Breast Augmentation

Three modern techniques give your femininity a boost without pain and with minimal downtime.

The breasts have always been considered to be women’s most important female assets. Therefore, those who do not have the ideal breast size for their body may feel less confident to embrace their femininity. Thus, those with small or aplastic breasts or breast asymmetry and women who have undergone a mastectomy are the ideal candidates for a breast augmentation procedure.

The breast augmentation techniques which are performed in modern plastic surgery are the following:

Non touch – No pain technique

A 100% atraumatic method, where the plastic surgeon avoids using his fingers to create the pocket for the silicone implant, since he may cause extended injury or bleeding of the tissue.

Dual plane technique

It is also known as the Two Level Technique, as the implant is found half under the muscle and half under the muscle fascia.

SubFascial technique

The implant is placed under a thin membrane that covers the muscle and is called fascia.

Before surgery

The pre-operative care involves a good planning concerning the type and volume of the implant. The plastic surgeon performs 5 important measurements of the patient’s chest. The woman then tries on the silicone implants in order to have a good idea of what her breast will look like after surgery. Her will in combination with the measurements of her chest define the type of implant and its size.

A number of lab tests are performed before the procedure: full blood count, coagulation test and heart examination, chest X-ray and mammography (in case the patient is older than 35). In general, patients are advised to stop taking any vitamins, refrain from smoking and alcohol and avoid aspirin for 1-2 weeks before the procedure as well as afterwards. A healthy diet may contribute to a better and faster recovery.

Local or general anaesthesia?

The new breast augmentation techniques may be carried out under local anaesthesia, with or without sedation. However, the procedure may also be undertaken under general anaesthesia (if the patient wants it). The surgery lasts approximately 1 hour and overnight stay at the hospital is not usually required.

Downtime

The surgery is followed by a mild oedema that subsides after 3-10 days. The patient may resume her daily activities almost immediately, apart from intense exercise and weight lifting. The woman may go back to work in 7-10 days. Thanks to the atraumatic technique no breast drains (tubes) or compression garments are required around the chest and there are no restrictions in arm movements. After 6-12 months incisions (they are made either under the breast or the armpit or around the nipple) will look like fading thin lines. Manufacturers give implants 15-20 years of life. However, in practice, implants may last much longer.

Possible complications

There is a <1% chance of haematoma or inflammation, while a capsular contracture is between 1-5%. There is also a slight chance of alteration of the nipple appearance which will return to normal after approximately one year.

The techniques

1.Non touch-No pain

Most people believe that breast augmentation is synonymous with pain that lasts for 2-3 weeks, compression garments or suffocating bandages, tubes inserted in the breast, bruising and long stays in bed. The truth is that today breast enlargement should be almost pain-free.

Modern techniques allow 90% of the patients who have had breast augmentation to resume regular activities 24 hours post surgery. There are no tubes, suffocating compression garments around the chest and movement restrictions, narcotic analgesics

This is possible with the Non touch-No pain technique, developed and published in 2002 by John Tebbetts, a plastic surgeon in Dallas, Texas. What is so special about it?

During breast augmentation surgery

The less we injure the tissues the less bleeding is caused resulting in quick recovery time. So, the secret of this technique is that the surgeon must fully avoid using his fingers to create the pocket for the silicone implant, since he may cause extended injury or bleeding. That is why we use specially designed tools in order to prepare the pocket inside the breast. The method is 100% atraumatic (almost no blood is lost during surgery).

The downtime

The advantages of the technique are the following:

-Accuracy and high respect for the tissues.
-Patients may go back home safely 6 hours after surgery.
-The woman may move around freely and drive 2-3 days post surgery.
-Immediate and long-term complications of the surgery are reduced.
-Haematomas are 0.05%, inflammations 0% and capsular contracture formation 0.4%, as shown in a recent analysis of the results of 1250 breast augmentation procedures during the 11th Congress of ESPRAS in Rhodes.

2. The Dual plane technique

Until now we knew about two techniques in breast augmentation: the subglandular and submuscular implant placement techniques. In 2002, the SubFascial technique was also introduced. Our technique (The Dual Plane) combines the two last ones: the silicone implant is placed both underneath the muscle and underneath the muscle fascia.

This is not complicated at all. The above part of the silicone implant is covered by the pectoralis major muscle and the lower part by the muscle fascia (a thin tissue that covers the muscle). Duration time of the breast augmentation procedure is 30-45’. There are no drains, bandages or suffocating compression garments around the breasts.

The advantages:

1. Much fewer complications, such as the formation of capsular contracture which occurs in 1-20% of women who have had breast augmentation surgery. By placing the implant below the muscle and the fascia, we minimise the implant’s contact with the mammary gland. This is a manoeuvre that can possibly minimise the formation of capsular contracture.
2. A natural result particularly for thin patients with very small breasts.
3. The possibility of implant dropping is reduced.
4. Breast implant defects due to the strength exercised by the pectoralis major are avoided.
5. Palpating of the implant’s borders is reduced.
6. No wrinkles are formed on the upper part of the body.
7. Recovery is speedy thanks to the combination of the Dual plane and the Non touch-No pain techniques. Complications and revision surgery are currently below 1%.
8. The level of satisfaction from this operation among women reaches 98-99%.

The disadvantages:

The doctor has to have more experience in performing this technique.

The award

In June 2007 Mr Evangelos Keramidas’ paper “Composite Plane Breast Augmentation: A new Concept” was awarded in Berlin, among 500 papers from around the world during the International Plastic Surgery Conference. This paper is about the dual plane technique.

The background: This is a new breast augmentation technique based on a modification of Dr John Tebbetts’ technique from Texas.

3. The SubFascial technique

In the subFascial technique, the silicone implant is placed under the fascia of the pectoralis major. The fascia is a very thin hymen that covers the pectoralis major.

The advantages

1. Minimum or no pain
2. Much faster recovery
3. Performed with local anaesthesia and sedation.
4. More natural shape of the breast, since the fascia is covering the implant and smoothes out the roundness that develops on the upper part of the breast
5. Minimisation of capsular contracture, possibly due to the fact that the implant is not in contact with the breast (the fascia separates the implant from the breast).
6. It may limit the possibility of implant dropping in the future since the implant is well secured.
7. In selected patients, it minimises the possibility of wrinkle formation mostly on the upper part of the breast.
8. As in all breast augmentation techniques, we perform the Non touch-No pain technique here as well.

The results

1. It yields the best possible results in selected patients
2. Complications are drastically reduced.
This reduction in complications is due to the SubFascial technique but also to the Non touch-No pain technique for pocket preparation.

The background: This breast enlargement method was first presented in 2000 by Dr Ruth Graf, a Plastic Surgery Professor in Brazil. The presentation was made in the Aesthetic Plastic Surgery journal and in 2003 it was also published in the American Journal of Plastic and Reconstructive Surgery.

Here at Kosmesis, we are currently among world leading practices with more than 800 surgical cases. This technique has been presented in many meetings (IMCAS meeting in Paris, January 2009, 14th Congress of the International Confederation of Plastic, Reconstructive and Aesthetic Surgery (IPRAS) in Berlin, 2007, 10th European Societies of Plastic, Reconstructive and Aesthetic Surgery Congress in Vienna, 2005 etc.). We have also published our experience with this technique in the two most prominent international journals of Plastic Surgery: “Plastic and Reconstructive Surgery” and “Aesthetic Plastic Surgery”.