Breast augmentation is one of the most desired and most commonly performed procedures in aesthetic surgery. The surgery can fulfill a long-standing wish for a fuller, more shapely décolletage, or address changes that many women experience after breastfeeding, when the breasts often lose some of their former volume.

After the procedure, increased satisfaction and improved self-confidence are often reflected in all areas of life, both private and professional.

The period from deciding on surgery to the actual operation is usually emotionally charged. Expectations and wishes must be aligned with what is surgically and anatomically possible. During this time, an honest, well-informed, and professionally guided conversation is one of the most important roles we, as surgeons, fulfill.

This is the most essential part of the entire breast augmentation process. We discuss the patient’s expectations and wishes, try to accommodate them as much as possible, but always in harmony with the realistic options provided by her tissues and anatomy. The discussion also covers recovery, potential risks, and complications.

In this phase, it is essential to address every doubt and concern – there are no unnecessary or “silly” questions. Only in this way can you approach the procedure in a relaxed, well-prepared manner.

To make it easier to choose the right implant size, we use 3D visualisation and special trial inserts with dedicated bras, which provide a clear, accurate picture of the likely final result. For a moment, a woman can truly imagine how much more attractive and confident she will feel after surgery – something that almost always brings a smile to her face.

The purpose of the measurements is to determine the most suitable implant and the most appropriate surgical technique for the augmentation (incision site, placement under the muscle or gland, possible simultaneous breast lift). The key factors are outlined below.

• Width of the breast, width of the chest, and tissue thickness
  These measurements determine the ideal width of the implant.

   

  • If the implant is too wide, it can protrude too far into the inner or outer breast, resulting in an unnatural appearance. The breasts may even merge in the cleavage area (symmastia).

     

  • If the implant is too narrow, the gap between the breasts in the décolletage may be too broad, again leading to an unnatural and less attractive appearance.

     

• Thickness of the tissues in the upper pole (décolletage)
  We do not want to create a visible “step” where the implant begins. If there is sufficient natural tissue in the upper breast, the implant can be placed above the muscle. In very slim patients with thin tissues, the implant is better placed under the muscle to soften the transition and create a smooth contour.

   

• Degree of breast ptosis (sagging)
  In more pronounced sagging, the breast needs to be reshaped with a mastopexy (breast lift). In cases of mild sagging caused mainly by tissue thinning, the implant alone can correct the problem.

   

• Patient’s preference for a subtle or more prominent décolletage
  A more striking cleavage is usually achieved with round implants, whereas teardrop implants create a more natural look. The degree of projection (“how far the implant sticks out” from the chest wall) also plays an important role.

   

Breast symmetry and chest shape
Any asymmetries in breast shape or size must be carefully documented and taken into account in planning. Perfectly symmetrical breasts are rare. Most of the time, differences are minimal, but where asymmetry is more pronounced, it can often be improved by choosing different implants for each side.

At our clinic, we use only implants by Motiva and Mentor.

There are two basic shapes – round and teardrop (anatomical) implants. Based on height, width, and projection, we select the most suitable implant for each individual patient.

• Round implants are ideal for women who already have nicely shaped breasts and want mainly to increase volume. The existing shape is enhanced and made fuller, and the cleavage is more noticeable.

Teardrop (anatomical) implants are more suitable for women who want a very natural breast shape.

Motiva implants are made from cutting-edge materials. Their innovative, advanced smooth surface, known as SmoothSilk® or SilkSurface®, offers maximum comfort and protection. The specially engineered outer shell is designed to reduce the inflammatory response and increase biocompatibility with surrounding tissues*, while simultaneously lowering the risk of capsular contracture and late seroma formation**.

Motiva implants are therefore considered sixth-generation implants – the only ones of their kind in the world.

* Reduced inflammatory response in an in vitro study compared with conventional smooth implants.
** Based on published clinical outcomes.

Silicone implants can be inserted using three different approaches:

• through an incision in the inframammary fold (under the breast),
• through a periareolar incision (around the areola),
• through the axilla (armpit).

Based on current experience and research, the safest method with the lowest risk of complications is insertion through an incision in the inframammary fold. This approach allows the most precise creation of the implant pocket. For a long-lasting, aesthetically pleasing result, the tissue must envelop the implant like a glove around a hand.

Using the inframammary approach also reduces the risk of bacterial contamination from the skin, which is more difficult to avoid with an axillary or periareolar incision.

Why is it so important to avoid bacteria?
One of the most common complications after breast augmentation – capsular contracture – has been linked to bacterial contamination of the implant pocket.

If a breast lift (mastopexy) is performed at the same time, the implant can also be inserted through the incision used for the lift – most commonly through a vertical incision, and more rarely via the areola.

An innovative breast augmentation technique using a smaller skin incision that allows faster recovery and a superior cosmetic result.

• 2.5 to 3 cm skin incision, which is 50 to 100% shorter than the standard incision used with many other implant brands
• Special minimally invasive surgical technique and dedicated instruments
• A minor wound means a lower risk of postoperative complications and a faster, more comfortable recovery
• The result is a small, almost invisible scar (2.5 to 3 cm*)

* Depending on the size and type of the selected Motiva implant.

Drains

Drains are clear plastic tubes that surround the implant and remove the small amount of blood or fluid that can collect in the first hours after surgery. Drains are used only occasionally and are usually removed after 6 to 12 hours.

Pain

Pain is generally present only in the first few days. With regular use of the prescribed medication, significant pain is uncommon. Discomfort is usually more noticeable when the implant is placed under the muscle. The pain subsides relatively quickly, improving with each passing day.

Swelling

Swelling and a feeling of tightness are normal and expected after surgery. The décolletage is often temporarily fuller in the early phase. Swelling gradually decreases – most of it in the first few weeks. With submuscular implants, it may take a few months to fully resolve, while with implants placed above the muscle, it subsides considerably faster.

Sutures and scar care

Sutures do not need to be removed, as they dissolve on their own. After 2 to 3 weeks, we recommend applying Micropore tape, which helps the scar to mature more favorably and become less visible. Tape use is recommended for 2 to 4 months.

Movement and return to work

After just a few days, most patients can perform normal daily tasks with minimal restriction. Return to work depends on the nature of your job and on respecting movement restrictions. For 6 weeks after surgery, you should wear a sports bra at all times. During this time, sports or activities that heavily involve the arms, put pressure on the implants, or cause excessive “bouncing” of the breasts should be avoided. After 6 to 8 weeks, most women can resume all activities they engaged in before surgery.

If the implants are placed under the muscle, recovery and gradual increase in activity are somewhat slower. In this case, chest-strengthening exercises and activities that strongly activate the pectoral muscles should be postponed.

Even later on, a good bra plays an important role in maintaining the aesthetic result and preventing tissue stretching and subsequent sagging. Because the implants add extra weight, regular and consistent bra use is strongly recommended long-term.

Capsular contracture

This is a rare complication. It initially presents as a subtle tightening around the implant, barely noticeable. Over time, however, the breast may feel firmer to the touch (Baker grade III). It can later become painful (Baker grade IV). In more advanced cases, the breast shape becomes distorted, and the implant may be pulled upwards. Usually, only one side is affected, which makes the asymmetry even more disturbing for the patient.

Correction requires surgery. The implant and its capsule must be removed, the pocket revise,d and a new implant placed.

If the implants are registered on the manufacturer’s website, Motiva provides a free replacement implant in cases of capsular contracture (Baker grade III or IV) within 10 years of the original surgery.

Implant rupture

This is also rare. The implants we use are filled with cohesive gel, which does not leak into the surrounding tissues even if the shell ruptures. The patient usually does not feel or notice the rupture. It is often discovered when investigating problems arising from capsular contracture.

As the implants are covered by a lifetime warranty, patients are entitled to replacement implants in such cases.

If the implants are registered on the Motiva website, the company provides a free replacement implant in the event of rupture.

Changes in nipple sensitivity

After breast augmentation, all breast tissues must adapt and stretch, including the nerve that supplies sensation to the nipple. Each woman experiences this differently. Sometimes sensation is reduced; sometimes there is an unpleasant tingling or irritation; in rare cases the nipples can be painful. Sensation usually improves over days or weeks, but in some cases only after several months. Very rarely, changes in sensitivity can be permanent.