Choosing the incision. The periareolar incision offers great access either below the muscle or below the muscle’s fascia. Moreover, the scar will not be visible through color changes of the areola. The inframammary incision, on the other hand, will always be visible and it may also cause disruptions to this anatomical element.
Choosing the implant position. The implant must be placed under the muscle when breast volume is not adequate, the skin and subcutaneous tissue are thin and the implant is round and mainly high-profile. This way the muscle mass can cover the implant’s roundness and possible wrinkles. This option offers results that appear more natural. It is absolutely necessary to fully detach the muscle in the lower muscle insertions. Starting from the 5th hour for the right breast and starting from the 7th hour for the left breast. Further detachment in the chest area may cause symmastia. The implant must be placed under the muscle’s fascia, but over the muscle when there is significant breast volume, thick subcutaneous tissue and mainly when there is a mild ptosis. Otherwise, as time passes the implant will remain high while the mammary glands will collapse, causing breast dysmorphia. Moreover, the implant should be placed over the muscle in case of tubular breasts.
Choosing the implant shape. If there is not an absolute indication for anatomical breast implants, the round breast implants are always more preferable. The possibilities of dysmorphia are lower in case the implant moves within the pocket. The implant can be high profile or low profile. It depends on the patient and the chest anatomy. A narrow chest along with thick subcutaneous tissue require high profile implants, in order to highlight the breast size. A broad chest along with thin subcutaneous tissue require low profile implants. Anatomical breast implants are chosen only in case of a fully atrophic grand and thin subcutaneous tissue.
Combining a breast lift with breast implants. In atrophic and sagging breasts, which are common especially after weight loss or pregnancy besides breast augmentation, breast lift is also required. Breast lift can be implemented by the classic technique inferior pedicle or L-incision. Once the flaps are produced, the implants are placed under the muscle. Afterwards, the incision is closed just like with the classic technique. In these cases, once the first week after surgery passes, it is necessary to wear elastic bandage for the rest of the month. Thus, the implants will gradually move downwards. In case of smaller ptosis, the implants are placed above the muscle. Consequently the percentage of skin slackening is estimated, designed and removed, around the areola. The cut will extend down the front of the areola. Removal of the skin slackening only around the areola will have as a result areola enlargement with an ungly scar.