Breast augmentation

Author: Dr. Oreste Di Mattei Di Matteo

Date: 20/01/2020

Breast augmentation,
surgery to increase the size of the breasts, is carried out to improve the appearance of the breasts and increase volume.

When do you decide on breast augmentation surgery?  
The reasons for undergoing breast augmentation surgery can be many, among the most frequent are:

  • To improve breasts that are considered too small
  • To restore the size or shape of the breasts after significant weight loss or pregnancy
  • To even out the size of the breasts, in cases where there are some dysmorphic features
  • To make the breasts more proportionate

The most commonly used techniques for breast augmentation Breast augmentation surgery allows you to increase the size of the breasts by means of various surgical techniques, among the most commonly used, are:

  • using your own bodyfat. This involves fat grafting, also known as lipofilling, the procedure remodels the volume of the breasts by taking an individual's own fat and moving it where needed
  • silicone implants. Silicone implants are silicone shells that contain a cohesive silicone gel that gives a more natural look to the breasts
  • saline solution implants. These are silicone shells with saline solution inside, which in the event of rupture would cause less problems as the saline solution is more compatible with our body fluids

Breast lipofilling

This technique is usually used for:

  • small increases in breast volume
  • to correct asymmetries
  • in combination with breast augmentation surgery

The fat taken and grafted, once purified, is autologous therefore there is no risk of rejection. The procedure is not very traumatic and the recovery time is quick. According to doctors who use this technique, this type of procedure does not generally interfere with medical check-ups of the breasts. As in many other cases, the medical community is divided. Research is still in progress to confirm the true effectiveness and duration of this procedure.


Implants for breast augmentation

In breast augmentation surgery, the specialist uses implants that can be of various shapes:

  • Conical
  • Round
  • Anatomical (or teardrop-shaped)
  • Ergonomic

The implants for breast augmentation can also be distinguished by the type of material contained within:

  • Silicone
  • Saline solution
  • Cohesive silicone gel
  • Polyurethane

Silicone implants, although more popular among patients, are more likely to break than saline implants.

Breast augmentation surgery is one of the most requested and performed procedures in the world.

When undergoing breast augmentation surgery, it is important to know not only the type of implants that will be used but also the breast implant technique and access route.


Breast implant placement and access route for breast augmentation surgery

The placement of the breast implants is chosen based on the physical characteristics of the patient who is to undergo this procedure. There are two main placement areas:

  • Submuscular (dual plane)
  • Subglandular

Both the access route for inserting the implants as well as the placement area, in breast augmentation surgery, is a choice for the surgeon, as he/she is able to evaluate and choose the best option to ensure an excellent result for the patient.

The access routes aka incision sites can be:

  • Periareolar
  • Inframammary
  • Transaxillary

The transaxillary route – through the armpit – allows for breasts that are completely free from scarring, as any scars will be hidden in an area out of sight and with optimal healing. This technique is performed using endoscopy, given that a complete view of the pocket that will be set up in the breast to accommodate the implant is an absolute must. With endoscopy, a fiber-optic camera is therefore used that provides a complete field of vision.

The inframammary route is the simplest technique of breast augmentation surgery which should only be indicated for replacement implant procedures at the request of the patient.


The operation

If you opt for an implant, this will be placed under the breast tissue or under the pectoral muscle under the breast.
An implant is a soft silicone shell that may contain a silicone gel or saline solution (physiological saline).
In order to position the implant, an incision can be made in the lower fold of the breast, the armpit, or along the lower edge of the areola. The implant is inserted through the incision site and can be placed under the breast tissue or alternatively under the chest muscle underneath the breast.
After the implant has been carefully adjusted to the right shape and placed in the correct position, the incision is closed with sutures.
A breast lift can be performed at the same time.
Breast augmentation with implants is an outpatient procedure that can be performed at a hospital or outpatient surgical clinic. An overnight stay in a hospital is not necessary as long as there are no complications during surgery.
General anaesthesia is usually recommended, although local anaesthesia or epidural may also be advised.

What to expect after surgery

Immediately after surgery, your breasts will be bandaged or supported by a special after-surgery bra. Stitches can be removed 7 to 10 days after surgery.
You may experience:

  • swelling
  • bruising
  • pain

for several days after the procedure. To alleviate pain, your doctor may suggest taking painkillers.
Swelling and bruising can last for several weeks.
Wearing a support bra for 24 hours a day can help reduce the swelling and support the breasts during the recovery phase.

Normal activities can be resumed within a few days, unless this involves heavy lifting or intensive exercise. The doctor will tell you when you will be able to resume physical activity and more strenuous exercises.
After breast augmentation surgery there will be some scarring. But these scars are usually in well-hidden areas (such as the fold underneath the breasts, in the armpits, or around the edge of the areolas). In general, the procedure is performed in such a way so that scarring is minimal and not very visible. The scars will fade after several months. If breast augmentation surgery is combined with a breast lift, the scars will be larger and more visible.

Risks related to breast augmentation

Among the most common risks, are:

  • Capsular contracture. This is one of the most common issues caused by breast implants, which may cause changes to the shape of the breasts.
  • Loss of sensitivity in the nipples or in the breast tissue due to nerve damage. This is often only a temporary problem, but it can be permanent in some women

Possible complications

Although a cosmetic surgery procedure, breast implant surgery may present complications, such as:

  • Pain
  • Scarring
  • Asymmetries
  • rupture and leakage
  •  surgical infections, bleeding and swelling.
  • loss of sensitivity of the breasts and nipples
  • hardening of the implant (contracture) Scar tissue forming and hardening in the area around the implant
  • implant rippling or wrinkling
  • difficulties or inability to breastfeed
  • Related health problems
  • interference with mammography accuracy

It is important to have realistic expectations and a good psycho-physical balance. 

Breast implants are not designed to last a lifetime.
Implants may need to be replaced if there are complications or if the size and shape of the breast changes over time.

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