The selection of breast implants depends on the anatomical structure, personal preferences, and expectations of each individual patient. This is a foundational step that requires comprehensive consideration, guided by a surgeon’s personalized evaluation and recommendation.
Types of Breast Implants
Based on the characteristics commonly utilized in current surgical practices at PPSI and according to international standards, breast implants can be classified into three primary categories :
1. Classification by Shape This is the most critical factor in determining the post-operative contour of the breast.
Round Implants: These are currently utilized as the standard option. The distribution of the silicone within these implants is spherically uniform.
Teardrop Implants (Teardrop): These feature a teardrop configuration that is flatter at the top and exhibits maximum projection near the nipple area. The point of maximal projection is situated lower than that of round implants.
2. Classification by Surface Texture The surface texture significantly influences tissue adherence and the incidence of capsular contracture.
Smooth Surface : This type possesses a soft texture, allowing for natural movement resembling genuine breast tissue. However, it is associated with a slightly higher incidence of capsular contracture compared to textured surfaces.
Textured Surface : This type features a slightly roughened surface that enhances implant adherence to the surrounding tissue, theoretically minimizing the risk of implant malposition or displacement.
3. Classification by Filler Material
Cohesive Gel : This is the most widely preferred and standard material utilized today due to the highly cohesive property of the internal gel. In the event of an implant shell rupture, the gel remains contained and does not extravasate outside the capsule.
Saline-Filled : The utilization of saline implants has decreased in contemporary practice. Their selection is generally restricted to specific reconstructive breast surgeries, as they provide a less natural tactile sensation and are more prone to leakage or deflation.
Approaches to Breast Augmentation
In terms of surgical methodology to achieve optimal aesthetic outcomes and maximum safety, breast augmentation can be categorized into three major classifications based on the techniques selected by the surgeon :
1. Classification by Augmentation Material
Silicone Implants : This remains the most globally prevalent method, as it allows for precise size determination, delivers a stable and aesthetically pleasing shape, and offers long-term durability spanning several decades.
Autologous Fat Transfer : This procedure involves harvesting excess adipose tissue from the abdomen or thighs via liposuction and injecting it into the breasts. It is suitable for individuals seeking a modest increase in volume and desiring the most natural tactile sensation without the introduction of foreign materials.
Hybrid Breast Augmentation : This technique combines the placement of a silicone implant with autologous fat grafting around the periphery to conceal the implant edges or enhance the cleavage. It is ideal for thin or asthenic patients concerned about visible implant rippling or palpable edges.
2. Classification by Implant Placement
Subglandular / Subfascial Placement : The implant is positioned beneath the mammary gland but superficial to the pectoralis major muscle. This approach preserves natural dynamics in patients with sufficient pre-existing breast tissue and minimizes disruption to the pectoral musculature.
Dual-Plane Placement : This involves positioning the implant across two anatomical planes, where the superior portion resides beneath the pectoralis major muscle and the inferior portion sits beneath the mammary gland. This results in a highly natural appearance of the upper breast pole with unnoticeable borders, while providing full projection and fullness to the lower pole, effectively correcting wide intermammary distance or mild breast ptosis.
Submuscular Placement : The implant is placed entirely beneath the pectoralis major muscle to minimize the visibility of the implant edges. However, this plane cannot secure or lift the breast tissue in cases presenting with ptosis, and it is associated with a higher degree of acute post-operative pain.
3. Classification by Incision Site
Inframammary Crease Incision : The inframammary fold approach is highly favored in contemporary practice due to its direct and safe surgical access, allowing for highly precise implant placement. It minimizes bacterial contamination, facilitates bilateral symmetry, reduces operative time, lowers blood loss, and accelerates patient recovery. Additionally, the resulting scar is well-concealed within the natural inframammary fold and can serve as the primary access route for future revisional surgery or implant exchange.
Periareolar Incision : The incision is made along the semi-circular border where the pigmented areolar skin meets the surrounding breast tissue. The resulting scar is small and blends optimally with the natural pigmentation, rendering it virtually imperceptible upon healing. This approach is indicated for patients whose areolar diameter is sufficient to accommodate the passage of the implant.
Axillary Incision : The incision is located within the deep natural folds of the axilla adjacent to the torso, providing excellent scar concealment. This approach is highly suitable for individuals prone to hypertrophic scarring, those with specific skin pigmentation concerns, or patients who desire an entirely scar-free breast appearance.