Breast Augmentation

The objective of Breast Augmentation is to enlarge the breasts. Important points to consider before undergoing the operation includes:

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1. There are 3 possible locations for the surgical cut: axilla, periareolar, and inframammary fold

• At axilla: The benefit of this is that there will be no cuts on the breast area. Traditionally, this approach makes it more difficult to create a symmetrical pocket for implants and to stop bleeding. However, the use of an endoscopic device allows this to be done more easily, and therefore offers a more desirable outcome.

• At periareolar: The scar will be hidden around the areola. This approach does not allow for a large size silicone to be inserted in, and some studies have found that this approach is more prone to capsular contracture in the future.

• Inframammary fold: This is the most practiced method, due to the ease in creating an opening and inserting silicone. It also allows the surgeon to stop the bleeding very quickly.

2. There are 3 possible layers to insert the implant:

• Subglandular: This method is relatively straightforward compared to the other methods, with natural-looking results. However, it is also more prone to having capsular contracture than the other approaches. This method is not recommended for very skinny individuals since the silicone rippling may be visible, and therefore may not look natural.

• Subfascial: This method is also another relatively simple approach, and requires little recovery time. The result will be natural while posing low risk of capsular contracture. However, this approach is also not recommended for skinny individuals for the same reason that the silicone rippling may be visible.

• Dual plane: This approach is not limited by the individuals’ shapes and builds, and poses a low risk of capsular contracture. The downside is that there may be more bleeding and pain post-operation relative to the other approaches. Moreover, it may take longer for the breast to be in shape. For individuals who regularly exercise whose breast muscles are strong, the implant may shift around during the movement, i.e. animated breast.

3. The shape of implant can be categorized into 2 types: Round and Teardrop

• Round: A round-shape implant is recommended for individuals with flat breast or wishing for a more prominent upper part of the breast.

• Teardrop: The top half of the implant will be relatively flatter, and is suitable for individuals who do not want a more prominent upper part of the breast, wishing to maintain the natural looks.

Regarding the clinical studies, it can be concluded that there are no significant differences in appearance between these two implants. Moreover, the teardrop shape approach may be more prone to having the implant shift or rotate over time, distorting the breast appearance. Nowadays there are teardrop-shape implants that will self-adjust to the gravity, lowering the risk of any movement.

4. The height of the implant can be categorized as low, medium, high, and very high. The surgeon will choose the most appropriate height depending what breast shape the patient wants, and how much breast tissue she has (the more breast tissue there is, the higher silicone can be).
 

To determine the appropriate implant size, the surgeon must first determine the individual's desired breast projection as well as measure the width of the breast. There are several misconceptions about implant size in that people often believe that size itself is the only factor to consider. Using an overly large implant can lead to complications, such as unnatural breasts, slanted breasts, visible/tangible implant edge, numbness around the nipple, neck and back ache, etc.

5. There are 2 types of implant surface: Smooth and Textured

• Smooth: This type of implant is less prone to having visible/tangible implant edge, but risks having more capsular contracture if applied in the subglandular layer. In the long run, there is also a higher risk of “bottoming out” than textured implant surface -- where the tissue beneath the nipple is overstretched, resulting in a disproportionate figure.

• Textured: Textured implant is less prone to having capsular contracture. However, it is more likely to have visible/tangible implant edge, and has a higher risk of Anaplastic Large Cell Lymphoma (ALCL) depending on the degree of texture -- macrotexture is more prone to having ALCL than micro-nanotexture. There is no evidence that using the smooth implant is associated with having ALCL.

6. Adding breast fat tissue is performed by taking the fat from the tummy, thigh or bottock and applying to the breast tissue surrounding the implant. This will result in a natural breast figure, without the risk of having the implant edge becoming visible. This is the recommended approach for subglandular or subfascial implants, individuals with small breasts, or those who prefer more projected implants.

There are several factors to consider that will lead to a successful operation, and minimising complications. This is why individuals are recommended to consult with a surgeon in great detail before agreeing to the operation.