Breast Augmentation
Before undergoing breast augmentation surgery, two key guidelines that the surgeon must carefully consider are proportions and overall harmony. In fact, to ensure an aesthetically valid, but above all, harmonious result, the breast and its shape must be proportionate to the chest and the height of the patient.
How to decide when to undergo breast augmentation?
Breast augmentation is useful in cases where the breast is naturally small or has lost volume due to pregnancy, breastfeeding, or if there is a congenital or acquired difference in volume between the two breasts. It is also indicated as a method of treating mild ptosis where lifting the mammary gland can be achieved by increasing breast volume. However, in cases where breast ptosis is significant, a breast lift procedure combined with implant insertion may be recommended.
Implants
The choice of breast implants is made by the surgeon in agreement with the patient’s needs, based on physical structure, psychological acceptance, and the chosen surgical approach. There are many types of implants available today, varying in shape and size. The shape can be round or anatomical, with low, medium, or high profile projection.
Anatomical implants mimic the shape of the breast and, in many cases, can provide more natural and satisfying results. Recently, anatomical implants with significant projection have entered the market, capable of correcting breasts with significant ptosis and emptiness without the need for a breast lift. The shell of the implants is always made of silicone (smooth or textured), while the content can be silicone gel or other materials. The surface of the implants can be smooth or textured, and some implants have an outer shell coated with polyurethane. Most surgeons prefer implants containing silicone gel because they still lack full confidence in alternative materials currently on the market. These alternatives have had numerous problems over the years, and their scientific documentation is limited, with the exception of saline solutions.
Preoperative exams
Anesthesia
The procedure can be performed under local assisted anesthesia or general anesthesia. It is carried out in equipped facilities that can ensure maximum assistance, as the primary criterion to pursue is safety.
The procedure for the insertion of the implant
The access route for implant insertion requires an incision of a few centimeters, which can be placed in the breast fold, the lower or upper half of the areola, or in the armpit. The scar is generally not very visible, although its quality is largely determined by individual reactivity. The incision site is decided together with the patient based on individual characteristics, desires, and technical possibilities.
Each access route has its pros and cons. The inframammary fold incision is the easiest for the surgeon, leaves the areola intact but, on the downside, often results in a visible scar, especially if the breast is not sagging. The axillary access route has the advantage of leaving the breast intact and not causing scars. However, it leaves a visible scar for some time in a potentially exposed area of the body, and anatomical implants cannot be inserted through this route. Additionally, in the case of breast cancer, this access route does not allow for sentinel lymph node detection. On the other hand, the areolar access route allows for the placement of implants both in the submuscular and subglandular positions and the shaping of the gland itself if necessary (e.g., in cases of tuberous breasts). The resulting scar is often almost invisible as it is located at the transition between the skin and the areola. However, cases of partial temporary and permanent numbness, and rarely total numbness of the areola, have been documented in the literature.
Breast implants and early diagnosis of breast cancer
Breast implants do not pose specific diagnostic problems. However, it is advisable to rely on a competent center equipped with the latest machinery. Below the age of 40, ultrasound alone is recommended as a basic examination, while above the age of 40, both ultrasound and mammography (preferably digital) are recommended.
Prosthetics and breastfeeding
If the implants are inserted through an inframammary fold or axillary access, breastfeeding remains unaffected, while with the areolar access route, breastfeeding is generally slightly reduced.
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