Breast Augmentation – Implants

The procedure is performed under general anaesthesia. After a ca. 5 mm long skin incision is made, a pocket is formed under the pectoralis major muscle in which the implant is inserted. Only in exceptional cases the implant is placed over the muscle, directly under the breast. Sometimes, the implant can be also placed partially under the muscle (dual-plane). Implantation can be performed from three approaches:

• Inframammary access
• Transaxillary access
• Periareolar access

Therefore, it is essential to discuss the potential effects of the breast augmentation procedure on the selected type of sport activity during the consultation with the plastic surgeon. This allows to select the best surgical method and implant type, adjusted to the individual needs of the patient.

Popularity of this procedure is growing around the world. It consists in making a ca. 5 cm skin incision in the axillary region and, subsequently, under control of a special camera, formation of a pocket under the muscle of the breast in which the implant is inserted. A great advantage offered by this technique is placement of the post-operative scar in the axillary region and not in the region of the breast itself.

Proper implant selection is one of the key conditions to achieve beautiful and natural breasts. I my practice, I use only latest generation silicone implants of the best producers in the world. The silicone material makes the augmented breasts natural in touch and minimises the risk of their rupture or formation of capsular contracture around the implant. Breast implants differ, inter alia, in shape (round or anatomical tear-shaped), size, surface structure (smooth or textured) or profile (high, medium, low). The said parameters are discussed in detail during the consultation appointment, when assistance in selection of the best implant is provided.

Breast implants are frequently an ideal supplementation to the mastopexy procedure. Along with age, as a result of breast
structure changes ad impact of gravity, skin elasticity increases with concurrent loss of breast firmness. This results in breast ptosis. The mastopexy procedure, frequently combined with reduction of the nipple-areola complex, allows to restore the attractive juvenile look to the breasts. In certain cases, the procedure requires use of breast implants to achieve the desired size and shape.

The key to achieve attractive breasts is a thorough planning process. Breast augmentation requires an individual approach to every patient due to differences in anatomy and perception of beauty. The role of the plastic surgeon at the stage is limited only to educating the patient with regard to available surgical techniques, types of implants as well as advising regarding selection of the most optimal size and type of the implant. I pay special attention to achievement of the best aesthetic results and patient's satisfaction level. Therefore, during the consultation I carry out a detailed analysis of the anatomic conditions of the breasts and body silhouette. It is also essential to know the patient's taste and expectations. The shape or degree of breast ptosis, proportions of the particular body parts, level of skin laxity or degree of chest asymmetry and patient's preferences are only some of the factors to consider when selecting the most suitable surgical technique and implant. The first consultation is usually educational and the patient is not encouraged to make an immediate decision. It is usually made at the second appointment, after she thinks all presented information through and develops her own image of ideal breasts. At every stage of planning, the patient can obviously count on my advice.

Absolute contraindications include:

• pregnancy or breastfeeding
• active infection
• breast neoplasm
• undiagnosed breast tumour
• allergic reaction to silicone
• unstable mental condition
• unrealistic expectations for the procedure result

Relative contraindications, usually requiring additional diagnostics or implementation of proper treatment, include, without limitations, autoimmune diseases, immune system deficiencies, uncontrolled hormonal and metabolic disturbances, coagulation
disorders or smoking.

After the procedure, the patient stays at the clinic for one day and is under care of qualified medical personnel. Tenderness, pain and sensation of distension often persist for several days. In this period, it is recommended to use the indicated pain relievers. Some patients experience sensation impairment in the nipple region. Nevertheless, it is transient and subsides after several months.

It is necessary to wear an elastic bra and a special compressing belt for at least 6-8 weeks. Massage of the breasts operated on is also recommended.

Office work can usually be resumed after a week from the surgery, but it is recommended to take some days off for the
tenderness of the area operated on to subside – usually ca. 2-3 weeks.

Cardio type sport activity can be resumed after ca. 4-6 weeks from the procedure. Whereas, returning to more intensive
exercise, especially with additional load, is possible not sooner than after 3 months.

Breast implants do not exclude sport activity. What is more, may sportswomen have undergone the breast augmentation
procedure. There are no contraindications to do such sports as tennis, volleyball or football. Scooba diving or parachuting are also possible. It must be, however, remembered that resumption of full sport activity should be gradual ad start not earlier than 3 months after the procedure.

Women doing contact sports, especially combat sports, should remain vigilant. Despite their high durability, modern implants can get damaged or dislocate as a result of chest injuries. Physically active women should also remember that extensive breast augmentation may lead to certain forms of fitness impairment. Therefore, it is very important not only to discuss your expectations with the plastic surgeon, but also your interests and habits. My consultation appointments feature detailed discussion with the patient of all aspects of the procedure and their potential impact on various aspects of her life.

The scar location results from the selected implantation technique. All proposed locations offer hiding the scar.
Observance of post-operative indications regarding scar care allows to achieve a flat, hardly noticeable scar over time.

The breast augmentation and shaping effect is noticeable already after the surgery but, due to the persisting post-operative swelling and healing process, the end result is achieved after several dozen weeks.

Implant replacement is not something unavoidable. Breast implants have no expiry date after which they have to be removed or replaced. The current world trends recommend replacing or removing them only if specific indications arise or if the patient so wishes.

Research shows that ca. 20% of patients undergoes an implant removal or replacement procedure during the first 10 years from implantation. The most common reason is the patient's wish, usually motivated by the will to change the breast appearance. It must be remembered that breasts, even after implantation, undergo natural changes related to the aging process. Over the years, the breast tissue and skin structure change, resulting in ptosis and loss of firmness. Body mass fluctuations, pregnancy and breast feeding can also affect the appearance of breasts. Therefore, to improve the breast aesthetics, it may be recommended to replace the implants for ones that are properly suited to the changed anatomic conditions of the chest and body silhouette.

Other, relatively rare causes of replacement/removal of implants include their rupture, infection, displacement or capsular contracture. In the case of latest generation implants, due to high cohesiveness of the filling silicone gel, potential damage is frequently symptomless.

Breast augmentation using implants is not a contraindication for pregnancy. Breastfeeding is also possible. However, when
making decision on the procedure, the patient has to bear in mind that these processes may result in breast ptosis and change of the breast shape. Therefore, it is recommended for the woman to consider breast augmentation after final family expansion. Otherwise, repeating the procedure with implant replacement for a different type/size might be necessary.
Latest generation breast implants, especially in case of placement under the muscle, do not disrupt the process of imaging
diagnostics of the breasts using ultrasound, mammography or MRI methods. These tests also pose no threat to the coherence of the implants themselves.

No they don’t. After the breast implant surgery, it is recommended to undergo breast ultrasound annually. Thanks to my close cooperation with an experienced radiologist, my patients can count on imaging diagnostics of the breasts and implants at the highest level.