Breast Augmentation with Implants

It is a surgical procedure that uses silicone implants to increase breast volume and improve breast shape and projection.

The purpose is to improve breast shape, volume and projection, with the result adapted to the patient’s anatomical characteristics.

The choice depends on the existing breast and tissue coverage. Anatomical implants generally allow a natural adaptation, while round implants may also provide a balanced result when sufficient breast volume is already present.

The volume is adapted to the patient. Larger implants are generally associated with a greater risk of complications and loss of a natural appearance in the medium or long term.

The implant may be placed in a prepectoral position, in front of the pectoral muscle, or behind the muscle using the dual-plane technique.

In the dual-plane technique, the upper pole of the implant lies behind the muscle and the lower portion lies, to a variable extent, in a prepectoral position.

It may be considered when there is sufficient breast tissue to disguise the implant or in patients who undertake very intensive sporting activity.

Breast-feeding remains possible in most cases, but surgery may reduce milk production in some patients. The risk depends on the patient’s anatomy and the surgical technique. A periareolar incision may interfere with the milk ducts more than an inframammary incision, so future pregnancy and the intention to breast-feed should be discussed during surgical planning.

The most common approaches are inframammary, along the lower breast fold, periareolar, along the lower half of the areola, and axillary.

Scars are usually about 4 to 5.5 cm long, depending on the chosen approach and implant size.

The operation takes approximately one hour.

Breast implants do not prevent breast cancer screening. The patient should inform the radiographer and radiologist that she has implants, as additional mammographic views may be required. Ultrasound or magnetic resonance imaging may be used when clinically indicated.

General anaesthesia or deep sedation may be used, always with a certified anaesthesiologist.

The procedure may be performed on an outpatient basis or with one day in hospital.

BIA-ALCL is a rare lymphoma of the immune system that usually develops in the fluid or capsule surrounding the implant rather than in the breast tissue. The risk is higher with textured implants. It may present years after surgery with persistent breast swelling, fluid around the implant, pain, hardening or a mass. In patients without symptoms, preventive implant removal is not recommended solely because of concern about BIA-ALCL.

Return to work is possible after approximately 5–7 days, provided that the activity does not involve physical effort.

Some patients with breast implants report fatigue, muscle or joint pain, memory or concentration difficulties and other systemic symptoms, sometimes grouped under the term “breast implant illness”. There is no specific test that confirms this diagnosis, and a causal relationship with the implants remains poorly understood. Each case should be assessed individually and other possible causes should be excluded.

More intense sporting activity may be resumed from six weeks. A compression bra recommended by the team should be worn during this period.

Implants increase breast volume and may improve breast fullness, but they do not necessarily correct significant breast sagging. When relevant ptosis is present, a mastopexy may also be required to lift and reshape the breast.

Implant replacement may be required during a patient’s lifetime, particularly in those who undergo surgery at a young age. Rupture, capsular contracture, bleeding, infection, seroma or implant displacement may also require implant removal, replacement or revision surgery.