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Breast plays a central role in the perception of femininity. Breast augmentation is one of the most common procedures in aesthetic surgery. This procedure aims to increase the breast volume with implants. At the same time is possible to correct eventual asymmetries and shape defects.
Only in the US, more than 290,000 procedures are performed yearly and this number is growing every year.
The indications to breast augmentation are:
- Desire of a larger breast
- Congenital or acquired breast hypotrophy
- Breast deformities or contour alterations
Breast augmentation requires general anesthesia and one night of hospitalization. The implants can be placed in three different ways, depending on patient’s habits, breast shape and desired result:
- Subglandular. Implant is placed over the muscle and behind the gland. The result is natural and the post-operative is less painful. This technique should not be applied for severe hypotrophies, small glands and thin patients because the implant profile could become visible.
- Submuscular. This technique is preferred when breasts are small and the patient is extremely thin. The implant is placed under the pectoralis major muscle, making implant profile less visible. In case of intense physical activity and pectoral muscle contraction, implant may dislocate. This could produce implant rotation, permanent dislocation and alterations of implant profile.
- Dual-plane. This solution is able to combine the advantages of submuscular and subglandular positioning. The implant is placed superiorly under the pectoralis major muscle, while the inferior pole lays in the subglandular layer. The prosthesis profile is smoothened superiorly by the muscle layer and inferiorly is able to fulfill the inferior pole.
Each procedure has advantages and disadvantages. None of these three methods can be applied always and indiscriminately to all patients. An accurate interview is essential to understand needs and desires of the patient and perform a tailored surgery.
Implants are composed by a special silicone shell, characterized by a textured surface that increases the adherence with surrounding tissues, consequently reduces the risk of rotations/dislocations, inflammatory reactions and capsular contracture.
Inside the shell, implants contain a highly cohesive silicone gel. This means that in case of shell rupture, the silicone gel does not leak, avoiding silicone dispersion in the surrounding tissues, making these prostheses extremely safe.
Implants could be divided according to their shape in anatomic and round:
- Round implants. height and width are equal by definition. They are classified according to diameter and depth (called "projection"). The advantage is that they are able to augment breast evenly. This feature is useful to enhance the upper poles, commonly hypoplastic due to glandular ptosis and thus exhalting décolleté. In case of rotation, these implants do not cause any breast deformity.
- Anatomical implants. Height and width are different. The maximum projection is not sited at the center of the implant, but it is slightly shifted downward. Their shape is therefore similar to the natural breast shape. They are extremely popular in reconstructive surgery because able to give a more natural appearance to the breast, especially where gland is absent or severely hypoplastic. Compared to round implants, they are less effective in fulfilling the upper poles and are subject to the risk of rotation. For this reason round implants are preferred in cosmetic surgery.
The choice of the implant is extremely important and should be discussed with the patient. The choice is based on the size of the breast before surgery, the desired breast size and eventual ancillary corrections of defects (asymmetries, shape defects, ptosis, etc.).
Implants do not require a particular care in the everyday life. Periodic mammography and ultrasound are necessary for prevention of breast cancer. Magnetic resonance imaging is preferred in patients with implants to achieve a more accurate follow-up.
The duration of current implants has not been estimated. Therefore, if breakage signs are not observed, implant replacement is not necessary. However, implant substitution is indicated when:
- the patient desires a larger or smaller volume
- Weight changes or simply aging that could change the breasts shape, making the implanted prostheses inappropriate
- Implant rupture
- Implants are over 20 years old. In this case the replacement is recommended even without rupture signs.