Breast augmentation

In breast augmentation with silicone implants, we add volume and shape by placing a silicone implant, a medical device used to add volume, behind the breast. Breasts may be naturally small or may have lost volume through pregnancy, breastfeeding, or weight loss. A difference in size between the breasts can also be a reason to consider augmentation.

You may want to change the proportions between your chest and hips or add fullness to a particular part of the breast. We can start the consultation with these wishes. We discuss your desired size and shape while explaining the options your existing breast tissue allows.

Who might consider breast augmentation?

Silicone implant augmentation can be performed for people who want to increase breast volume or replace lost volume. After pregnancy and breastfeeding or weight loss, a decrease in volume may be accompanied by sagging.

Implants can also be used to reconstruct a breast removed because of breast cancer. Replacing or correcting previously placed implants is another reason people seek a consultation.

If you have a chronic condition or take medication regularly, we adapt the preparations for surgery accordingly. You are also welcome to bring records of previous breast operations to your consultation.

A first breast augmentation, replacement of an existing implant, and reconstruction of a removed breast require different surgical plans. A first operation is based on the existing breast tissue and skin envelope, while previous incisions and the implant pocket also need to be considered in a breast that has already undergone surgery. The name of the implant alone therefore does not explain the scope of the operation.

When describing your desired size, you might refer to fullness in the upper breast, its side view, or its width across the chest. These features relate to different implant dimensions. For example, filling out the upper breast and increasing how far the breast projects forward describe different expectations.

Previous breast imaging and any biopsy results provide information about breast health before augmentation is planned. A biopsy is the removal of a tissue sample for examination. A family history of breast disease and any changes noticed in the breasts also belong in this part of the discussion. Necessary investigations are chosen according to age, examination findings, and medical history.

Completed breast development is one of the requirements for cosmetic augmentation. Cosmetic augmentation is not planned during pregnancy or breastfeeding because breast volume and tissue change during these periods. If you are planning a pregnancy, you can mention this at the consultation, since these processes affect the breast volume and skin envelope on which the augmentation plan is based.

Chest measurements and tissue thickness at the examination

The breast base is the area the breast occupies on the chest wall. Its width indicates the inner and outer limits within which an implant can be placed. Considering skin elasticity and nipple position alongside the volume assessment at the examination helps establish the tissue envelope that will accommodate the implant.

The width of the rib cage, its forward curve, and its shape on the right and left affect how the breasts sit. When the breast base is narrow, implant width is chosen accordingly. The slope of the chest wall and the distance between the breasts also define the anatomical framework for implant selection.

Tissue thickness refers to the covering of skin, fat, and breast tissue that will lie in front of the implant. Its thickness may vary in the upper, inner, and lower parts of the breast. During an examination called the pinch test, the skin and underlying tissue are held between the fingers to assess the thickness of the layers that will cover the implant.

The distance between the nipple and the fold beneath the breast indicates the space available for an implant in the lower breast. Skin elasticity and the shape of the lower breast are considered alongside this measurement. The position of the fold on the chest wall and the nipple position are recorded separately on each side.

If the right and left breasts differ in size, one or both breasts may need procedures of different scope. We can reduce the larger breast, add different amounts of volume to each breast, or combine augmentation with a lift.

Differences between the breasts may involve base width or nipple direction as well as volume. If one side of the rib cage projects forward, this also affects breast fullness on that side. When choosing implant dimensions, differences arising from the breast tissue and those arising from the chest wall are recorded separately.

Standing upright reveals nipple position and upper breast fullness, while examination by touch helps assess tissue distribution. The inner edge of the breast base relates to the midline of the chest, and the outer edge relates to the side of the rib cage. Implant position within these boundaries is determined alongside the anatomical features that affect the distance between the breasts.

Choosing round or teardrop implants

Round implants resemble a hemisphere. In teardrop implants, volume is concentrated in the lower part. In our practice, we may prefer teardrop implants for slender women with thin breast tissue and chest muscles. In other situations, we generally use round implants.

Teardrop implants are also called anatomical implants. This name describes how their volume distribution changes from top to bottom. A round implant has a circular base and, together with the overlying breast tissue, forms the breast’s outer contours.

The visible shape of the breast depends on the distribution of the overlying tissue as well as the implant’s shape. The skin envelope, chest wall, and layer in which the implant sits also contribute to this appearance. Upper breast fullness and the structure of the lower breast are therefore considered when choosing between round and teardrop implants.

How are implant volume and profile chosen?

Implants of the same volume can have different base widths and forward projections. Implant selection depends on these dimensions as well as volume. Profile describes how far an implant projects forward relative to its base.

An implant with a narrow base and pronounced forward projection occupies a different area of the breast from an implant with a wide base and limited projection. Profile selection relates to chest width and breast base measurements. Even at the same volume, changes in these dimensions change how the implant sits on the chest.

Bra size combines band size and cup size. The same cup letter does not represent the same breast volume at different band sizes. Your desired bra size can be a starting point for describing your expectations. Implant selection brings this description together with existing breast volume, chest circumference, and the desired shape.

Breast tissue thickness and the volume the skin can accommodate set limits on size selection. Thin tissue coverage and a narrow breast base may not allow the same implant options as a breast with a wide base. Implant width, height, and profile are therefore not decided on volume alone.

Implant height is the top-to-bottom length of the base. Width describes the horizontal space across the chest, profile describes forward projection, and height completes the vertical dimension. Particularly with anatomical implants, the proportions of these measurements help determine which part of the breast will hold the most volume.

At the consultation, you can ask which areas of your chest correspond to the implant’s width, height, and profile. In a breast with a wide base, a wish for fullness toward the sides involves different dimensions from a wish for forward fullness. How the existing tissue will be distributed in front of the chosen implant is also part of this discussion.

Implant placement planes

An implant pocket is the space prepared between tissues to accommodate the implant. The plane describes the layer in which this pocket lies in relation to the breast tissue, muscle fascia, and chest muscle. The choice of placement relates to existing tissue coverage, breast shape, and the dimensions of the implant to be selected.

Beneath the breast tissue: the subglandular plane

In subglandular placement, the implant sits behind the breast tissue and in front of the chest muscle and its covering fascia. The person’s own breast tissue and subcutaneous tissues cover the front of the implant. This option may be considered when there is enough tissue to cover the implant and the breast shape suits this placement.

Beneath the muscle fascia: the subfascial plane

Fascia is the thin layer of connective tissue covering the muscle. In subfascial placement, the pocket is prepared beneath this layer and above the muscle, with the fascia becoming part of the covering in front of the implant. It is an option when placement above the muscle is being considered and tissue coverage is suitable.

Muscle fascia is thin connective tissue and differs in structure from the muscle beneath it. In subfascial placement, breast tissue still makes up most of the covering in front of the implant. The amount of tissue in the upper and inner breast is also considered when assessing the subfascial plane.

Beneath the muscle: the subpectoral plane

In subpectoral placement, the implant sits in a pocket prepared beneath the large chest muscle, the pectoralis major. The muscle contributes to coverage, particularly over the upper part of the implant. This plane may be considered when breast tissue is thin in the upper part and additional coverage is needed. Muscle structure and breast tissue distribution also inform the choice.

Dual plane placement

In dual plane placement, the upper part of the implant lies beneath the muscle and the lower part beneath the breast tissue. The relationship between the lower edge of the muscle and the breast tissue is surgically adjusted. Different tissue layers therefore cover the upper and lower parts of the implant.

Dual plane placement may be considered when muscle coverage is needed in the upper breast and the lower breast also needs reshaping. The position of the breast tissue within the skin envelope and the need to expand the lower part inform this decision. If there is substantial excess skin and a low nipple position, the need for a lift is assessed separately.

Incision sites for breast augmentation

We usually use an incision in the fold beneath the breast to place the implant. We prepare the implant pocket without entering the breast tissue or coming into contact with the milk glands. We take steps to prevent the implant from touching the air and breast skin, then close the tissue layers along the incision one by one after placement.

The inframammary fold is the crease at the lower edge of the breast where it meets the chest wall. An incision here provides access to the implant pocket from the lower breast boundary. Its location relates to the position of the existing fold and the implant’s base dimensions.

The approach described as an incision at the nipple edge is made along the border of the areola, the colored area surrounding the nipple. The diameter of the areola and the planned implant dimensions are considered for this option. It follows a different tissue route to the pocket from an incision in the fold beneath the breast.

With an underarm approach, the incision lies in an armpit skin crease, and the breast pocket is reached through this route. The underarm incision describes the access route, while the implant’s relationship to the muscle depends on the pocket plan. Depending on the selected technique, the pocket reached through this incision may lie above or beneath the muscle.

Surgery and anesthesia planning

Breast augmentation is performed under general anesthesia in a hospital operating room. Preparation for anesthesia considers the scope of augmentation alongside medical history. Implant placement alone, replacement of an existing implant, and the addition of a lift involve different tissue adjustments, so the planned procedure is discussed with the anesthesiologist.

If implants have been placed before, the previous operative report and implant information help clarify the new plan. These records may include implant dimensions, the placement layer, and the incision site. The volume to be added to the existing breast tissue is selected with the boundaries of the previous pocket and the condition of the skin envelope in mind.

Augmentation and a lift when breasts are sagging

For breasts with mild sagging, augmentation alone may be planned. If the nipple lies below the fold beneath the breast, we explain the option of adding a lift.

When a lift is added, excess skin and tissue may be removed, and the nipple may be moved upward. We can combine volume enhancement with an implant and reshaping of the breast tissue in the same surgical plan.

Loss of upper breast fullness and a low nipple position are different anatomical findings. For volume loss, the main consideration is fullness added by an implant. For sagging, the skin envelope and nipple position also form part of the surgical plan. If existing volume is sufficient, a lift without implants is another option.

Areola diameter and nipple height are different features. Adjusting the diameter of the colored area requires a plan involving the skin around the areola. If reshaping this area is also desired, the surrounding skin and nipple position are included separately in the surgical plan.

Before your augmentation consultation, you can note the details that concern you, such as upper breast volume loss, differences in how the breasts sit, or volume seen from the side. These descriptions help distinguish which features relate to adding volume with an implant and which involve adjusting the skin. For example, when volume loss accompanies a low nipple position, implant selection and the incision plan for a lift can be explained at the same consultation.

Preserve and MIA in breast augmentation

With the Preserve approach, we aim to preserve breast tissue, nerves, supporting ligaments, and muscle. Placing the implant above the muscle, beneath the breast tissue or muscle fascia, through a small incision forms part of this approach. Existing tissue thickness guides preparation of the pocket without cutting the chest muscle.

MIA refers to a minimally invasive approach to breast augmentation. A limited pocket sized to the implant is prepared through a small opening, and the implant lies above the muscle, behind the breast tissue. We assess suitability in people considering their first augmentation who have no pronounced sagging and want a moderate increase in volume.

How fat transfer breast augmentation differs from implants

Fat transfer breast augmentation uses fat tissue taken from another part of the person’s body, prepared, and transferred to the breast. The implant method involves creating a pocket for a device of specific dimensions, while fat transfer distributes tissue in small amounts. The availability of donor areas and the breast’s volume needs inform this choice.

Fat transfer may be considered when fullness is needed in specific areas or when the aim is to refine breast contours. The amount of tissue that can be transferred depends on the available fat and the breast’s capacity to accommodate it. When implants and fat transfer are part of the same plan, the implant addresses overall volume, while the fat tissue shapes selected areas.

What should you pay attention to after breast augmentation?

Our care recommendations in this section apply to breast augmentation with implants.

Pain, tightness, and swelling

A period of troublesome pain is not expected after surgery; there may generally be pain for about a week, but it does not prevent you from meeting your daily needs.

A feeling of tightness is normal after breast augmentation with implants because new volume has been added to the chest area. The operation does not cause excessive swelling and bruising; there may be mild swelling, particularly in the upper and outer parts of the breasts. Swelling and tightness decrease after 1-2 weeks.

Drains, stitches, and scar care

After surgery, you will have two drains, one on the right and one on the left side of your breasts, to remove fluid that collects inside. Depending on the amount of fluid, we usually remove these drains the morning after surgery. You can remove the dressings at the drain sites the day after the drains are removed; these areas do not need further dressings.

We use dissolvable stitches in the 3-4 cm incision through which we place the silicone implant. These stitches do not need to be removed. We ask you to leave the special brown tape over the incision in place for a total of 10-14 days. After this period, you can remove the tape yourself by soaking it in the shower.

Once the tape is removed, scar creams such as Contractubex, Noscar, or Scarex are used twice a day for 3 months.

Showering and bra use

You can shower after surgery without getting the breast area wet. After 5 days, you can also wash the operated area and bathe your whole body.

We recommend using the medical bra and chest compression band we provide after surgery for a total of 4 weeks. After the 2nd week, you can also switch to a sports bra. At the end of one month, you can wear any bra you wish, provided the parts over the incision are not too tight and do not compress the wound.

Returning to work, sleep, and exercise

You can return to work and your social life within 3-7 days after surgery. We recommend avoiding situations that put pressure on the operated area, such as lying on your stomach and hugging. You can start lying on your stomach after 2 months.

In the 2nd week after the surgery, you can take walks, and after the 4th week, you can do exercises that will not work the chest area and do not require jumping. You can resume sexual activity 2 weeks after surgery.

You can message our clinic coordinator on WhatsApp with any questions.

These timeframes may vary depending on the person and the extent of surgery. Dr. Hakan Bulam will clarify them for you at your follow-up appointments.