Breast Augmentation Surgery and Recovery

I follow the breast implant technique popularized by Dr Per Heden known as the Akademikliniken method. It is a specialized approach to breast augmentation that emphasizes achieving natural-looking results with reduced long-term complications.

Our breast augmentation expertise include three principles:

  • Customized Implant Selection: selecting implants that closely match the patient's breast anatomy and desired outcome. This involves choosing implants that fit the breast envelope well, which can help minimize potential complications such as implant malposition or unnatural appearance.

  • Detailed Pre-operative Assessment: conducting a thorough pre-operative assessment to understand the patient's anatomy, breast characteristics, and aesthetic goals. This allows for a personalized surgical plan that considers factors such as breast size, shape, symmetry, and tissue quality.

  • Emphasis on Natural Results: by selecting implants that fit the breast envelope properly, the method aims to reduce the likelihood of long-term issues such as implant displacement or visibility.

Are you a good candidate?

  • Usual contraindications to breast augmentation are patients responding to peer, spousal, or parental pressure, women <18 years and if there is a significant breast disease (severe fibrocystic disease, ductal hyperplasia, high-risk breast cancer)

  • Implant volume is chosen via a patient-surgeon cooperative approach. Bra sizes are not accurate in predicting final cup size (125–150 ml may increase one cup size, but larger frames may need more).

  • Patient measurements are taken to determine breast capacity and tissue coverage and accurate methods are used to find a range of the most appropriate sizes from which the patient chooses - To create a long-lasting result, harmony between patient’s desires and what the tissue characteristics and envelope will allow is essential.

    • Micro-textured implants form thicker capsules therefore are more palpable in thin patients but are less prone to implant displacement.

    • Smooth implants form thinners capsules therefore are less palpable in thin patients but are more prone to implant displacement with time. They also carry a higher risk of capsular contracture in the subglandular pocket.

    • Long chain silicone have increased viscosity and will stay cohesive if the implant ruptures. It has a more natural feel and less wrinkling.

    • Saline is safely absorbed by the body and therefore completely deflates in case of implant rupture. It can be overfilled or underfilled to correct minor asymetries. There is a less natural feel and more wrinkling.

    • Round implants are circular so they give upper pole fullness. They do not change breast shape in case of a malrotation.

    • Microtextured anatomic implants give a more natural breast shape (less upper pole fullness and more lower pole fullness) and are form-stable (breast shape conform to it). There is a slight risk of malrotation which could change breast shape.

    • Inframammary incisions are usually preferred because they offer the highest degree of precision and control, and avoids contact with breast ducts. It is well hidden in the fold and usually fades away at 1 year.

    • Peri-areolar incisions can be used if no manipulation of the inframammary fold is planned but is associated with a possible risk of bacterial contamination (passage through the breast tissue).

    • Dual Plane pocket (half under the muscle) where the implant is covered by the pectoral muscle at the upper pole and the breast gland in the lower pole

    • Subglandular (over the muscle) where there is a higher risk of implant palpability in thin patients, and a higher risk of capsular contracture with smooth implants. It is used in very active patients to minimize implant deformation by the muscle)

Surgery and Recovery

  • Under regional anesthesia + anesthetic infiltration into tissues + sedation (thoracic spinal anesthesia) or general anesthesia.

  • Presurgical scrub, intraoperative antibiotics, antibiotics irrigation of the pocket and minimal manipulation of the implant reduce infection and capsular contracture

  • Moderate pain usually controlled with pain medication

  • Diazepam may be given for pectoral muscle relaxation

  • Postoperative antibiotics are of no proven benefits

  • Implant pushes up and in at day 3 for a month when minimal pain

  • Medical brassiere with downward pushing strap for 6 weeks, worn day and night (no push-up bras or harsh manipulation)

  • Aerobic exercises at 2 weeks (gently at first)

  • Heavy lifting at 6 weeks

  • Swelling for 1 month usually, implant descends during the first 3 months and conforms to the breast envelope

  • Scar usually fades in about a year.

What are the risks of breast augmentation?

Breast augmentation is generally a well-tolerated procedure, but complications can occur. They include:

  • Bleeding or hematoma

  • Infection

  • Changes in nipple or breast sensation

  • Asymmetry and implant malposition

  • Implant-specific complications include capsular contracture, implant rupture, rippling or visibility, and the possibility of requiring further surgery over time. Rare implant-associated conditions, including BIA-ALCL, should also be discussed as part of informed consent. Read more about BIA-ALCL here.

    Breast implants are not lifetime devices, and future revision surgery may eventually be necessary.

Frequently asked questions in my practice

  • The FDA recommends ultrasound or MRI for silent rupture beginning 5–6 years after implantation and every 2–3 years thereafter in asymptomatic patients; MRI is also recommended for symptoms or equivocal ultrasound.

    Rupture risk is 1%/year

  • No. Breast implants do not need to be routinely replaced after 10 years if they are intact and causing no problems. However, they are not lifetime devices, and the likelihood of needing further surgery increases with time. Revision may eventually be required because of rupture, capsular contracture, implant displacement or changes in the breast itself.

  • Most patients return to light daily activities within a few days and desk-based work within approximately one week. Heavy lifting, swimming and running are permitted after 6 weeks. Walking is encouraged early, while running, heavy lifting and upper-body exercise are reintroduced progressively over the following weeks. The breasts may initially appear high, firm or swollen and continue to soften and settle over several months.

  • Available evidence suggests that the risk of breastfeeding difficulties after breast augmentation is similar to that of women without implants. However, breastfeeding ability can also depend on the surgical approach, particularly the incision used and whether breast tissue, ducts or nerves are disrupted.

  • Yes. Routine breast cancer screening remains possible with implants. The radiology center should be informed beforehand so that appropriate implant-displacement views can be obtained. Breast implants can obscure some breast tissue on standard mammographic views, which is why appropriate technique is important.

  • Read more about this topic here.

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