Breast augmentation

There are many types of breast implants. But they are distinguished by three main parameters: shape, filler, and shell surface.

According to the shape, there are 3 types of implants:

1)  round  – the implant evenly enlarges the breast, makes it spherical, higher in the décolleté (pronounced upper pole of the breast);

2)  anatomical (teardrop-shaped) – repeat the natural shape of the breast in a standing position, look more natural compared to round ones;

3)  ergonomic  – have a round shape, but look as natural as possible due to the fact that their shape changes depending on the position of the body (this is achieved due to a softer filler gel).

According to the filler, there are the following types of implants:

• silicone:
  1. highly cohesive gel (holds its shape perfectly, does not spread if the implant shell is damaged);
  2. cohesive gel (gives a natural shape, if the shell is damaged, it gradually dissolves without harm);
  3. Soft Touch gel (similar to highly cohesive gel, but less dense and more natural texture);
• hydrogel (have a high safety profile, their peculiarity is that in case of damage to the membrane, the hydrogel decomposes into glucose and water);
• saline (silicone bags that are filled with saline before surgery or immediately after installation through a special valve, the least durable);
• silica gel (rarely used).
  According to the type of surface, they are distinguished:

• textured – a porous-rough surface gives good adhesion to tissues, and also does not allow the connective tissue to overgrow the implant, and therefore, the endoprosthesis sits tightly in place and the risk of complications (implant reversal) is minimal;
• smooth  – there are only round implants, since with such a coating the implant can turn over.

In plastic surgery, there are several methods for placing breast implants. The surgeon makes the choice during the initial consultation.

Method I – Subglandular (the implant is placed under the breast tissue);

Method II – Submuscular (the implant is placed completely beneath the pectoralis major muscle);

Method III – Dual-plane (the implant is placed partially under the breast tissue and partially under the muscle);

Method IV – Subfascial (the implant is placed beneath the fascia of the pectoralis major muscle).

Breast augmentation surgery can be performed through several approaches.

The first access is axillary (groin) The incision is made in the armpit area along the edge of the pectoralis major muscle. The length of the incision is about 5 cm. This method is used only if the patient wants to avoid visible scarring on the breast. The only advantage is the absence of a scar on the breast itself. Disadvantages:

• The scar is the longest compared to other access points;
• It is the most traumatic approach, as the incision is located far from the implant site, resulting in significant pain and a longer, more difficult recovery;
• Higher risk of hematoma formation;
• It is difficult to correctly place an anatomical implant through the armpit (improper placement may lead to breast deformity or unnatural shape);
• It is hard to place the implant under the muscle (submuscular placement is the most effective and reliable method), and it is also challenging to achieve a natural breast shape.

The second approach is periareolar  .

The incision is made along the lower edge of the areola. The diameter of the areola must be at least 4 cm. The scar may be barely visible or quite rough, depending entirely on the individual characteristics of the body (how the body heals and reacts to incisions).

Advantages:

• The areola can be reshaped, or a periareolar breast lift can be performed simultaneously.

Disadvantages:

• If the breasts are large, a thin and neat scar may become wider over time due to the constant tension of the skin in the scar area;

• More traumatic than the inframammary access (possible complications include insufficient blood supply to tissues, skin necrosis, and damage to the mammary gland);

• There is a high risk that breastfeeding may not be possible in the future.

The third approach is  submammary (inframammary incision) .

The incision is made under the breast – along the natural breast fold or slightly below it if the fold is to be repositioned downward.

Advantages:

• Considered the safest access point for the patient, with minimal trauma, quick recovery, and less postoperative pain;

• When placing the implant under the pectoral muscle, this access allows precise and symmetrical placement due to gentle muscle separation from the chest wall;

• Scar length ranges from 2.5 to 5 cm;

• The plastic surgeon can place special sutures to reinforce the inframammary fold to prevent implant displacement;

• Within a year after surgery, the scar, even if initially visible, becomes hidden in the breast fold.

Inframammary surgical approach for breast augmentation is considered the safest according to  clinical studies  .

To minimize the likelihood of negative outcomes, a consultation with a plastic surgeon is conducted before the surgery, and the patient undergoes an examination. The doctor determines the acceptable implant volume (taking into account height, weight, chest structure, initial breast condition, thickness of the fat layer, and skin).

Breast augmentation is a surgical procedure, and therefore, although extremely rare, complications may occur:

1. Implant rejection;

2. Necrosis (death) of the soft tissues around the implant;

3. Hematoma;

4. Seroma of the mammary gland;

5. Irreversible loss of sensitivity in the breast, areola, and nipple;

6. Capsular contracture;

7. Implant displacement;

8. Implant extrusion;

9. Atrophy of glandular tissue.

Preoperative consultation, the professional work of the surgeon, and adherence to the rehabilitation program minimize the risk of complications to a minimum.

• Age – up to 18 years
• Chronic diseases of internal organs
• Diabetes, HIV, hepatitis B and C
• Oncological diseases
• Mental health disorders