What is breast augmentation?

Breast augmentation surgery is a procedure through which we exclusively modify the volume of the breasts without affecting any physiological function of the patient's organism.  

To date, it is the most requested surgery for plastic surgeons, thanks to the high quality of the materials used which reduces possible complications to a minimum and the technical improvements made to the surgical procedure.   

Women who want to improve the shape or size of their breasts (cosmetic surgery), but also those who wish to reconstruct them due to congenital malformations, traumas or following mastectomy (plastic-reconstructive surgery), turn to mastoplasty (or mammoplasty). 

This operation makes it possible to correct breasts that are small, but also sagging and not very toned, for example due to sudden slimming, pregnancy or breastfeeding. The increase in volume is achieved thanks to the insertion of implants that vary in the materials they are made of, in shape and size.

The objective of breast augmentation is to create a harmonious and natural effect, which can be pleasant and aesthetically pleasing to the patient: for this reason, it is very important to rely on an experienced plastic surgeon, who takes into account your needs and provides a result that meets your expectations.

How is breast augmentation surgery performed?

First of all, before performing breast augmentation surgery, the patient must be examined beforehand, taking appropriate anthropometric measurements, so as to use the most suitable type of implants and technique, just like when deciding on a tailor-made dress.

The type of procedure we offer patients today involves the Rem Technique. This technique allows us to study and decide the most suitable breast augmentation surgery for each patient, in order to ensure the most suitable personalised result, in a "tailor made" way: the choice of the prosthetic implant is of fundamental importance so that the visual effect at the end of the surgery can be as natural and harmonious as possible.

In this regard, the desired size must be carefully evaluated on the basis of the initial anatomy and the expected aesthetic result: it must be proportionate to the rest of the body so as to guarantee optimal results and avoid creating the effect of "fake breasts". The surgeon must guide the patient in the choice of the implant (shape and volume) and the most suitable type of positioning .

Before breast augmentation surgery the patient must be assessed as suitable and this requires a series of tests to be performed: blood tests, electrocardiogram, mammary ultrasound and mammography (in women over 40 years of age) are required. A few days before the operation, the intake of any medication must be stopped and 12 hrs before, the intake of food. The patient is then admitted to hospital, undergoes surgery and after a few hours is discharged. 

The duration of the operation is about 1 hour. Breast augmentation can be performed under local and regional or general anaesthesia, which is preferable for a less painful post-operative phase and faster recovery. The incisions are sutured with stitches which are removed after a few days.  There is usually no drainage or bandages.

Insertion routes for implants used in breast augmentation surgery

The incision can be made at the level of the submammary groove or around the areola (hemi-areolar), depending on the physical body shape and the type/size of the implant. 

Type of implant used in breast augmentation surgery

The breast implants used in breast augmentation surgery are class III medical devices (Ministry of Health). Currently the range of implants is very extensive and it is possible to choose implants with different physical characteristics and textures. Usually the most commonly used ones are silicone implants, containing a cohesive silicone gel. 

The shapes vary:

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

The choice of the type of implant depends on the size of the chest, the breasts and the specific physicality of each patient so that the result of the procedure is as natural as possible. 

The surface structure of the implant determines the response of the breast tissue: 

• Smooth implants are preferred in breast augmentation procedures that involve submuscular positioning.  These are associated with a lower risk of bacterial infection but their reduced adherence to the tissue increases the risk of dislocation.
• Textured implants (wrinkled on the surface) are suitable for breast surgery involving any type of positioning (submuscular, retro-glandular, Dual Plane). These are more resistant to breakage and rippling (surface waviness) and thanks to their microstructure they provide greater adherence to the tissues and therefore a lower risk of dislocation. 

Positioning of the implants 

The implants used in breast augmentation surgery can be inserted in a retro-glandular position (behind the mammary gland, above the pectoral muscle) if there is sufficient glandular or sub-muscular tissue (below the pectoral muscle). However, today the "Dual Plane" is widely used, a mixed technique that involves positioning half behind the gland and half behind the pectoralis muscle. This type of breast augmentation ensures, together with the desired volume, a pleasant and natural shape. 

Breast augmentation surgery: post-op

Following breast augmentation surgery, it is necessary to use a surgical containment bra, which has a dual function: on the one hand, it reduces pain, and on the other, it keeps the breasts compressed and promotes healing. 

The following conditions may occur during the post-operative period: 

• Swelling and pain in the breast(s)
• Capsular contracture

Capsular contracture is the most frequent complication, although it is extremely rare (3–5%). What does it involve? Following breast augmentation surgery and the implantation of a prosthetic implant, the organism reacts to the presence of the foreign body by triggering an immune response leading to the development of a fibrous collagen capsule. This normally performs a "positive" function, as it isolates the implant from the rest of the body and helps to keep it in place. Sometimes, however, it can contract around the implant and cause major deformities and dislocations, with hardening and soreness of the breast.  

At present, the percentage of contractures resulting from breast augmentation surgery is very low, both for implants positioned below the pectoral muscle and for those inserted using the Dual Plane technique. 

The scars can be more or less visible, depending on the incision site: those that form at the level of the submammary groove are in fact not very visible, because they are hidden by the breast, while those around the areola are more visible. The sutures are removed after about 7 days after breast augmentation surgery, so during this time trauma at the incision points should be avoided and the area should not be washed in order to promote healing. 

It is necessary to regularly carry out the prescribed check-ups to ensure that there are no breakages of the implant or invisible capsular contractures. 

Recovery time following breast augmentation surgery

After breast augmentation surgery it is necessary to rest completely for about 24 hours. From day three you can resume a normal routine, avoiding arm strain and physical activity for about a month. After that, you can also take part in sports activities. During the recovery time, you should use specific chest straps and bras. 

What not to do after breast augmentation surgery

After breast augmentation surgery, you should avoid physical exertion and physical activities that may induce complications, such as displacement of the implants. In particular, the use of the arms induces the contraction of the pectoral muscle and can move the implant from the site where it was inserted.

This precaution must always be followed, especially if anatomical implants, inserted at the sub-muscular level, are used.