Sinonimi: Breast augmentation, Augmentation mammoplasty
This is a surgical procedure that has for an objective to increase the circumference and volume of the breasts through use of implants. Breast augmentation in this manner is usually used on persons with significantly underdeveloped (underdeveloped gland and fatty tissue) or unequal breasts, after child birth when the breasts get smaller and saggy (moderate loss of voluptuousness and droopiness), and after breast surgeries in which a part of the breast tissue was resected.
Any female person who is unsatisfied with the size and/or shape of their breasts is a potential candidate, as well as persons with asymmetrical and breasts in disproportion with their stature.
Women after breastfeeding, when breasts lose their volume and the skin becomes too lax, can use this procedure to resolve the issues with droopiness and loss of volume.
What needs to be known before deciding on the procedure?
Before making a decision on any surgical procedure, it is important to know that all surgeries come with a potential risk of complications. Fundamental principle in esthetic surgery is that persons undergoing procedures are HEALTHY. Other than that, it is necessary to be well informed about your procedure and every aspect of it.
General risks of the surgery
This surgical procedure is generally considered a low risk surgery.
There a re two potential risks involved: embolism (fat or thrombus) as a consequence of the surgery and an immunological reaction of the organism to a foreign object (silicone).
Breast augmentation as a surgical procedure isn’t considered an extensive surgery so the risk of embolism as a complication is relatively small. Essentially, none greater than a tonsillectomy, appendectomy, hernias etc. Also, it needs to be mentioned that early activation and verticalisation after the procedure are of utmost importance in preventing this complication.
As far as immune reactions of the body to the implants as a foreign object go, there are two possible groups of problems: a local immunological reaction and a systemic immune response. In case of a local reaction, either the entire breast turns hard to the touch (capsular contraction), or there is forming of small lumps in the vicinity of the breast (silicone leakage). These complications are rare, and you can learn more about them in sections on Post op complications and Our experience.
Where can the implants be implanted?
This selection is based on the position of the implant relative to the pectoralis major muscle, in effect – is the implant placed under or over the muscle.
Implant placed over the muscle
Under the breast tissue
With this procedure the implant is placed over the pectoralis major muscle, just under the skin and the mammary gland. In order for the implant to be placed in the supramuscular position any of the approaches for the incision can be used..
Under the muscle fascia (subfascial)
With this approach the implant is placed between the muscle and the muscle sheeth (fascia). The favored placement of the incision is in the fold beneath the breast.
Implant placed under the muscle
With this procedure the implant is placed under the pectoralis major muscle, just over the ribs. In order for the implant to be placed in the submuscular position two of the incision placement approaches can be used: the fold beneath the breast and the axillary (arm) pit.
Which approach for the incision can be used?
There are three approaches for placing the implant:
Through a fold beneath the breast
Incision (a cut in the skin) in the fold beneath the lower pole of the breast is the most common approach and the approach with most history for placing the implants. The fold is situated under the lower pole of the breast, where it meets with the rib cage. The incision is 3 to 5 cm long, depending on the size of the implants. Implants can be placed both under and over the muscle this way.
Through a semilunar incision around the areola
A semicircula incision around the areola is made, usually on the lower half. Length of the incision is 3 to 5 cm long, and is dependant on the size of the implants and the size of the areola. Implants are placed over the muscle using this approach.
Through the axillary (arm) pit
Incision in the arm pit is an approach of less frequent use (it was popular for a brief time in the late 80s and early 90s). Length of the incision and the scar is 3 to 5 cm long, depending on the size of the implants. Implants are placed both over and under the muscle using this way.
What does the procedure look like?
Through an approach of choice, usually the fold beneath the breast, the breast tissue is accessed. Followed by creating room for the implant at desired level ( supramuscular, subfascial, submuscular) and placing the chosen implant itself. After placement is finished, tissue and skin is closed up using the finest sutures to keep the scar minimally visible.
Almost immediately after surgery, the early activation of the patient commences (getting on your own feet), 2 to 8h after the surgery. First dressing of the wound is done in the first post op day, and after it a special bandages are applied which are removed at first follow up.
Sutures are remoced successively, outer microsurgical on the 7th, inner sutures on the 14th day.
Care and treatment after the procedure?
After the final sutures are removed, scar can be treated with a scar reducing cream.
Possible post op complications
Hematoma , bleeding, infection, implant prolapse, capsular contraction (reaction to a foreign object)…
The final form of the breasts can be expected in 3 to 6 months after surgery, depending od the position of the implants, over (3m) or under (6m) the muscle. Of course, the preliminary results are obvious immediately after the surgery, and they will continuously progress to full form from week to week.
Health check ups are mandatory after having implants, in the form of regular follow ups, lab checks, and ultrasonic diagnostics, mammogram can be done if needed.
Different types of breast augmentation
Basic division refers to which surgical procedures we use to augment and remodel the breasts. In that manner, we could be talking about simple placing of the implants (augmentation), or a procedure where in addition to placing the implants, we do a lift, tightening and remodeling/reshaping of the breasts (augmentation and lifting).
Division relative to the problem:
Simple placing of implants (augmentation)
This surgical procedure is used in all cases of small, underdeveloped, moderately saggy, moderately asymmetrical breasts and with rib cage deformities conjoined with small, underdeveloped breasts.
Placing of implants, lifting and tightening the breasts (augmentation and lifting)
Augmentation and remodeling of the breasts by placing implants combined with breast lift and changing the position of the nipples is a surgical procedure that resolves the issue of saggy breasts without enough glandular and fatty tissue. Breasts that used to be well balanced with the stature, of appropriate size, sometimes during life (change of body weight, gravity, loss of skin elasticity) tend to droop,losing form, size and firmness. Augmentation and remodeling of such breasts is achieved by placing implants in combination with lifting..
Placing implants with asymmetrical breasts
There is a certain umber of asymmetrical breasts, when one breast is bigger than the other ( combinations go from one of normal size, other completely undeveloped or significantly underdeveloped to one being significantly overdeveloped or lax and droopy and the other being minimally underdeveloped).
Placing implants after a mastectomy
Breast cancer is unfortunately one of the most common forms of cancer in Serbia. Over the last two decades, rate of curing has fortunately been constantly climbing, but the cure of choice is usually a complete mastectomy. Reconstruction of a removed breast can be done in the same surgery when it’s removed, called a primary reconstruction, or after a period of time, called a secondary reconstruction.
Experience at ORS Plastic Surgery
Assessment of the results by patients themselves
Contribution of having breast implants to the looks of the figure as a whole, most patients describe as excellent or highly satisfactory.
Discomfort of having a scar is usually deemed acceptable by the patients, and in cases of a more pronounced scar (which is a rare occurance) they still consider that the surgery was justified, despite the scar.
During our 27 years of experience, there were no serious complications.
Complications which endanger the life and health of the patient, such as thromboembolism, or fat embolism were never observed.
Post op bleedings were never incurred.
Leaking of clear – yellowish fluid (seroma) at the wound was observed in five patients, and all of them resolved spontaneously during recovery.
Deflation (leaking) of implants was never observed.
In only one case there was a drop of silicone gel observed on the surface of the implant. The implant was removed and replaced by another one promptly, during the surgery itself. Patient has not had any complications in post op.
Infections were never observed.
A slower rate of healing around the incision line occurred with 3 patients, with no need of a surgical intervention.
There were no observed cases of implant rupture and capsular contraction (hardening, stiffness).
Hypertrophic scar was observed in two patients, with surgical correction (excision of the scar and resuturing) done on one patient, the other patient deemed the scar non-problematic, and was completely satisfied with the size and form of her breasts.
There were no cases of keloidal scars .
- • Creating the space (pocket) for the implant is simpler
- Downtime is shorter
- Lesser and shorter post op pain
- Shorter time to final result (3- 6 weeks)
- • Minimal palapation (implants are virtually impalpable)
- Occurance of capsular contraction is more rare
- There is less possibility for gravitational ptosis (droopiness of breasts over time)
- Implant is palpable
- Possibility of gravitational droopiness over time
- Capsular contraction occurs more often
- Making adequate space (pocket) for the implant is more difficult
- 3 days of moderate pain post op
- Longer downtime and recovery
- Longer time to final result ( 3- 6 months )
Concise pros and cons of diferrent approaches
Frequently asked questions
How long does the procedure last?
Procedure takes an hour and a half on average.
How long is the hospital stay?
Is there a best period of the year for this procedure?
Any time of the year is appropriate, you just need to be healthy at the time of the surgery and try not to have the surgery when you have a cycle.
Does it hurt after the intervention?
When the implant is placed over the muscle there is minimal amount of pain during the first post op day. The pain is usually resolved with no medication.
When the implant is placed under the muscle there is a moderate amount of pain during the first 3 post op days. The pain is usually managed with medication on the first post op day.
When can I return to my regular physical activities?
It takes, on average, 3 to 4 weeks to a full recovery. The process is somewhat shorter and easier with supramuscular implants.
Is the breast and nipple sensation changed?
Full touch sensation usually returns in 6 to 12 months. It needs to be mentioned that there are differences in establishing natural sensations depending on the place of the implant (supramuscular or submuscular) and the placement of the incision ( in the fold under the breasts, around the areola or in the arm pit). With supramuscular placement of the implants, especially with incision around the areola, full sensation recovery takes longer, 6 to 12 months, with most of the patients reporting increased sensitivity, and with submuscular placement of the implants with the incision in the fold, occurance of increased sensitivity is rare.
Is breastfeeding preserved?
When placing the implants directly under the glands, the function of the glands can be disrupted but is not always the case.
With any other approach, function of glands and breastfeeding is completely preserved.