Breast augmentation
Breast augmentation and augmentation mammoplasty is a cosmetic surgery technique using breast-implants and fat-graft mammoplasty techniques to increase the size, change the shape, and alter the texture of the breasts. Although in some cases augementation mammoplasty is applied to correct congenital defects of the breasts and the chest wall[1] in other cases it is used purely as a cosmetic surgery, primary breast augmentation changes the aesthetics – of size, shape, and texture – of healthy breasts.[2]
Breast augmentation
plastic surgeon
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The surgical implantation approach creates a spherical augmentation of the breast hemisphere, using a breast implant filled with either saline solution or silicone gel; the fat-graft transfer approach augments the size and corrects contour defects of the breast hemisphere with grafts of the adipocyte fat tissue, drawn from the person's body.
In a breast reconstruction procedure, a tissue expander (a temporary breast implant device) is sometimes put in place and inflated with saline to prepare (shape and enlarge) the recipient site (implant pocket) to receive and accommodate the breast implant prosthesis.
In most instances of fat-graft breast augmentation, the increase is of modest volume, usually only one bra cup size or less,[3] which is thought to be the physiological limit allowed by the metabolism of the human body.[4]
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Non-surgical procedures[edit]
In 2003, the Thai government endorsed a regimen of self-massage exercises as an alternative to surgical breast augmentation with breast implants. The Thai government enrolled more than 20 women in publicly funded courses for the teaching of the technique; nonetheless, beyond Thailand, the technique is not endorsed by the mainstream medical community. Despite the promising results of a six-month study of the therapeutic effectiveness of the technique, the research physician recommended to the participant women that they also contribute to augmenting their busts by gaining weight.[136]
Surgical breast augmentation[edit]
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Breast implants[edit]
There are four types of implant:
Complications and limitations[edit]
Medical complications[edit]
In every surgical and nonsurgical procedure, the risk of medical complications exists before, during, and after a procedure, and, given the sensitive biological nature of breast tissues (adipocyte, glandular), this is especially true in the case of fat graft breast augmentation. Despite its relative technical simplicity, the injection (grafting) technique for breast augmentation is accompanied by post-procedure complications – fat necrosis, calcification, and sclerotic nodules – which directly influence the technical efficacy of the procedure, and of achieving a successful outcome. The Chinese study Breast Augmentation by Autologous Fat-injection Grafting: Management and Clinical analysis of Complications (2009), reported that the incidence of medical complications is reduced with strict control of the injection-rate (cm3/min) of the breast-filler volume being administered, and by diffusing the fat-grafts in layers to allow their even distribution within the breast tissue matrix. The complications occurred to the 17-patient group were identified and located with 3-D volumetric and MRI visualizations of the breast tissues and of any sclerotic lesions and abnormal tissue masses (malignant neoplasm). According to the characteristics of the defect or abnormality, the sclerotic lesion was excised and liquefied fat was aspirated; the excised samples indicated biological changes in the intramammary fat grafts – fat necrosis, calcification, hyalinization, and fibroplasia.[137]
The complications associated with injecting fat grafts to augment the breasts are like, but less severe, than the medical complications associated with other types of breast procedure. Technically, the use of minuscule (2-mm) incisions and blunt-cannula injection much reduce the incidence of damaging the underlying breast structures (milk ducts, blood vessels, nerves). Injected fat-tissue grafts that are not perfused among the tissues can die, and result in necrotic cysts and eventual calcifications – medical complications common to breast procedures.
Technical limitations[edit]
When the patient's body has insufficient adipocyte tissue to harvest as injectable breast filler, a combination of fat grafting and breast implants might provide the desired outcome. Although non-surgical breast augmentation with fat graft injections is not associated with implant-related medical complications (filler leakage, deflation, visibility, palpability, capsular contracture), the achievable breast volumes are physically limited; the large-volume, global bust augmentations realised with breast implants are not possible with the method of structural fat grafting. Global breast augmentation contrasts with the controlled breast augmentation of fat-graft injection, in the degree of control that the plastic surgeon has in achieving the desired breast contour and volume. The controlled augmentation is realised by infiltrating and diffusing the fat grafts throughout the breast; and it is feather-layered into the adjacent pectoral areas until achieving the desired outcome of breast volume and contour. Nonetheless, the physical fullness-of-breast achieved with injected fat-grafts does not visually translate into the type of buxom fullness achieved with breast implants; hence, patients who had plentiful fat-tissue to harvest attained a maximum breast augmentation of one bra cup size in one session of fat grafting to the breast.[121]
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