Breast Augmentation

What is Breast Augmentation?

Breast feminization is synonym to breast augmentation, although technically, feminization of the nipple is achieved otherwise. Breast augmentation is key, when gender transitioning, because through this operation, both femininity and self-esteem are boosted. Feeling like a woman depends on being accepted as a woman, and breast appearance plays a crucial role in personal and social acceptance.


There are many different techniques and implants available, however some general rules apply to breast augmentation, depending on anatomical traits and individual wishes. Implant selection can be very confusing, and patients must understand what to expect from various shapes and sizes. Regarding the implant shape, it can either be round, anatomical, or something in between. Round implants with cohesive gel give a fuller upper pole and rounder shape, which sometimes is wanted, and sometimes is too unnatural. Anatomical implants give less fullness of the upper pole and a more natural look. Newer types of implants are both round and anatomical, due to the softer gel inside.

Implant size also plays a very important role. Implants are selected according to the width of the chest, so that the base width of the implant matches the width of the new footprint of the breast. Implant projection is what makes the breast small or big. In order to visually realize the size, patients can try on probe implants prior to surgery, mimicking the result of breast augmentation. One must take in regard that transgender patients have a tighter breast pocket, which might limit the implant size. Hormonal therapy might help in these cases, however if a much bigger size is aimed, the procedure must be staged, inserting initially a smaller implant and advancing to bigger implants after one year.


The operative technique is also very variable and different surgeons prefer different approaches. However, there is enough literature and statistic available to lay out some basic principles. Skinny patients profit most when implant is placed underneath the muscle, whereas in patients with more gland and fat layer, placing above or beneath the muscle does not change appearance so dramatically. The placement of the incision can be below the nipple, in the inframammary fold or in the axilla. Statistically seen, placing the scar in the inframammary fold has lower capsular contracture rate, thus lower complications and is the only access which allows to perform the dual plane technique properly. In our practice, in most patients the implants are place below the muscle, using the dual plane technique.


Having chosen the appropriate implant and selected the operative technique, the actual procedure is rather straightforward, with minimal complications and fast recovery. The procedure is performed under general anesthesia and as day surgery, no drains are placed, and the stiches are absorbable. When placing the implant beneath the muscle, moderate pain is to be expected for 4-5 days. Patients can return to daily routine after 10-15 days and exercise after 6 weeks. Full recovery is after 6 months.

Changing older breast implants is often a necessity, due to complications or preference, in which cases, revisional surgery is performed. The main reasons leading to implant replacement are capsular contracture, implant rupture, change in shape or size and implant malpositioning. Whichever the case, thorough clinical examination is performed, often in combination with sonography or MRI scans, in order to determine the status and position of the implants. Ruptured implants must be removed ASAP, in order to prevent leakage of silicone outside the capsule. The implants are removed in conjunction with their capsule, and either new implants are inserted, or a more conservative approach is selected, leaving the tissue to heal for some months and then performing a new breast augmentation. Other complications such as implant malpositioning, which may appear in form of bottoming out, double bubble or a waterfall deformity, also require surgical correction, involving different reconstructive techniques.