INTRODUCTION

Historically, the modern era in breast augmentation in surgery began in 1963 when silicone breast implants were introduced in surgical practice. Since then, the technology of their production has constantly improved, so the latest generations of implants are produced in a wide range of sizes and shapes, as well as consistencies and they can be considered safe and long lasting. Together with this technological improvement, various surgical techniques for implant placement were being improved.

All implants used today consist of silicone membrane and the content which is inside the membrane. This content can be silicone gel (with a different degree of density-cohesiveness) or a saline solution. So far, attempts to introduce some other substances to fill out the silicone membrane, vegetable oils or hyaluronic acid to name some, were not successful. It was found that the silicone membrane has the least negative effects to the surrounding tissue and that, as an inert substance, it causes the least tissue reactions. The silicone gel is most successful in “imitating” the breast tissue and is most similar to it on touch.

The breast augmentation procedure is one of the most sought after and most common procedures, so at this moment, there are millions of women worldwide with silicone implants.

PLANNING THE OPERATION

There is a number of objective parameters which are considered during the patient’s examination and planning the operation as they influence the final outcome. Some of the most important are:

  1. condition and shape of the whole body frame, body height and weight
  2. shape and width of the chest
  3. condition of the chest musculature
  4. breasts position on the chest
  5. breast size
  6. breast shape (semi-round, pear, conical)
  7. breast symmetry or asymmetry
  8. breast consistency, the fat to glandular tissue ration
  9. breast mobility
  10. position, size and projection of the nipple and areola
  11. skin thickness and quality, stretching ability, stretch marks

Based on these parameters, the surgeon decides on:

  • location of the incision (incision type)
  • location of the implant (pocket type)
  • implant type (shape and size)

THE INCISION TYPE may be:

  1. Inframammary – where the incision is in the fold on the transition between the lover part of the breast and the chest wall and it is 3-5cm in length
  2. Periareolar – the incision goes along the lower edge of the areola, i.e. on the borderline between the dark pigmented and normally pigmented skin
  3. Transaxillary – the incision is in the armpit, on its from edge
  4. Umbilical – the incision is in the navel and a special type of implant is needed to be inserted as an empty silicone membrane which is filled with saline solution after placement

THE POCKET TYPE may be:

  1. Subglandular – the implant is placed directly under the mammary gland, above the large breast muscle
  2. Subpectoral –the implant is placed under the large breast muscle (m.pectoralis major)
  3. Subfascial – the implant is placed under the fascia, i.e. the large breast muscle membrane so that it remains preserved
  4. Dual-plane - the lower part of the implant is under the gland, and the upper part is below the large breast muscle

IMPLANT TYPE

  • the implant size can go from 100 to 800cc, and more
  • the implant surface can be smooth or rough textured
  • the implant shape can be hemispherical semi-round or anatomically pear-shaped
  • the implant content may be of silicone gel of saline solution
  • silicone gel may be cohesive or highly cohesive
  • the implant can be low-profile (wider diameter and smaller projection) or high-profile (smaller diameter and larger projection)

OPERATION

The operation itself is performed with general anaesthesia andlasts 1-2 hours. The patient leaves the clinic the same or the next day. It is recommended to wear special brassieres duringthe next 4 weeks.. The stitches are removed after 10-14 days. The pain and the tightening sensation are present for the first several days and they are regulated with analgesics. The breasts are more or less swollen, taut and hard, andbrusing may occur. Strenuous physical activity,heavy lifting and sports are prohibited for a month. The scars are treated with special crèmes and after a while (6-12 months) they soften and pale.

All implants used today consist of silicone membrane and the content which is inside the membrane. This content can be silicone gel (with a different degree of density-cohesiveness) or a saline solution. So far, attempts to introduce some other substances to fill out the silicone membrane, vegetable oils or hyaluronic acid to name some, were not successful. It was found that the silicone membrane has the least negative effects to the surrounding tissue and that, as an inert substance, it causes the least tissue reactions. The silicone gel is most successful in “imitating” the breast tissue and is most similar to it on touch.

The breast augmentation procedure is one of the most sought after and most common procedures, so at this moment, there are millions of women worldwide with silicone implants.