What Are the Breast Augmentation Methods?

Women may be dissatisfied with their breasts for various reasons. Small breasts, shape irregularities, asymmetry between the two breasts and sagging are common complaints. Breast augmentation methods aim for a fuller appearance that is in proportion with the body.

There are two main methods of breast augmentation: the most commonly used method is breast implants; fat injection using the person's own fat is also an option. Because implants are produced in different shapes and sizes, a model suited to the person's build can be chosen.

Breast augmentation should be performed by a plastic surgeon. The doctor assesses the person's situation in detail and decides which method is suitable. The wish for breast augmentation often arises after pregnancy and breastfeeding, when the breasts have become smaller and started to sag. Significant weight loss can also affect the shape and volume of the breasts. If there is marked sagging, a breast lift may also be needed together with augmentation.

How Is Breast Augmentation Performed?

Breast augmentation is a frequently performed operation worldwide, and silicone gel-filled implants are used most often. In breast augmentation surgery, the implant can be placed through different incision sites; the incision site is chosen according to the person's body structure and skin.

In the most commonly used method, the implant is placed through an incision in the fold under the breast. An incision around the nipple is one of the methods that leaves little scarring; however, loss of sensation in the nipple can occur with this method, while the risk is lower with incisions under the breast or in the armpit. In some cases, the implant can also be placed through an incision in the armpit. Whatever incision is used, some scarring remains; the scar fades over time and becomes less noticeable.

Depending on the tissue structure of the breast, the implant is placed under the breast tissue or under the chest muscle. It is reported that placement under the muscle may give a more natural appearance in some people; the doctor decides on the placement after the examination.

Types of Implants

By content, implants are divided into two types: silicone gel-filled and saline (salt water)-filled. Silicone gel-filled implants are mostly preferred because they feel more natural. If a saline-filled implant leaks, the contents are absorbed by the body and the implant deflates; in this case the implant needs to be replaced.

Implants also differ in shape. Round implants also add fullness to the upper part of the breast, while teardrop (anatomical) implants aim for a more natural appearance. The suitable shape and size are chosen by assessing the person's expectations and body structure together.

Breast augmentation surgery is performed under general anaesthesia and takes on average 2–4 hours; the duration may be longer if additional procedures such as a breast lift are performed. After surgery, the patient usually stays in hospital for one night. People can usually return to daily life within the first three weeks; it can take about six months for the implant to settle and the breasts to reach their final appearance.

When an appropriate technique is used, breastfeeding is generally possible after breast augmentation, because the implant is placed beneath the breast tissue and does not directly affect the milk ducts.

Do Implants Last a Lifetime?

Implants are not lifetime devices. Although they do not have to be replaced routinely after a set period, they may need to be replaced in cases such as rupture, capsular contracture (thickening and tightening of the tissue around the implant) or a change in appearance. Silicone gel-filled implants do not shrink; however, rupture of silicone implants sometimes causes no symptoms. For this reason, check-ups at the intervals recommended by the doctor, with imaging when necessary, are important.

Like any surgical procedure, breast augmentation has risks: these include bleeding, swelling, bruising, nipple sensitivity or reduced sensation, and capsular contracture. Breast implants have not been shown to increase the risk of breast cancer; however, very rarely, a type of lymphoma that develops in the capsule around the implant (BIA-ALCL) has been reported. If you notice new swelling or a lump in a breast with an implant, you should consult your doctor.

Fat Injection

In fat injection, fat taken by liposuction from areas such as the abdomen or hips is processed and transferred to the breast. No breast implant is used; however, the fat harvesting stage is a surgical procedure performed under anaesthesia. The procedure consists of the following steps:

• Fat tissue is taken from another area of the body, most often the abdomen or hips.
• The harvested fat is processed to make it suitable for transfer to the breast.
• The prepared fat is transferred to the breast with fine cannulas.
• The swelling of the early period decreases over time; it can take about six months for the breasts to reach their final appearance.

Part of the transferred fat is absorbed by the body over time; for this reason, the enlargement achieved is usually limited and more than one session may be needed. Because weight changes can also affect the result, it is recommended to keep your weight stable after the procedure. This method may not be suitable for people who do not have enough areas from which fat can be taken.

Fat injection also has risks: bleeding, infection and asymmetry can occur; death of fat tissue (fat necrosis), cysts and calcification can develop in the transferred fat. Because these can cause lumps that can be felt in the breast and changes on imaging, you should mention the procedure when having breast screening.

Author: Op. Dr. Yücel Sarıaltın