AESTHETIC MEDICINE AND SURGERY
Small breast size is determined by a number of factors, which include genetics and hormones. Pregnancy and weight loss can determine loss of breast size.
Breast augmentation is a procedure that aims to increase mammary volume. In most cases the volumetric increase is achieved by the insertion of breast implants; in some cases it is possible to achieve breast augmentation by injection of fat from other areas of the body.
The surgeon will conduct the pre-operative assessment and will advise the best solution in each case. Careful pre-operative analysis of pre-existing breast shape is essential: breast asymmetries are often present (one breast is larger than the other); malformations (e.g. tuberous shape); tissue descent (after pregnancy or after weight loss) or conditions where simple breast augmentation cannot achieve an optimal outcome. In these cases, in addition to breast volume, the breast shape has to be modified with additional procedures, such as mastopexy or unilateral breast reduction.
The most common technique, which allows a permanent and predictable volume increase, is the placement of breast implants, made of silicone gel covered by a silicone shell and produced in different shapes and sizes. Concerning shape, the implant can be largely divided into two types: round and anatomical. The former have a semi-spherical shape with a round base, while the latter have a “tear-drop” shape, which achieves a noticeable filling of the lower portion of the breast. It is necessary to carefully analyse the shape of the initial breast and understand the patient’s wishes in order to choose the most appropriate type of implant.
Regarding the choice of implant volume, the main limits are met according to the patient’s anatomical characteristics: to accommodate a given implant the patient needs enough space for placement. For this reason the prostheses are selected taking into consideration the width of the breast, the tissue elasticity, the chest width and the patient’s stature. Generally speaking, very large implants result in less natural outcomes. The surgeon will show a variety of implant shapes and sizes to the patient, to explain the type of increase achieved with a particular type of prosthesis.
The main regions for implant insertion are:
- inframammary fold
- lower areolar border
In the first case the scar is hidden slightly above the sulcus below the lower pole, in the second at the lower border between the areola and the skin.
The implant is generally placed, in the upper pole, underneath the pectoralis major muscle (dual-plane technique). This contributes to the most natural result, rendering the implant’s edge invisible at the top and at the sides of the breast. This technique also results in a more stable result over time and a lower chance of capsular contracture.
Breast augmentation is performed under general anaesthesia (the patient is asleep) with a one-night hospital stay after the surgery.
Careful administration of pain-killers during and after the surgery ensures that post-operative pain and discomfort are kept to a minimum.