Breast augmentation
Nothing beats a nice breast
When we refer to a breast augmentation, most people think of the aesthetic procedure in which we augment the breast volume with breast implants. Clearly, that is also the number one request when a patient consults for an aesthetic breast surgery. However, there are several other indications to perform a breast augmentation. Some are aesthetic, some reconstructive, and some are a combination of both. I was trained in one of the most renowned centres for breast surgery worldwide, so I had the opportunity to build up an extensive experience regarding both aesthetic and reconstructive breast surgery.
The essentials
A breast augmentation is a procedure to augment the breast volume and at the same time enhance the breast shape and symmetry.
A breast augmentation can be performed in multiple ways: fat injections (lipofilling) - breast implants - a tissue flap.
A breast augmentation can be done for aesthetic or reconstructive reasons. These include: small breast volume, tuberous breasts, breast asymmetry after breast reconstruction, deflated breasts after weight loss, developed breast asymmetry, Poland Syndrome, genetic breast maldevelopment.
In any case, a breast augmentation aims to improve the breast shape, size and symmetry, as well as to improve the chest proportions and balance, enhance the cleavage, and maintain natural results.
I strictly use silicone implants for multiple reasons: durable, form-stable, softer aspect, more choice in shape and volume, best long-term outcome.
The choice between round or anatomical implants is a choice we make together. In some cases, the choice for anatomical implants gives the best outcome.
Choosing the best implant volume depends on 2 factors: your breast and chest measurements, as well as your preferences.
Breast implants can be placed in 4 planes: under the gland, under the muscle, partially under the muscle, or between the muscle and the covering fascia. The choice depends on a few factors, of which the most important one is the clinical investigation.
Together, we choose the best incision to place a breast implant: below the breast (inframammary) or around the areola (peri-areolar).
Consider a downtime of 1 week with easy dressings. Avoid physical activity for 6 weeks.
Respect the recovery time well and you will profit from the transformation for the rest of your life.
What are good indications for a breast augmentation ?
There are several indications to perform a breast augmentation. Most are bilateral, but some may be indicated for one of both breast. In my practice, these are the most common indications for which patients request a breast augmentation:
You may have limited breast volume and would like an enhanced breast volume, shape, and projection
You may suffer from a restricted breast development, or so called "tuberous breasts" and would like an improved breast shape and volume
You underwent a breast reconstruction on one side and would like to improve the symmetry of both breasts by increasing the volume of the other breast
You may have developed breast asymmetry and wish to improve the symmetry of both breasts by increasing the volume of the smaller breast (and sometimes reducing the volume of the bigger breast at the same time)
You may have lost breast volume (after weight loss, pregnancies or breast feeding) and would like to restore the breast volume, shape, and symmetry
You may suffer from a genetic maldevelopment of one or both breasts, such as amastia or Poland syndrome
You may suffer from a genetic maldevelopment of the thoracic wall that influences the breast shape and projection, such as pectus carinatum
Tuberous breasts
Breast asymmetry
Poland syndrome
Amastia
Deflated breasts
Which types of breast augmentation are possible ?
When it comes to breast augmentation, there are several possibilities to increase the breast volume, improve the shape and enhance the projection:
With the use of a breast implant
By using your own body fat
By using a tissue flap
Each method has its advantages and disadvantages. In some cases there is a clear indication to go with one specific option, while in other cases we have a choice. The combination of your wishes and expectations, together with a thorough clinical investigation, will usually guide us to one clear option. During your consultation, I will explain to you in detail what the best choice is for your body and your request. In my blog, you can also find a few posts in which I explain some of my views in more detail. In summary, my experience has taught me this:
A breast implant may be a very good option in primary breast augmentation, the correction of tuberous breasts, the correction of a significant breast asymmetry, and the correction of genetic malformations.
Fat injections in the breast (breast lipofilling) may be indicated in case you desire a limited breast augmentation, the correction of smaller breast asymmetries, in breast reconstructive cases, or in the restoration of deflated breasts.
A breast augmentation with a tissue flap may be a creative solution in body contouring surgery after massive weight loss, during which the excised tissue can be used to augment the volume and enhance the shape of the breast.
In some cases, a combination of two techniques is also a very good option. For example, in a breast lift with augmentation or in a hybrid breast augmentation. In those cases, the implant gives the required volume and projection, while your own fat is used to mask the edges of the implant and give an extra wow-effect in the upper pole and cleavage.
I approach every patient individually and adjust my technique accordingly. My goal is that you leave my consultation with a clear view of what we will do, how we will do it and which results you can expect.
How to choose the right implant type, shape, and volume?
I could write a whole book answering this question. However, in order to prepare you as much as possible for your consultation, I will try to give you a few key points and take-aways to keep in mind.
Saline vs Silicone
Nowadays, there are many implants to choose from. They all differ in shape, texture, content, and surface. I have a strong preference to only use silicone implants for many reasons:
They are more durable to give you a stable result for many years
They offer a wider range of shapes and sizes. So it allows me to select the best implant for your breast size and dimensions
They will give a softer, more natural result with a much lower risk to develop capsular contracture
They do not deflate over time and are form-stable, which is crucial to guarantee a long-term stable result
They offer the best quality silicone with the best surface technology to guarantee the best outcome on the long term
I am not allowed to mention any brand or firm name on my website, so I cannot explain to you in detail which implants I use. But do know that I was trained in one of the world-leading centres for breast surgery and mentored by a pioneer in breast surgery. That is why I am only using the highest quality implants available. They are extremely durable, are made of the best quality silicone and have a specialised surface that limits the risk of capsular contracture. All this will help me to give you the softest breasts with the most stable result.
Round vs Anatomical
Regarding the implant type, you have the choice between round and anatomical implants. The round implants usually give a fuller look and more filled cleavage, while the anatomical implants maintain a more natural, teardrop shape of the breast. In some cases, mainly the primary aesthetic breast augmentation, the choice is yours. Which type of implant we choose, will then mostly depend on your preferences and your desires. I refuse to purely stick to one type of implant shape, as every patient has different expectations. Both round and anatomical implants can give a beautiful result, as long as the patient's wishes are respected and the surgery is performed adequately.
However, there are a few clear indications to opt for anatomical implants. The main indications are:
Correction of tuberous breasts
Correction of breast asymmetry
Limited breast ptosis
Breast reconstruction
Breast or chest wall genetic maldevelopment
These types of surgeries are less straight forward and demand a specific set of surgical skills and expertise. In order to achieve the best result with the best symmetry possible, I prefer using anatomical implants. They give me a wider range of dimensions to choose from and enable me to select the absolute best implant that fits your breast and chest wall. Round implants simply do not offer this broad choice. In addition, the specific shape of an anatomical implant has a beneficial effect on the position of the nipple-areola complex and the shape of the lower breast pole.
The ideal implant volume
The ideal implant volume is a choice we have to make together.
What do I mean by that ?
In case of a correction of breast asymmetry or in case of breast reconstruction, the choice of volume will of course depend on the difference in volume between both breasts. It is then mostly up to me to estimate the amount of added volume that is needed in order to achieve the best symmetry.
However, in case of a bilateral breast augmentation, the ideal implant volume is based on:
The measurements of your breasts and chest
Your preference
I write the measurements as number 1, on purpose. From a medical standpoint, it's important that I consider your specific body measurements when deciding on what size is right for you. Because choosing the right implant volume depends more on what you can have than what you may want. To have the best result and the most stable result on the long term, you should not go for an implant that is too big. Trust me, a too big implant will put unnecessary stress on your tissues, causing an unnatural and imbalanced breast shape with a higher risk of re-operation down the road. On the other hand, an implant that is too small may also not give you the result you had hoped for or improve your body contour sufficiently. The measurements of your breasts and chest play a key role in the story. I call this tissue based planning. During the consultation, I will select a range of implants that will fit you perfectly. They will differ in size and volume, but the selection is based on the measurements that I have taken. So you definitely do have a choice! But it is a restricted choice, based on your body and you individual characteristics. It is then up to you to choose the volume that you prefer. Of course you will be able to try out a few different implant sizes during the consultation to give you an approximate idea of the result you can expect.
Where to place the breast implants ?
Breast implants can be placed in different planes inside the breast:
Over the muscle and under the gland
Under the muscle
Between the muscle and the covering fascial tissue layer
Partially under and partially over the muscle
Just like for the choice of implant shape, I apply a specific surgical technique for each individual patient. Simply because every patient has a unique set of breasts. I do not believe that using the same plane in every patient will result in the best outcome. So to give you the best possible result, my technique should be adjusted to your breast shape, volume, and position. The clinical investigation plays again a key role, as this will answer a lot of questions, including the best plane to place the implant.
For example:
If you have enough gland to cover the implant, I can definitely place the implant over the muscle. This gives a very natural result with the least amount of pain.
If you have limited gland, I want to avoid as much as possible that you feel the implant or that the implant is visible. I will therefor choose to either place the implant between the muscle and the covering fascial tissue or partially under the muscle.
If you are very sporty or use your chest muscles for your profession, then I prefer to place the implant above the muscle in order to not disturb its function
If you wish to reduce the space between your breasts to have a nicer cleavage, I will place the implants in front of the muscle and definitely not under the muscle.
If you need a breast reconstruction with implant and the skin is very thin, I might choose to put the implant under the muscle to avoid any risk of wound dehiscence with implant exposure.
So as you can see, the surgical technique depends on both your wishes and the characteristics of your breast. I approach every breast augmentation with a very patient-tailored approach, no matter what the indication is.
Breast implants can be placed in 4 different planes, depending on several factors.
Which incision is needed for a breast augmentation ?
The incision that is needed will of course depend on the surgical technique that is used. What do I mean by that ?
A breast augmentation with only the use of fat injections (lipofilling) requires the smallest incisions possible. I only need a few incisions of 3-4mm to harvest the fat. The fat injections te breasts are done with a scarless technique. You will barely see the scars and they usually heal without a problem.
A breast augmentation with a tissue flap will require longer incisions, depending on the region where you have excess fat and skin. That is logical. The area where I have to remove the skin needs to be sutured together to restore the contour and give you a nice body shape. The used tissue will then be transposed to augment the breast volume and enhance the shape and projection. During the consultation I will use extensive drawings to explain to you the technique I use and the scars you can expect.
A breast augmentation with implants is a different story. I like to keep the incision as small and short as possible, but of course I need a way to place the implant. I you would search the Internet or read some books, you will find many incision types to place breast implants. The most common incisions are:
In the fold under the breast (inframammary)
Around the areola (periareolar)
Through the armpit (axillary)
Through the belly button (transumbilical)
I do not believe that every access will give you the best result. So in my practice, I only use two options: either through an incision under the breast or around the areola. Those two incision types give me the best exposure, the best control, and the best way to manipulate the tissues. I need those three advantages to give you the best outcome and most beautiful breast shape. Depending on your wishes and the clinical investigation, we will discuss together the best incision type and the scars you can expect.
During the consultation, I will explain to you the procedure in more detail, with pictures and photographs, as well as which scars to expect and the post-operative care that will be needed. You can expect a down time of 1-2 weeks, with light dressings.
What are the benefits of a breast augmentation ?
There are numerous benefits to a breast augmentation, but they mainly depend on the indication. However, in both aesthetic and reconstructive cases, I strive to give each patient the following benefits:
Enhanced shape, size and projection of the breasts
Restored volume of the breasts
Improved breast symmetry
Improved inner breast volume (cleavage)
Better chest proportions
Improved balance between breast volume and chest wall
Natural results
Boost in self-confidence
Are you a good candidate for a breast augmentation ?
When I talked earlier about the several indications to perform a breast augmentation, it is clear that there are many good candidates to undergo this kind of procedure. A breast augmentation may also have a different goal for each patient individually, depending on their initial breast shape, their wishes and expectations. A part of this question has therefor been answered at the beginning of this page. However, in general, a good candidate for a breast augmentation will be someone:
Who wishes to improve their breast aesthetics
Who has any form of breast asymmetry
Who has suffered from loss of breast volume and wishes to restore it
Who has realistic expectations
If you recognise some of these signs and concerns, I recommend you to plan a consultation in order to see how we can improve your breasts aesthetics and bring a positive impact to your life.
