Planning
The process of breast enlargement with silicone implants begins with a discussion of your wishes and a physical examination. To ensure thorough planning, we will then discuss together which implants and methods are ideal for your desired figure.
Types of breast implants
Saline implants
A saline breast implant consists of a silicone shell filled with a sterile saline solution or salt water. Some saline implants are prefilled, while others are filled during breast augmentation. If the implant shell leaks, the saline implant collapses and the saline solution is absorbed.
Silicone implants
Silicone breast implants consist of soft silicone shells filled with a silicone gel. Patients often report that the silicone gel is very similar to the texture of natural breast tissue. If the implant ruptures, the gel remains in the shell, although some silicone may leak into the implant pocket over time. However, unlike saline implants, a leaking silicone implant will not collapse. Modern gummy bear implants do not contain liquid silicone, so the risk of silicone migration is lower.
Anatomical vs round implants
Anatomical implants are teardrop-shaped, have a larger projection at the bottom and a textured surface. When they rotate, which is more common than you might think, it can result in an unusual breast appearance. In this case, corrective intervention is necessary. The rough (textured) surface, where bacteria can attach more easily, should theoretically prevent turning, but this is not possible due to the fine texture. I do not use anatomical implants on my cosmetic patients because, apart from these disadvantages, they do not provide better aesthetic results compared to round implants and they retain their teardrop shape even when you are lying on your back, which is not natural. Round breast implants behave naturally both when lying on your back and when standing. When standing they are teardrop-shaped, when lying down they are round and flat, just like a natural breast. Higher profile versions can provide good upper breast and cleavage filling, which is desired by most women. There is no risk of rotation with round implants, although they could potentially rotate with the flat side forward, as is the case with all implant shapes.
Smooth vs textured implants
Smooth breast implants can move freely in the breast implant pocket, which is only a problem if the pocket is too large for the implant. Precise preparation of the pocket is crucial, which is why the incision in the inferior mammary fold is most suitable as it provides the best and most direct anatomical access. Textured breast implants should theoretically promote the formation of scar tissue around the implant to fix it in place and reduce the risk of capsular contracture. The former is theoretical and not based on clinical reality, as the texturing of currently available implants (apart from polyurethane implants) is too fine to cause any kind of tissue integration. Implants with a coarse texture (macrotexture) have been withdrawn from the market in many countries because they can cause problems, presumably through bacterial colonisation, and are linked to a rare type of cancer (anaplastic large cell lymphoma, ALCL). This very rare disease was only found in patients who had previously received this type of implant. I use round, mostly smooth, rarely micro- or nano-textured implants in a wide range of sizes, cohesiveness and filling volume from premium brands such as Mentor, Polytech, Motiva, Nagor and Eurosilicone.
Incision
When preparing for your breast augmentation, you need to know where the incisions will be made and how long they will be.
In the breast fold (inframammary)
The incision in the inframammary fold is the most common and most widely used method of breast augmentation. The incision is located below the breast, just where it meets the chest wall, and allows experienced plastic surgeons to place the implants either above or below the muscle, ensuring optimal placement for a natural result. The length of the incision depends on the size of the implant or whether it is an implant exchange and is usually between 3 and 4 cm.
Around the nipple (periareolar)
A periareolar incision is made along the border between the areola (the darker skin around the nipple) and the adjacent breast skin. This incision allows for the creation of a pocket either above or below the muscle. After preparation, I insert the implant through the access incision, place it in the breast pocket and carefully adjust its position to achieve optimal results. A disadvantage of this incision is that the milk ducts are severed during dissection of the implant pocket, which usually does not cause problems with breastfeeding but increases the likelihood of contamination of the implant by bacteria found in the milk ducts.
In the armpit (axillary)
The transaxillary method is an advanced surgical technique that involves making a precise incision in the armpit. A tunnel to the breast is then prepared for the placement of the breast implant. We do not use this method because it requires a large preparation area with blunt dissection technique, which increases the risk of bleeding, implant malposition, bacterial contamination, and capsular contractures.
Through the belly button (umbilical)
During transumbilical breast augmentation (TUBA), a small incision is made in the belly button. A blunt dissection creates a tunnel through which the implants can be inserted either under or over the muscle. This technique is limited to inflatable saline implants and has the same problems as other more distant incisions. I therefore do not offer breast enlargement through the belly button.
Implant pocket
Above vs below the muscle
Both types of implant pockets offer different advantages and disadvantages. Placement over the muscle (subglandular) is the most natural level for breast augmentation. Dissection is the least traumatic and there is no risk of muscle movement affecting the shape and position of the implant. However, many patients do not have enough soft tissue to create a smooth transition between the implant and the chest wall. In this case, a pocket can be prepared in two planes, partially releasing the pectoral muscle below and covering only the upper pole of the implant. Complete submuscular placement should only be used in special reconstructive cases to avoid deformity when tensing the muscle.
Subfascial breast augmentation
Nowadays, most of my patients receive subfascial breast augmentation, in which the implants are placed under the membranous connective tissue layer (muscle or fascia) that covers the pectoral muscle. I prefer subfascial placement as it allows for a very natural look to the breast with good tissue coverage.
No-touch technique
The no-touch technique for inserting breast implants is a well-established marketing slogan. In reality, it is a technique with minimal contact with the implant, aimed at reducing contamination with skin germs, which is considered one of the main factors in capsular contractures after breast augmentation with implants. The insertion aid (Keller funnel) is made of a special plastic that allows the implant to slide smoothly into the breast pocket. Squeezing the funnel from above applies light pressure to guide the implant into the breast pocket. This method avoids the implant rubbing against the patient’s skin and is significantly less traumatic. It is also associated with a shorter operation time and shorter incisions.
Rapid recovery drainless breast augmentation
Rapid recovery drainless breast augmentation takes a differentiated approach to speed recovery and reduce risks. It includes a tailored surgical and postoperative protocol designed to facilitate resumption of daily activities within 24 hours after surgery – a departure from traditional postoperative protocols. In addition to less pain, faster healing and no need for annoying drainage, rapid recovery breast enlargement offers further advantages over traditional breast enlargement. It poses fewer risks, such as significantly reduced bruising, swelling, seroma and infection risks. The risk of secondary bleeding is minimal and there are fewer side effects from painkillers. Part of this protocol is the nerve block. This technique involves injecting anesthetics near specific nerves to block pain signals before they reach the brain, thereby reducing postoperative pain. It is a minimally invasive procedure that has fewer complications compared to other pain management methods. Studies have shown that nerve blocks also significantly reduce the incidence of nausea and vomiting after breast augmentation. In my practice, I avoid the use of drains after breast enlargements as much as possible because in most cases they are not effective in preventing complications. Instead, prolonged drainage increases the risk of infection and can provoke and sustain a seroma (fluid collection around the implant).
If you would like more information about breast augmentation and breast implants, continue reading here and here and do not hesitate to contact me or schedule a consultation!