Breast augmentation is mainly performed with silicone implants. It is a short procedure (lasting around 45 minutes), performed with general anesthesia and the patient usually is discharged on the same day.
The latest technology silicone implants (textured cohesive silicone gel) are placed either below the pectoralis major muscle or above it and below its fascia. The selection of the position depends on the existence or not of the mammary gland. In women that do not have adequate breast volume, the implant in placed under the muscle; as a result the implant cannot be traced below the skin, while the shape appears more natural. In women with significant breast volume, the implant is placed under the muscle’s fascia, but over the muscle. This is done because when the implant is placed under the muscle, it tends to become fixed at a higher level and does follow the possible slight ptosis of the breasts over time. So breasts with significant original volume that have undergone silicone-implant augmentation under the muscle will in the immediate future appear bilobal, with the implant higher and the breast lower.
The incisions are either made along the lower areoral border, close to the armpit, or in the imframammary fold. Most preferred from our point of view is the incision along the lower areoral border, since it nearly always disappears or is slightly visible.
The breast augmentation procedure is extremely safe. Past medical experience (over the last 50 years) in the use of medical silicone gel undoubtedly shows that it is inactive and is not connected to any known diseases of the breast or the rest of the body. The only possible complication in a very small percentage of patients is the reduction or loss of the sexual sensation in the nipple, especially if the augmentation is quite large. After the procedure, the patient has fully functional breasts, and may be able to breastfeed in the future. In addition, she may be able to undergo any preventive examination of the breast (e.g. mammography).
Silicone implants are also placed in the cases of congenital breast atrophy (Poland syndrome). In this case, due to atrophy of the pectoralis major muscle, the implant cannot be placed under the muscle. In order to achieve more natural-looking results, the surgeon may use anatomic, tear-drop-shaped implants.
Tuberous breasts are the result of abnormal development of breast volume and shape during puberty due to the congenital inelasticity of the skin around the areola. The degree of inelasticity of the skin varies from patient to patient, but also from one breast to the other in the same patient. As a result, the degree of deformity also varies. The mammary gland tries to develop through the areola, and, therefore, the deformity that arises is quite evident. It is usually a small breast in the shape of a tube with a large areola. Corrective surgery usually involves placing a silicone implant through a small incision (3-4 cm) at the areoral border. The procedure should also include relaxing incisions internally along the areola so as to allow stretching of the skin around it. Usually breast augmentation surgery and relaxing incisions are enough to reconstruct the shape, size and natural proportion of breast and areola size.
Sometimes, the areola has to be reduced and in rare occasions it may be shifted to achieve symmetry of the two reconstructed breasts. These require surgical incisions, which may resemble in some cases those used in breast lifts with minimal ptosis.
The postoperative course is nearly always smooth and almost painless if the implant has been placed above the muscle. Patients may experience pain for a few days if the implant has been placed below the muscle, but this can be alleviated with mild painkillers taken orally. Women are not restricted from their normal activities postoperatively, but are advised not to sleep in the prone position for a month. The sutures are absorbable and do not need to be removed.
Other breast augmentation techniques involve stem-cell-enriched fat transplantation. This technique has certain limitations with regard to success. Large augmentation is nearly never possible, while it is imperative that the patient has enough body fat that can be collected via liposuction. Stem-cell techniques are more suitable for breast reconstruction and some mastectomies.
The injectable hyaluronic acid gels being recommended lately are not suitable for breast augmentation, since the results are temporary, while it is quite an expensive technique.
Useful Facts about Breast Augmentation
Length of surgery: 30 min-45 min
Anesthesia: General or local
Duration of Hospitalization: ODC (one-day clinic)
Return to normal activities: In a few days (3-4)
Postoperative care: First dressing change on the second postoperative day. Shower on the fourth postoperative day. No removal of stitches. Avoid sleeping in a supine position for a month.