Breast augmentation with implants
About the procedure
Breast augmentation with implants (augmentation mammaplasty) is a surgical procedure that aims to increase breast volume, improve breast shape and achieve harmonious body proportions. It can be performed for aesthetic reasons and, in selected cases, for reconstructive reasons.
Breast augmentation is intended for women with underdeveloped mammary glands, breast asymmetry or loss of breast volume, for example after pregnancy, breastfeeding or significant weight loss. In appropriately selected cases, implants can also form part of the correction of congenital breast deformities or of reconstructive procedures.
During the operation, breast implants filled with silicone gel or, with suitable products, with saline solution are placed. Implant selection takes into account volume, shape, base width, projection and surface properties. An important part of planning is the choice of surgical access and of the plane in which the implant is placed — above the pectoral muscle, below the pectoral muscle or in another appropriately chosen anatomical plane.
The aim of the operation is a proportionate breast shape and volume that takes into account the patient's anatomy, tissue quality and expectations. Planning should be based on an objective anatomical assessment, not only on the preferred implant size.
Indications for the procedure
The most common indications for breast augmentation with implants include:
Breast hypoplasia — underdevelopment of the mammary glands, resulting in small breast volume.
Loss of breast volume — associated with pregnancy, breastfeeding, ageing or significant weight loss.
Breast asymmetry — a difference in breast volume, shape or projection, if it can be corrected with implants.
Congenital breast deformities — in selected cases, including some forms of tuberous breasts or other breast development disorders, which often need an individually planned correction.
Breast reconstruction — as part of selected reconstructive methods after mastectomy or other surgical procedures.
For aesthetic indications, what matters is the patient's informed and voluntary decision, realistic expectations about the result and acceptance of the potential risks and the possibility of further operations.
Individual planning of the procedure
Choosing the implants and surgical technique is one of the most important stages of preparation. During the consultation, we assess the shape of the chest, breast base width, the volume and position of the mammary glands, the thickness of the tissue that will cover the implant, skin elasticity and the position of the nipple–areola complex.
We also take into account the patient's health, previous pregnancies, plans for motherhood, physical activity, smoking, medications and any previous breast operations.
Depending on the indications, the implant can be placed above or below the pectoral muscle, including a partially submuscular technique. The choice of plane depends, among other things, on tissue thickness, breast anatomy, the risk of the implant being visible or palpable and the expected long-term effect of the procedure on the tissues.
If there is significant breast sagging, excess skin or an unfavourable position of the nipple–areola complex, augmentation alone may not give the optimal result. In such cases, augmentation combined with mastopexy, that is, a breast lift, should be considered. The combined procedure needs particularly careful assessment, because the tissues carry an implant and must be reshaped at the same time.
Contraindications and eligibility for surgery
Assessment for breast augmentation includes a detailed medical history, a physical examination, an assessment of general health and breast diagnostics appropriate to age, symptoms, risk factors and current guidelines.
Circumstances that contraindicate planned surgery or require it to be postponed include:
active infection, including infection of the skin or tissues in the operated area;
pregnancy and breastfeeding, during which planned surgery should be postponed until lactation has ended and the tissues have stabilized;
uncontrolled systemic diseases that increase the risk of anaesthesia, bleeding, infection or impaired healing;
significant clotting disorders, if the associated risk cannot be safely reduced;
a suspected or diagnosed unexplained breast lesion that needs further investigation;
lack of the patient's informed consent, unrealistic expectations or disorders that significantly limit the ability to make an informed decision about surgery.
Smoking, obesity, some chronic diseases, certain medications and previous breast operations can increase the risk of complications and need individual assessment. Not all of these circumstances are absolute contraindications, but they may justify optimizing the patient's health, changing the surgical plan or postponing the procedure.
The operation and recovery
The procedure is usually performed under general anaesthesia. The implant is inserted through a carefully planned incision, most often in the inframammary fold and in selected cases around the areola. A pocket is then created for the implant, the implant is placed in the planned anatomical plane and the wound is closed.
After the procedure, pain, swelling, bruising, temporary changes in sensation and a feeling of tissue tightness may occur. Recovery time depends on the extent of the operation, the technique used and individual healing. The patient receives instructions on wound care, wearing a suitable post-operative bra, limiting physical exertion and follow-up appointments.
The return to everyday activities should be gradual and follow the surgeon's recommendations. The final breast shape settles over the following months after surgery.
Complications and possible consequences of the procedure
Like any surgical operation, breast augmentation with implants carries a risk of early and late complications. Their likelihood depends, among other things, on the patient's health, anatomy, the type of implant, the surgical technique and the healing process.
Early complications include:
haematoma and post-operative bleeding, sometimes requiring another surgical intervention;
infection of the wound or the area around the implant, which in severe cases may require removal of the implant;
delayed healing, wound separation, necrosis of the skin or tissues, particularly when blood supply is impaired;
pain, swelling, bruising and temporary changes in sensation;
complications related to anaesthesia and, more rarely, thromboembolic events.
Late complications include:
capsular contracture — excessive tightening of the scar tissue around the implant, which can lead to hardening, breast deformity and pain;
implant malposition — an incorrect position or displacement of the implant, including asymmetry, downward displacement of the implant or its lateral shift;
a visible or palpable implant, wrinkling of its surface (rippling) and excessive tissue tension;
changes in breast and nipple sensation, which can be temporary or permanent;
an unsatisfactory aesthetic result, asymmetry, hypertrophic scars or an unfavourable change in breast shape;
rupture or damage of the implant, which may require diagnostics and surgical treatment;
atrophy or thinning of the tissue covering the implant, and changes in the mammary gland and skin associated with time, ageing or weight changes;
the need for another operation, including implant exchange or removal, position correction or treatment of other complications.
Breast implants are not lifetime devices. The risk of complications and the likelihood of another operation increase the longer the implants are in place, although not every patient will need an implant exchange after a specific period.
Rare but significant implant-related diseases must also be taken into account. These include breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Before surgery, current safety information about the specific product and the symptoms that require further investigation should be discussed.
New breast swelling years later, fluid collection around the implant, a lump, persistent pain or a sudden change in breast shape requires a medical consultation and appropriate diagnostics.
Post-operative follow-up and long-term monitoring
Follow-up visits according to an individual schedule are necessary after the procedure. The patient should know how to examine her breasts and should report new or worrying symptoms.
Having implants does not exempt you from breast cancer screening. Mammography, ultrasound or other imaging should be performed according to age, individual risk and clinical indications, and the diagnostic staff should be informed about the implants.
Safety and an informed decision
Breast augmentation needs an informed decision and a thorough discussion of the expected benefits, the limitations of the method and possible complications. During the consultation, we discuss the available options, anatomical factors, recovery, post-operative follow-up and the long-term consequences of having implants.
The aim of the assessment is to choose a method that meets the patient's needs and keeps the risk as low as possible. The final decision about the procedure should be made after receiving comprehensive information and consciously accepting both the potential benefits and the risks.
