. We distinguish the following cases:
- Completely below the pectoral muscle (submuscular)
- Partly below the pectoral muscle (dual plane)
- Above the pectoral muscle (subglandular)
- Under the fascia of the pectoral muscle (subfacial)
In general, when it comes to a relatively thin person, without particularly large breasts, it is preferable to place it under the muscle in order to better camouflage the implants, especially at the upper pole. Also, with the techniques under the muscle we can give even more natural shape to the breast and ensure greater stability over time, since the implants are better fixed on the chest wall and do not bottom out due to gravity downwards. When the implants are placed above the muscle, they are easier to palpate but offer other advantages, such as better convergence of the breasts towards the center, as well as the fact that we can place larger implants and emphasize more the upper pole and décolleté. In each case, a personalized assessment is made and the choice arises after extensive discussion, in order to offer exactly the desired result. This means that beyond size, we can choose any of the above techniques, shapes and peculiarities of materials.
However, in our practice, the most frequent option is the so-called dual plane no touch. This technique probably suits the expectations of most women, who do not want even excessive breasts and generally aim for a very natural result. The advantage of this technique is the simultaneous breast lift with pseudoptosis, without additional scars, the reduced pain and the completely predictable and harmonious result.
Any of the above techniques can be combined, if necessary, with other surgeries, such as breast lift, fat transfer, etc. The simultaneous breast augmentation and lift aims to create a stable base and a full upper pole with the implants, while at the same time with the lift the sagging is removed and the nipple is relocated to the appropriate position. Fat transfer along with silicone implants is a hybrid technique that can in some cases correct problems such as the large distance between the breasts, rippling of the implants in general, can “photoshop” minor imperfections without additional scarring.
The implant is shaped either under or above the pectoral muscle, although modern hybrid techniques such a dual plane or subfacial offer in many cases more advantages. In skinny women with minimal breast tissue, the implant is usally placed under the muscle, to offer better coverage and camouflage the implant. Women with adequate breast tissue or with ptotic breasts benefit from a placement above the muscle, which maximizes the lift effect of the implants.
After a breast augmentation surgery
Breast augmentation surgery is usually performed under general anaesthesia, without staying in the clinic, while exceptionally it can be performed under local anaesthesia and sedation. The special bra is placed immediately, so one can move outside avoiding only abrupt and large hand movements as well as heavy lifting.
After surgery, there are no drains and no stitches need to be removed. The pain for the first 1-2 days is minimal, because during the operation the areas are filtered with a special long-lasting anaesthetic solution, which numbs the area. Then the pain is very mild, similar to a muscle pain after rigorous exercise at the gym but subsides with common painkillers. Regarding pain, our experience shows that it is more intense when we choose larger silicone implants or when the breast is generally very tight. Physical exercise begins after the 6th week and pectoral muscle training is not recommended for 6 months.
The scar under the breast is hidden right in the submammary fold and after about 6 months is not discernible. The final shape of the breasts is formed after about 3-4 months.