Breast augmentation is perhaps along with liposuction the most popular cosmetic procedure in plastic surgery. Every day, more and more women are visiting their plastic surgeon for correcting and restoring their breasts. Usually these patients have hypoplasia or even aplasia of their breasts.

The restoration of hypoplasia or even aplasia of the breasts helps  by improving her volume and shape. It also has a positive effect on the self-esteem of the woman. Her breasts and, by extension, her overall figure  look more attractive and proportional. The woman’s self-confidence is improved and her femininity is greatly enhanced. Furthermore, with her improved external image, the woman can follow exactly the fashion trend of the time, which is all about a woman with a satisfactory breast volume.

There are several ways to perform  breast augmentation procedures and these have to do with the means used to increase the breast volume. The most widespread method worldwide is the use of silicone implants. Other methods include the use of saline implants and the transfer of fat to the breast from another part of the body. The method with the best immediate and long-lasting results is the use of silicone implants.

Breast Augmentation with Silicone Inserts

There are various techniques for breast augmentation and these have to do with the incision and the access as well as the anatomical plain where the silicone insert is placed.

1. Incision – access:

• Incision in the submammary fold: this is the most commonly used approach and the one with the best results. Approximately 75% of breast augmentation procedures involve an approach through the submammary fold. From there, both the breast and the pectoral major muscle are easily identified and the plastic surgeon can finish the procedure quickly and safely.
• Peritoneal incision: It is usually recommended in cases where there is a small breast ptosis and this is when a peripatetic mastopexy is performed. If the patient only needs breast augmentation, then it is not preferable. Approximately 20% of breast augmentation procedures involve the peritoneal approach. The main disadvantage of this incision is that the nipple and areola are susceptible to a greater number of pathogens than the submammary fold, hence there is a slightly higher chance of postoperative inflammation and infection.
• Gastric incision: It concerns less than 5% of breast augmentation procedures and this is because it has two major disadvantages :

1. Increased number of pathogenic microorganisms in the axillary region
2. Difficult to identify the underlying anatomy so that the pouch for the insertion can be created in the correct anatomical place.

2. Silicone insert case:

• Underbust pouch: It is not the preferred technique because it has two major disadvantages over time. The first is that there is not enough support for the insert, resulting in loosening and the second is that the insert is not covered by a sufficient amount of soft tissue, which makes it more exposed to the environment.
• A pouch under the fascia of the pectoralis major muscle (subfacial): it is technically more difficult to prepare the surgical field as there is more bleeding. The insertion is more stable because the fascia is a hard tissue.
• Submuscular insertion under the pectoralis major muscle (submuscular): this is a widely used technique with good results both immediately and in the long term. The insert is well covered by soft tissue and because the muscle is a resilient tissue it protects the silicone insert from the environment.

3. Dual Plane: this is the most common technique and usually the most common choice based on the existing breast. The pouch is prepared in two planes, first under the breast and then the muscle is separated and continued under the pectoralis major muscle. It has significant advantages over the other techniques both in terms of immediate results and durability ( breast enhancement, breast shaping and long lasting results).
4. Choice of silicone implants:

• Based on the shape: The first choice made between the plastic surgeon and the patient is the shape of the implant to be used.

1. Round implants: These are the most widely used silicone implants worldwide. They give a great result and have fewer complications than anatomical implants.
2. Anatomical implants (tear-shaped): they are used for a more natural result as they do not have a large volume in the upper breast pole. The most important disadvantage is that they can change position within the socket, resulting in a change of breast shape, requiring surgical correction.

• Based on sizing: a simulation with the patient is done with a special bra (sizing) and the desired insert is chosen always based on the plastic surgeon’s instructions.
• Based on the base of the insert: It is decided whether to use an insert with a wide or small base depending on the patient’s chest and breast.
• Based on the type of implant: In the past, smooth implants were mainly used, but it has been proven that rough implants create smaller reactions (capsule) and thus are the number one choice.
• Based on the outlook of the insert: It depends on the chest , the existing breast as well as the patient’s expectations whether to use a high profile , moderate plus, moderate or low profile insert.
• Based on the consistency of the silicone: Inserts are divided into Cohesive I and Cohesive II according to the consistency of the silicone they contain. Cohesive I are very soft inserts that simulate the feel of the breast itself.

Breast Augmentation with Fat Transfer

It is the second most commonly used option for breast volume restoration. A liposuction in another area of the body is planned. After the liposuction is performed, the amount of fat is collected in a special sterile canister, the fat is applied to specific anatomical areas of the breast. The most important advantage of this method is the natural look and feel of the breasts.

However, there are also significant disadvantages. The most important is the absorption of some of the transferred fat by the body in the 1st half of the year after the procedure. The second disadvantage is the duration and the long-term effect.

Breast Augmentation with Normal Serum Inserts

This method is not used in Greece and is not an option.

Conclusion

Like any surgical procedure, breast augmentation is a procedure that will be performed after a relationship of trust has been built between the patient and the plastic surgeon. The plastic surgeon must listen to the patient’s needs and expectations and the patient must listen to the “musts” of the procedure for optimal results. Proper communication between the patient and plastic surgeon that takes place during pre-operative appointments will build this relationship of trust.

The results of breast augmentation are long lasting , so preoperative planning is very important along with the patient’s requirements and expectations.