Breast augmentation, commonly known as breast enhancement surgery, involves the use of silicone implants or fat grafting to increase the size of a woman’s breasts. Breast augmentation with implants has been performed since the early 1960s and has seen continuously growing demand. Silicone implants themselves have improved significantly and now incorporate features and technologies that allow them to remain safely in the human body for many years.
Additionally, modern fat transfer techniques allow the transfer of fat from other areas of the body to the breasts. Breast augmentation is often referred to as fat grafting due to the process used to achieve breast volume enhancement. Essentially, this procedure requires harvesting fat from one area of the body and using it to add volume to the woman’s breasts.
The procedure can be performed at any age after 18.
Indications for Breast Augmentation
The most common reasons women undergo this procedure include:
- Dissatisfaction with the size of their breasts
- Loss of breast shape and volume after weight loss, pregnancy, or aging
- Loss of fullness in the upper pole of the breast
- Breast asymmetry
- Tuberous breasts
Ideal Candidates for Breast Augmentation
There are two main groups of women who choose to undergo breast augmentation:
Women who have always had small breasts
These are usually young women who have never been satisfied with their appearance due to the small size of their breasts. This can negatively affect their body image and cause psychological discomfort. These individuals are typically aware of their desire to change their body.
Women who experienced breast changes after pregnancy
These women had satisfactory breast size and shape prior to pregnancy and breastfeeding but wish to restore their breasts to their previous condition.
Any woman considering breast augmentation should understand that the procedure improves body image but will not solve social, emotional, or professional problems.
The ideal candidate should meet one or more of the following criteria:
- Psychological stability: Candidates must be emotionally balanced and not undergoing significant life stress such as divorce, loss, or major career failure.
- Mature decision-making: The desire to undergo surgery should develop over time and not result from impulsive decisions.
- Personal motivation: The decision must be solely their own and not influenced by external pressure.
- General health: Candidates should be in good health without serious conditions that increase surgical risk or affect recovery.
- Responsibility and realistic expectations: Candidates must understand the procedure and have realistic goals regarding the outcome.
These criteria help ensure that breast augmentation is performed safely and under the appropriate conditions for each individual patient.
Implant Placement Levels
During breast augmentation, the silicone implant can be placed at various levels within the breast tissue. The appropriate placement depends on the patient’s needs, preferences, and existing breast anatomy.
Below is a brief explanation of the different placement options:
Subglandular (above the muscle, below the gland)
The implant is placed beneath the breast gland but above the muscle. In women with small and loose breasts, the implant may be easily palpable or even visible through the skin, especially in the upper pole of the breast. Larger implants are more likely to be noticeable, and this may worsen over time.
Subfascial (under the fascia)
The implant is placed under the fascia of the chest muscle but above the muscle itself. This offers some protection for the implant. However, in very thin and athletic women, this technique is avoided due to a high risk of complications such as capsular contracture or visible/palpable implants.
Submuscular (below the muscle)
The implant is placed entirely beneath the chest muscle. This provides greater coverage and protection for the implant but can result in more postoperative pain and a longer recovery time.
Dual Plane
This technique combines the advantages of both subglandular and submuscular placement. The upper part of the implant is covered by the muscle for protection, while the lower part is covered by the breast gland, resulting in a more natural breast projection. This technique is excellent for all women needing augmentation and is especially indicated for thin women with small breasts or athletes with well-developed muscles. It offers a safe solution with very natural-looking results.
The choice of implant placement level depends on many factors, including individual needs and the surgeon’s recommendations. It’s important to discuss all options with your plastic surgeon to determine the best plan for your case.
Types of Implants
The options for the type of implants used in breast augmentation vary depending on the patient’s needs, preferences, and the surgeon’s recommendations. Here are the main types of implants used in breast augmentation:
Round Implants
These implants have a round shape and provide a full and uniform breast appearance. They usually offer more volume in the upper part of the breast and are a good choice for patients who desire full and rounded breasts.
Anatomical Implants (or “Teardrop”)
These implants resemble the natural shape of the breast, offering a more natural look with more fullness in the lower part of the breast. They are often used in very small breasts or for reconstructive procedures.
Textured Surface Implants
These implants have a textured surface that helps prevent mobility and rotation within the breast. They provide a very natural result and generally have fewer fitting issues.
Smooth Implants
These implants are smooth to the touch and can move more freely within their pocket. They do not easily integrate with the surrounding tissues and have gradually been replaced by textured implants.
Silicone Implants
Silicone implants are very popular and offer a natural texture and feel. They are filled with soft, elastic silicone gel.
Saline Implants
These implants contain saline solution. They provide a natural feel and eliminate the risk of allergic reactions or other complications in case of rupture.
Choosing Implant Size – Breast Augmentation
Choosing the right implant size is an important decision that affects the final result and overall satisfaction. It is important to discuss your options with your surgeon, taking the following factors into consideration:
- Natural Appearance: The selected size should aim for a natural result that fits your body type and structure.
- Personal Preference: Discuss the desired appearance with your surgeon—if you prefer a more natural look, a smaller implant might be best; if you want a fuller chest, a larger implant may be preferred.
- Lifestyle: Your lifestyle also affects implant size choice. For example, if you are very active or athletic, a large size may interfere with physical activities.
- Professional Needs: If your profession impacts your appearance (e.g., model, actress), this may influence the implant size you choose.
- General Health: Your surgeon will also consider your breast and tissue condition to determine a safe and natural-looking size.
The size selection is made during the consultation session. The surgeon will evaluate all these factors and recommend the size that best fits your needs and preferences. It is important to be honest and open with your surgeon.
Incision Site Options
In breast augmentation, selecting the incision site—where the implants will be inserted—is also important. The common incision sites are:
- Inframammary fold – under the breast
- Periareolar – around the areola
- Transaxillary – through the armpit
Inframammary Incision
This incision is placed in the fold under the breast and is the most commonly used method worldwide. Its advantages include:
- It can be used with any surgical plane for implant placement.
- It heals well and is hidden in the breast fold.
- It does not affect any part of the breast related to future breastfeeding (milk ducts).
- It is completely atraumatic to the breast gland, as the procedure occurs below the gland without touching it, preventing microcalcifications.
- It remains well hidden under the breast itself.
- It provides excellent visibility for the surgeon during surgery.
Nipple
The periareolar approach is beneficial when the nipple is large and the breast is small. However, there remains a risk of implant contamination with this approach.
In order to place the implant under the gland or the pectoralis major muscle via a periareolar incision, the gland must be cut, which results in trauma. This trauma may cause:
- Reduced nipple sensitivity or hypersensitivity.
- Reduced ability to breastfeed in a future pregnancy.
Armpit
The incision in the armpit avoids scarring on the breast but leaves a scar in the axillary area, which may be visible in some patients. This approach is suitable only for submuscular implant placement.
There is also a risk of damaging small sensory nerves that innervate the outer breast. Additionally, due to the distance from the inframammary fold, there may be technical difficulties. In challenging cases, correction may be difficult or even impossible with this incision.
Breast Augmentation with Fat Transfer
Breast augmentation with fat transfer is an alternative technique that increases breast size without silicone or other implants. The procedure includes the following steps:
- Fat Harvesting: The surgeon collects fat from areas like the buttocks, abdomen, or other regions with excess fat.
- Processing: The harvested fat is purified and only the highest quality fat is prepared for injection.
- Injection: The purified fat is injected with small syringes into the breast. The surgeon distributes the fat evenly to achieve the desired shape and volume.
- Recovery: Fat transfer is typically less invasive than implant surgery, with a shorter recovery period. However, postoperative care instructions must be followed closely.
Advantages of fat transfer breast augmentation include:
- Natural Appearance: Since the fat comes from the patient’s own body, results tend to look more natural.
- Minimal Scarring: Due to the use of small injections, scarring is usually minimal or invisible.
- Dual Benefit: The procedure often includes liposuction from other areas, reshaping the overall silhouette.
However, fat transfer has limitations regarding the volume that can be achieved. It requires sufficient donor fat, and volume outcomes may be less predictable compared to implants. A consultation with a specialized surgeon is essential to evaluate whether this method is suitable for your goals.
Consultation Session
The breast augmentation consultation is a key step to help the patient prepare and make informed decisions. The session typically includes:
- Assessment of patient’s needs and expectations, including desired size, shape, and aesthetic goals.
- Discussion of available techniques, implant types, and potential risks.
- Evaluation of the patient’s general health and medical history.
- Explanation of potential risks and side effects.
- Step-by-step overview of the surgical procedure.
- Opportunity for the patient to ask questions and clarify concerns.
- Development of a personalized surgical plan, including implant selection and placement technique.
Preoperative Guidelines
Before undergoing breast augmentation, patients should follow specific preoperative instructions to ensure a safe and successful surgery:
- Medications: Discontinue anticoagulants and supplements that affect blood clotting at least 10 days before surgery, always under medical supervision.
- Smoking: Stop smoking well in advance, as it may negatively impact healing and scar quality.
- Alcohol: Limit alcohol consumption a few days prior to surgery, as it may interfere with anesthesia and recovery.
- Follow Instructions: Carefully follow your surgeon’s preoperative and postoperative care guidelines.
- Comfortable Clothing: Wear loose clothing that is easy to remove without putting pressure on the chest.
- Companion: Arrange for someone to accompany you to the hospital and assist you afterward.
Procedure Description – Breast Augmentation
Before the surgery, preoperative examinations are performed, including blood tests, chest X-ray, and electrocardiogram. These are usually conducted on the day of the procedure.
The patient undergoes general anesthesia. The operation typically lasts between one to three hours. In most cases, the patient returns home a few hours after the procedure. If she wishes, she may stay overnight at the clinic as a precaution.
Postoperative Instructions
Following the procedure, the patient should expect the following:
- The breasts may be more sensitive for 2 to 4 weeks after the surgery.
- It is advisable to avoid sexual activity during this period.
- The patient may return to work after a few days.
- If the job involves physical activity, one more week of recovery is recommended.
- Scars may initially appear red but will gradually improve in appearance.
The plastic surgeon will provide specific instructions to aid in recovery, including:
- Incision Care: Keep the incision area clean and dry. Follow the surgeon’s guidelines for changing dressings and caring for scars.
- Support Bra or Bandage: A support bra or special bandage will be recommended to help support the breasts during recovery. Follow your surgeon’s instructions regarding how long and how to wear it.
- Pain Management: Breast augmentation can cause discomfort and pain. Take the prescribed pain medications as directed by your doctor.
- Limit Physical Activity: Your doctor will advise you on when to resume normal activities and exercise. Generally, avoid heavy physical activities for a certain period and gradually return to your fitness routine.
- Monitoring Symptoms: Watch for symptoms such as swelling, pain, or anatomical changes. Contact your doctor immediately if you notice any unusual symptoms.
It is important to carefully follow all postoperative instructions to ensure a safe and successful recovery. Contact your doctor if you have any concerns or experience any symptoms.
Complications – Breast Augmentation
As with any surgical procedure, breast augmentation carries risks. It is important to be aware of potential complications and discuss them with your doctor in advance.
Some possible complications may include:
- Pain and Discomfort: Postoperative pain and discomfort in the breast area are common and usually managed with pain medication.
- Breast Swelling: Swelling and tenderness after augmentation are normal and tend to subside over time.
- General Surgical Risks: Such as deep vein thrombosis, cardiac or pulmonary complications.
- Infection: There is always a risk of infection following surgery. Preventative measures include taking antibiotics and proper wound care.
- Implant Rupture: Rarely, implants may rupture, requiring surgical correction.
- Reaction to Implant Material: Some patients may experience adverse reactions to implant materials, which may necessitate removal.
- Bleeding or Hematoma Formation: Occurs in approximately 1% of cases.
- Poor Wound Healing: In some cases, incisions may heal poorly.
- Nipple Hypoesthesia: Reduced nipple sensation may occur.
- Breast Asymmetry: Uneven appearance of the breasts postoperatively.
- Capsular Contracture: Scar tissue forming around the implant, potentially causing firmness or distortion.
It is important to read and understand all possible complications associated with breast augmentation. Discuss your expectations, the risks, and postoperative care openly with your doctor.
Do not hesitate to contact Plastic, Reconstructive, and Aesthetic Surgeon Dr. Daskalakis with any questions regarding breast augmentation or any other aspect of plastic surgery that concerns you.
References
- Nolan IT, et al. Systematic Review of Complication Rates of Gender-Affirming and Tuberous Breast Augmentation. Plast Reconstr Surg Glob Open., 2025.
https://journals.lww.com/prsgo/fulltext/2025/08000/systematic_review_of_complication_rates_of.51.aspx - Perrotta RE, et al. Incidence of Long-Term Complications in Breast Implant Prostheses: A Systematic Review. Prosthesis, 2025.
https://www.mdpi.com/2673-1592/7/2/38 - Li XY, et al. Analysis of Risk Factors for Capsular Contracture After Breast Augmentation. Frontiers in Surgery, 2025.
https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2025.1596993/full
