Breast Augmentation with Implants

Why opt for breast augmentation

Breast augmentation with implants can be performed on women who have always had small breasts and on women who have lost breast volume due to childbirth and breastfeeding. It can also be performed on patients who have vastly different sized breasts in which case either different size implants can be used or only one implant can be applied in order to achieve the required symmetry.

Our clinic shows a particular interest in breast surgery, using the latest surgical techniques available worldwide with complete safety as well as high quality silicone implants, which have been approved by the FDA.

Breast augmentation surgery in short

The silicone implant can be placed directly below the breast (sub-glandular placement) or under the muscle (under the pectoralis major chest muscle- Sub-muscular placement). Implants can be inserted through a small incision in the armpit or nipple or more commonly in the inframammary fold. The advantages of these different options concerning both the approach and the placement of the implant are analyzed in detail below.

Placement of the silicone implant under the muscle or under the mammary gland?

Following a detailed consultation and clinical examination, we will advise you on the ideal solution for your specific case, always acting with your safety and the best aesthetic result in mind. Placing the silicone implant under the muscle is usually recommended in patients whose skin is very thin and there is risk of the implant being visible.

Dual Plane

This is the most modern silicone implant placement technique which has the benefits of both the above techniques. In this case, the silicone implant is placed half under the muscle and half under the gland, in order to achieve better lifting, but also better coverage of the implant.

Positioning of incisions

Armpit

The incision in the armpit has the advantage that one avoids the formation of a scar on the breast, but is only suitable for submuscular placement of the silicone implant. It also has the disadvantage of a possible injury to many small sensory nerves thus causing local hypoaesthesia.

Nipple

The periareolar incision is beneficial as long as the nipple is large and the breast is small. However, one should take into account the rates of infection of the implant with this type of approach, as well as possible problems with the nipple sensation. However, if this incision remains your first priority, all aspects of this approach will be analyzed in our clinic.

Inframammary fold

The incision below the breast in the inframammary fold is the most widely used worldwide and can be used in any surgical placement plan of the implant we decide upon. The incision heals very satisfactorily and is hidden in the fold of the breast.

Breast augmentation technique with autologous fat placement

The method of injecting autologous fat involves the use of the patient’s own fat which after special treatment is reinserted in the same organism so as to increase the size of the breasts.

The fat is removed by the method of liposuction (PAL – Power Assisted Liposuction) from any area of the body you want and is re-injected into the breasts. The PAL method achieves the collection of multiple amounts of fat, while increasing its survival rates and achieving smoothness in the breasts without the risk of inhomogeneity on the skin surface. The autologous fat injection technique is applied both to breast augmentation and to breast asymmetry correction surgery. It is also an established technique for repairing small asymmetries or cavities created after the removal of part of the breast due to malignancy.

The biggest advantages of this technique are that it is performed under local anesthesia, no hospitalization is required, there are no visible incisions and you also have the benefit of liposuction. One should also not overlook the fact that the result is clearly more natural than that of the silicone implants both visually and tactilely. In addition, no recurrent surgeries are required in the future, as with silicone implants, which will inevitably need to be replaced over time.

The main disadvantage is the unpredictable survival of fat. About 50-70% of the fat usually survives, so during the operation an over correction is sought, so that when the excess fat is absorbed, the desired result is achieved.

It is important to emphasize that fat is injected into the space between the skin and the breast and also under the breast, and not actually into the breast tissue itself. This is done to avoid any changes in the appearance of the breast on mammograms or other imaging methods for the breast (e.g. MRI) to be done in the future. The postoperative scars that form on the breast are extremely small and over time will be become complete indistinguishable. Regarding liposuction, scars will be approximately 3mm in length and special importance is given to hiding them as much as possible in “key” points, such as along the underwear line or on the inner surface of the thighs.

Major changes in breast volume cannot be achieved in a single session. Approximately, with a single fat injection, patients gain an increase in breast size of 1 cup size Repeat surgery for more volume is possible if desired and ideally should be performed at least six months after the first session.

Medication

In our clinic, a complete medical history is always taken before each surgery. As a precaution, over-the-counter medicines or herbal products should not be taken before and for 3 days after surgery. It is also considered necessary to avoid taking non-steroid, anti-inflammatory drugs such as aspirin (salospir), ibuprofen (Nurofen), diclofenac and any other anticoagulant or antiplatelet drug.

Smoking

If you are a smoker you should try to stop smoking for at least 1 week before and 1 week after the surgery as this will dramatically reduce the incidence of postoperative complications and help achieve the best possible result.

Breast screening, self-examination and breast cancer

There is no direct correlation between silicone implants and breast cancer. In fact, the incidence of breast cancer in patients with silicone implants is marginally lower.

Silicone implants can make palpation and mammography examinations a little more difficult technically, compared to patients who do not have implants. For this reason, more screens than usual may be needed during mammography. It should be noted, however, that all of this has absolutely no impact on the diagnosis and validity of the mammogram for any formation that may occur in the future (benign or malignant).

Types of silicone implants

There is not one ideal implant for all patients. The main differences between them lie in the shape, texture and composition of the silicone gel and their profile. Silicone implants are available in round or teardrop shape (anatomical implants). Silicone inserts are also available in three different profiles: Moderate, Moderate Plus, and High Profile. The higher the projection of the implant, the greater the projection of the breast from the side.

During your visit to our clinic you will try and see up close the whole range of implants, so that after a detailed discussion with the doctors you can come up with the ideal implant based on your body type.

Quality of silicone implants

Our clinic uses two of the best and most widely used companies in the world, Mentor and Polytech, both of which are approved for use by the US Food and Drug Administration (FDA).

Is silicone safe?

Silicone implants are completely safe. Silicone is the most widely used of all medical substances and has been used for over 40 years. Extensive and thorough studies have shown that there is absolutely no association with breast cancer, arthritis, autoimmune diseases or fatigue syndromes.

How Long do Silicone Implants last?

There is no clear time limit, but on average silicone implants can have a lifespan of 10 to 40 years.

There is evidence that the implant shell weakens after the first two decades. This can lead to possible rupture of the implant and although it is not dangerous, it can cause problems if silicone leaks out of the capsule surrounding the implant. One of these problems may be the appearance of silicone lumps in the breast or lymph nodes. Rupture is of course detected in 95% of patients with a simple ultrasound or MRI.

Recovery from breast augmentation surgery with silicone implants

Duration of the procedure

The surgery usually lasts from 1 to 1.5 hours depending on the type of technique used to insert the silicone implants.

Hospitalization / Duration

The duration of hospitalization ranges from a few hours to one night.

Wound dressing

After the operation incisions will be bandaged using a small adhesive gauze which must remain for 2 days. Sutures are absorbable and do not need to be removed. The re-examination of incisions will be done in seven to ten days.

Bras

Immediately after the operation, you will need to wear a simple sports bra (without underwire). The measurement of the chest circumference does not change. After four weeks you will be able to wear a bra with an underwire which will have to be adjusted to the new shape and the size of your breasts.

Absence from work

It will generally take at least 2-5 days for a patient to be able to fully return to work. Patients whose work involves a lot of movement or manual labor may need more time.

Refraining from exercising

Patients are usually able to go brisk walking within five to seven days and swimming in 10 to 14 days (if they have fully recovered). However, strenuous exercise should be avoided for at least four weeks.

Post-op instructions

From day one to day four, you should ideally avoid any activity. You should not take care of small children or do household chores without help.

From day 5 to day 14 you can start exercising more, as for instance go walking for a longer period of time, go shopping etc. By the end of this period you will feel minimal pain. If all wounds seem to have been healed by day 10, it is rather unlikely that you increasing your level of activity could cause any issues. You should only resume your activities if you feel healthy.

From the third week onwards you will be able to fully return to your normal pace of life and do whatever you want.

Driving

Patients who have undergone breast augmentation with silicone implants should ideally avoid driving until they are completely free of any discomfort or restriction, in order to be able to make a sudden movement, such as braking, freely and without any pain. This parameter is proposed so that patients can secure coverage from their insurance company in case of accident. Thus, it may take up to two weeks for them to fully recover. There are of course patients who feel able to drive after 1-2 days, but always at their own risk.

Recovery and final outcome of breast augmentation surgery

There may be some bruising and slight swelling in the chest area, which will last up to three weeks. Your breasts will be slightly harder in texture and will be positioned slightly higher than the expected end result. Within a short time your breasts will soften and acquire a very nice and natural shape. This will happen around the fourth to sixth week, but the result will continue to improve for the next six months.

Postoperative follow-up

Incisions and the result will be checked on the second and seventh postoperative day. However, if you need any clarification or there is something that worries you, doctors are always at your disposal. Your next appointments will be after one and three months respectively and during said appointments, postoperative photos will be taken. For these visits, there will of course be no extra charge for any follow-up related to your surgery.

Possible complications from breast augmentation surgery with silicone implants

Breast augmentation is a routine operation and is completely successful for the vast majority of our patients, which is a result of the large number of cases that doctors have in their belt. However, as with any surgery, it is very important to understand that there is a possibility of complications. Possible complications are listed below:

Temporary loss of nipple sensation

It is common for the patient to initially experience loss of sensation in the nipple after breast augmentation surgery with silicone implants, but sensation returns for the majority of patients within the next few weeks. It is also common to affect only one side of the chest.

Asymmetry

Most women have a normal and small degree of breast asymmetry, which we try to normalize and improve through breast augmentation surgery. However, it is possible for one breast or one nipple to be slightly different than the other side after surgery.

Incisions

The quality of the scars varies among patients.

Wound Dehiscence

Very rarely, and especially in smoking patients, the surgical incision may reopen

Hematoma

There is a possibility of a hematoma forming in the chest, which will result in the patient returning to the operating room for its removal. Hematomas usually occur within the first 24 hours after surgery and affect about 2% of patients.

Breastfeeding

About 99% of women can normally breastfeed after breast augmentation surgery.

Infection

The possibility of postoperative infection is insignificant, but if it occurs it can be severe and sometimes lead to the removal of the silicone implants.

Complications from silicone breast implants and treatment

Patients with silicone implants may experience a variety of complications, which may be related to either the implant itself (including hardening of the breast due to a condition known as “capsular contracture”, rupture of the implant, excessive folding of their outer sac, incorrect size, etc.), or to changes in the skin that is over the silicone implant (drop of the skin or nipple and poor quality scars). Most cases, however, experience a combination of the above problems, so it is important to choose a specialized breast plastic surgeon for such a demanding operation.

Hardening of Silicone Implants | Capsular contracture

Capsular contracture is when the body forms a layer of scar tissue around the implant, which, although not dangerous in itself, creates problems when it is torn. About 10% of patients form such a capsular contracture over a period of ten years, while a small number of patients develop it much earlier. Some implant types, including saline implants, rough surface implants, and polyurethane implants may have a slightly lower risk of hardening.

Options for treating hardening include removing the implant with the accompanying capsule and replacing the implant with a new one. If this is possible, it would be preferable for the insert to be placed in a new position, e.g. under the muscle instead of under the gland. Also, if a new implant is inserted, it should usually be slightly larger in size. It is also important to note that if the implant needs to be removed, the patient will have a larger scar.

An alternative option is the removal of the implant and then the regeneration of the rest of the breast by performing a breast lift surgery (mastopexy). This surgery is an excellent form of treatment, as long as the patient has enough massive tissue to form an adequate breast. If there is severe sagging of the skin accompanied by capsular contracture, a combination of a new implant and augmentation mastopexy will be required.

Breast Silicone Rupture

Rupture of the silicone implant is reasonably of great concern to patients and is a problem identified during the safety findings of PIP implants used worldwide between 2011 and 2012. Although rupture of the silicone implant can be quite a concern, its treatment is not considered urgent and can be performed in a reasonable amount of time, depending on the preferences of each patient.

Intracapsular rupture of the implant

For more than forty years there is evidence that silicone implants are very safe. When this type of implant ruptures, silicone can remain inside the “capsule” (also known as an intracapsular rupture) without leaking into the breast. In this case, it is considered more difficult for a patient to perceive the rupture as the symptoms are minor and the problems that can be caused in the short term are minimal.

Extracapsular rupture of the implant

In more severe cases, the rupture can cause the silicone to leak out of the capsule and into the breast (extracapsular rupture). In this case, the implant should always be removed, as it can become problematic and cause the formation of silicone particles, silicone deposits in the axillary lymph nodes, and possible deformities of the breast as well as the appearance of infections.

Loose skin, sagging, or poor quality scars

Depending on the degree of skin loosening of each patient, the breast can be lifted again at the cost of creating new incisions. The replacement of implants should be considered at the same time as the lifting, based on the age of the silicone implants.

Breast implant rippling

Wrinkles and folds on the skin, after breast augmentation with silicone implants, occur when the natural folds of the implant are visible through the skin. It occurs mostly in patients with thin breast skin or in those in whom silicone implants have been placed under the gland and not under the muscle.

Treatment

There are various treatment options including the following:

• Replacement of the implant with a more stable and better quality (consistency 3) implant.
• Transfer the existing implant sub muscularly (in which case the muscle should be lifted and reattached to the breast).
• Application of fat injection techniques in order for the skin to obtain the appropriate thickness.
• Use of the ADM-acellular dermal matrix (a special type of material) which is placed on the implant, in the affected area and acts as a “shield” against the folds.