A breast augmentation or augmentation mammaplasty is a procedure that aims to give sufficient volume (again) to a breast that is too small, by placing breast implants. Injecting your own fatty tissue may be appropriate to add smaller volumes. 

WHAT IS A BREAST AUGMENTATION?

A breast augmentation involves increasing the volume of the breast. The classical method is the insertion of a breast implant. An alternative can be the injection of your own fat tissue (the lipofilling technique). However, this is only indicated for adding smaller volumes. It is also possible to combine both techniques. It is important to inform yourself well about the feasibility of the procedure and the impact of inserting a breast implant.

WHY A BREAST AUGMENTATION?

Breast augmentation is performed to add volume and improve the shape of the breast. One may have congenitally smaller breasts or the breast may have decreased in volume following pregnancy or weight loss. Asymmetry (congenital smaller volume of one breast compared to the other breast) is also often seen. 

BEFORE YOUR SURGERY

The surgeon will clearly discuss your expectations and the feasibility of the operation. Your medical history will be noted and a clinical examination of both breasts will be performed. If required, a mammogram will also be requested. Photos will also be taken for your medical file. During the consultation, the volume you desire will be determined. This can be determined with test implants or, if feasible, a 3D scanner. 

PROCEDURE

The procedure is performed under general anaesthesia and a breast implant can be placed in front of or behind the large pectoral muscle. The position of the implant is determined by the volume of the mammary gland and will often depend on the surgeon's preference. The best option will be discussed with you, as well as the advantages and disadvantages of each technique. The location of the incision will also depend on the surgeon's personal technique and preference.

VOLUME OF THE BREAST IMPLANTS

The volume of the breast implant will be determined by your wishes and your anatomical build. The surgeon will take specific measurements at the level of the breasts to determine which type of implant is best for you. Round and anatomical prostheses are available.

IS SILICONE SAFE?

Silicone for medical applications is safe. Your body's reaction to a prosthesis is to develop a capsule around the device. This capsule is scar tissue. Sometimes this capsule may thicken over time and change the shape of the breast or cause pain symptoms. If this is pronounced, a revision surgery may be considered. Breast augmentation with implants is not associated with the development of breast cancer. A very rare condition is the development of anaplastic large cell lymphoma (ALCL). Over time, silicone may leak from the implant and cause swelling or pain. The implant must then be removed and possibly replaced.

SHOULD I UNDERGO A BREAST LIFT?

A mild form of sagging breasts can be corrected by inserting a breast implant. If it is more pronounced, an additional operation may be necessary (mastopexy). However, if the volume of the breast is sufficient, a mastopexy may be performed without a prosthesis.

POSSIBLE COMPLICATIONS

  • poor wound healing
  • unfavorable scarring
  • bleeding
  • fluid accumulation (seroma)
  • infection
  • swelling, bruising or pain
  • hypersensitivity or decreased sensitivity of the nipple
  • asymmetry between both breasts
  • allergy.

POSSIBLE COMPLICATIONS DUE TO THE IMPLANT

  • capsular contracture
  • on average, 10-30% of patients undergo revision surgery after 10 years (mostly due to capsule formation)
  • palpable or visible breast implants
  • ruptured implant
  • leaking implant
  • sagging of the breast.

 

 

 

Physiological saline solution obviously offers the advantage of absolute safety, even in the event of a leakage of the contents. The prosthesis is filled when it is inserted, thus reducing the surgical approach and the residual scar. These implants also allow the volume to be adjusted during surgery, which is useful for breast asymmetry. However, they have a shorter lifespan, in the order of 12 years, because the filling valve is their weak point. Small leaks inevitably occur and over the years lead to a decrease in volume and the formation of sometimes perceptible folds. These then become the areas where the shell shows premature wear and tear. Finally, the obtained breast curve is comparable to that of a silicone implant, but the feeling is less natural. The advantages of silicone gel filled prostheses can be deduced from the above: they have a longer life span - about 20 years - and their consistency is more natural. However, they require a slightly wider access (about 5 to 6 cm) and are relatively less biocompatible. Liquid or cohesive silicone gel replacements are currently available. The latter makes the implant slightly firmer, but provides an additional guarantee against leakage. In the event of a proven leak, the implant must be replaced immediately due to the inflammation generated by silicone. It is of course best to replace the implant systematically as soon as it shows signs of weakening. One of the most important recent developments is the use of so-called anatomical prostheses. Their "drop shape" is closer to the natural shape of a breast than traditional implants. For a given volume there are 3 different heights and 3 different projections. This offers 9 possible combinations, enough to adapt to all situations, but the planning is all the more difficult.