Breast Augmentation (Implant)
Breast augmentation is surgery to increase breast size. Breast augmentation can also reshape the breasts and correct breast sagging (breast ptosis) to a certain extent. Breast augmentation is done by using either breast implants or autologous fat graft.
Breast augmentation is most commonly done using breast implants. A breast implant has an outer silicone shell filled with either silicone gel (silicone implant) or saline water (saline implant). The gel inside a silicone implant is cohesive silicone gel (for example MENTOR® MemoryGel®) which holds together uniformly while resembling the natural give of breast tissue. Compared to saline implants, silicone implants have a more natural feel and much lower rippling and leakage incidence.
The outer surface of an implant can either be smooth or textured. Generally, smooth breast implants feel softer than textured implant. Smooth implants can also move more easily with the implant pocket, giving them a more natural movement. Textured breast implants stimulate scar tissue to stick to the implant, making them more stable and less likely to move around inside of the breast. Textured implants are reported to have lower incidence of tight scar capsule (capsular contracture).
Breast implants are available in two shapes: round or teardrop shape. Round implants are the classic design and remain very popular even until today. Round implants tend to create fuller and curvier breasts compared to teardrop implants. Teardrop implants, also known as anatomical implants, slope gently from the top to the bottom, resembling the natural shape of a breast. Teardrop implants tend to give the breasts a more natural shape and are suitable for patients who prefer more natural and subtle results.
Breast implants are either put under the breast (subglandular placement) or under the chest muscle (submuscular placement). Subglandular placement is easier and faster to perform, and subglandular implants offer more pronounced roundness to the breasts and better cleavage line. However, subglandular implants may be more visible and palpable especially in skinny patients. Subglandular implants also are associated with higher incidence of capsular contracture. Submuscular placement offers extra tissue coverage for the implant and is suitable for thin patients, patients with very small breasts, or patients who had undergone mastectomy. Extra tissue cover also means less chance for the implants to be visible or palpable. Submuscular implants have lower incidence of capsular contracture and are less likely to interfere with mammography. On the other hand, submuscular placement takes longer operation time and recovery is usually longer. Compared to subglandular placement, the results of submuscular placement may be more subtle and less pronounced, and the breasts may not move or feel as natural as in subglandular implant placement. Submuscular implants may interfere with chest muscle movements in athletic patients and cause distortion that may be visible during exercises involving chest muscles. Dual plane placement is a variant of submuscular placement, in which the upper portion of the implant is placed underneath the muscle, while the lower portion remains in a subglandular position. Dual plane placement offers good tissue coverage for the implant while provides excellent support to the lower breast, enable the breasts to look full and yet natural.
There are 3 common incision sites for insertion of breast implants: in the breast fold (inframammary approach), around the areola (periareolar approach), under the armpits (transaxillary approach). [please refer to Surgical Techniques below]