Breast Augmentation

Breast augmentation increases volume and changes shape, either with an implant, with the patient’s own fat, or with both.

Breast size and shape change over time with pregnancy, hormonal change, weight loss and ageing. Augmentation is used to enlarge small, asymmetrical or deflated breasts and to restore volume and shape that has been lost.

Most of the consultation is spent on the tissue rather than on the implant: skin quality, the amount of breast tissue covering the device, the position of the fold beneath the breast, and existing asymmetry. Those findings determine the implant type, size, plane and incision.

Implant plane

Implant placement should suit the patient’s anatomy and their aesthetic goals. There are two principal planes.

Under the chest muscle (sub-muscular or dual plane) Suited to patients with little breast tissue and thin skin over the breast. The additional muscle cover makes the implant edge less apparent, and there is a clearer separation between breast tissue and implant for mammography.

Behind the breast tissue (sub-glandular) Suited to patients with thicker skin and adequate breast tissue. Recovery after sub-glandular placement is often less uncomfortable and faster.

Incision

Inframammary fold (IMF) The most common approach. It has been shown to carry a lower risk of complications such as capsular contracture and loss of nipple sensation, and gives direct access to the muscle and to the pocket into which the implant is placed.

Periareolar Placed at the junction between the darker areolar skin and the lighter skin of the breast. It is associated with higher rates of capsular contracture and, potentially, reduced nipple sensation compared with the IMF incision.

Transaxillary A small incision within the armpit, through which the implant is placed using a camera and specialised instruments. The thin skin of the axilla forms natural creases and shadows that conceal the scar.

Hybrid augmentation

Hybrid breast augmentation combines an implant with autologous fat transfer. Fat is harvested from an area where the patient stores it — most often the abdomen or the inner or outer thighs — collected in a sterile container, then washed and strained before being transferred to small syringes and injected into the breast.

Fat is used to camouflage contour irregularities and to add soft-tissue cover. In patients with very little breast tissue it acts as a layer between the implant and the overlying skin, which reduces the chance of visible rippling.

What the operation involves

Anaesthesia is administered by a consultant anaesthetist. The incision is made in the inframammary fold, around the areola or within the axilla, planned around the size and type of implant and the patient’s anatomy. The implant is placed under the chest muscle or behind the breast tissue according to the tissue findings. The incision is then closed in layers.

The technique aims to preserve the normal physiology of the breast, including the ability to breastfeed after surgery.

Recovery

Breast augmentation is a day case. Most patients are walking unaided a few hours after surgery and feel able to leave the house within a day or two.

During the first 48 hours a raised temperature, fatigue and soreness are common. The breasts may look larger than expected; most of that early swelling settles quickly. A feeling of tightness across the chest is usual as the skin adjusts.

A compression bra and chest band are worn immediately after surgery. They limit movement of the implant and maintain the pocket that has been created. Arms and elbows should be kept close to the sides and lifting avoided until permitted.

Light everyday activity resumes gradually from the first day after surgery. Most patients return to work and to physical activity after two weeks, beginning with lower-body exercise and building up to upper-body work.

The result continues to improve as the implants settle into position. Results are long-term, though changes in body weight and pregnancy may alter the appearance of the breast.

After surgery — do

• Rest and take pain medication as instructed
• Wear the support garments the surgeon has specified
• Sleep on your back
• Begin mild activity as soon as you are able
• Attend follow-up appointments
• Arrange help at home for the first few days
• Perform the recommended exercises and massage the breasts as instructed
• Protect the breasts from pressure and compression

After surgery — do not

• Lift, push or undertake intense activity for several weeks
• Ignore the post-operative instructions
• Smoke
• Remove the surgical tape yourself
• Expose scars to the sun
• Sleep on your side or front
• Wear ordinary bras
• Touch the incisions
• Take blood thinners

Who it suits

Augmentation suits healthy patients with realistic expectations who are not satisfied with the size or shape of their breasts. Assessment covers the breasts, skin condition, muscle tone and body proportions, together with general medical history and allergies. Previous breast surgery, family history of breast disease, pregnancy, childbirth and lactation should all be disclosed.

Most candidates are patients who have not achieved the breast size and shape they want, and patients whose breasts have changed after pregnancy and breastfeeding. Breast development should be complete before surgery is considered.

In selected cases, augmentation or implant exchange may be considered after breast cancer surgery to restore volume and balance.

Where the surgery takes place

Dr. Stavrou performs breast augmentation in accredited medical centres in Cyprus, Greece and Malta. After surgery the patient is transferred to the recovery area and monitored by the clinical team.