Breast Augmentation

What is breast augmentation surgery?

Breasts may be small due to structural reasons or various causes such as trauma, burns, cancer surgery, or infections. One breast may be smaller than the other, resulting in asymmetry. Surgeries performed by placing a prosthesis inside the breast to equalize both breasts or increase their volume are called breast augmentation surgeries. However, today the concept is not only about enlarging the breasts but also about reshaping them and giving them a form that is proportional to the body.

What is a silicone breast implant?

Silicone breast implants, which have been used since the 1960s, are balloon-like silicone elastomer structures prepared in the shape of a breast and can be round or teardrop-shaped. Silicone implants are made from the silicone element, which naturally occurs and forms silica when combined with oxygen. Silicone is actually present in many materials we use every day at home, such as polishes, sunscreen and hand lotions, soap, processed foods, waterproof coatings, and even chewing gum. They come in round or teardrop shapes and in different heights. Depending on how silicone is processed, it may have a liquid, gel, or rubber-like structure. The outer shell of the implant is made of rubber-like silicone, while the inner part that provides the softness of the breast is made of silicone gel.

Are silicone implants safe?

Silicone is present in small amounts even in pasteurized cow's milk that we consume daily and even in baby formulas. In fact, this amount has been found to be higher than the silicone level in the breast milk of a mother who has silicone implants and breastfeeds her baby. In other words, living with silicone implants and breastfeeding a baby is not considered harmful.

Do silicone breast implants cause cancer or other diseases?

As a foreign object, silicone implants have been subject to some accusations. It has been claimed that they may cause connective tissue diseases, make breastfeeding difficult, or even lead to cancer. However, none of these claims have been scientifically proven. Research conducted by the FDA (American Food and Drug Administration) and various universities has demonstrated that silicone implants do not cause cancer and that the risk of developing cancer in breasts with implants is the same as in natural breasts. It has also been shown that silicone implants are not associated with chronic diseases in the body, especially rheumatic diseases, and do not cause them. Women and all people are constantly exposed to silicone in daily life.

What are the shapes and sizes of silicone breast implants and how is the implant selected?

Implant sizes are measured by volume rather than bra size, and the volume to be used is determined according to the patient's needs and body proportions (such as implants ranging from 120 cc to 350 cc or larger). However, implant volume alone is not sufficient to determine the implant to be used. The patient's body shape is one of the most important factors (for example, a slim and tall body type, a proportionate body type, or a shorter and heavier body type). In addition, chest width and the distance between the nipple and the collarbone, in other words the degree of breast sagging, are very important in implant selection. By measuring these ratios and evaluating the body proportions, selecting a silicone implant suitable for the breast is essential to achieve the desired shape. Today, breast augmentation with silicone implants does not simply mean increasing breast volume but rather reshaping the breast to fit the body proportions.

For this purpose, there are many implant options available with different shapes, sizes, surface types, profiles, and volumes. In general, silicone implants today come in round and anatomical (teardrop) shapes. Both types may contain silicone gel or saline solution. To increase the breast profile, there are many options ranging from low, moderate, moderate plus, high, to ultra-high profiles. These profile options are available in both round and anatomical implants.

Implant surfaces can be smooth and shiny or textured. Textured implants are generally preferred because the risk of capsule formation around the implant is lower. Polyurethane-coated implants are also available. All of these implants contain silicone-based cohesive gel that mimics the softness of natural breast tissue. Even if the implant is cut in half, the gel remains together and does not flow like a liquid. This means it has a "shape memory" and maintains its form. This reduces the chance of silicone gel leaking outside the implant boundaries. For this reason, plastic surgeons often prefer cohesive silicone gel implants over saline-filled implants.

Which incision techniques are used in breast augmentation surgeries?

There are three different incision locations used in breast augmentation surgeries. These are the underarm incision (transaxillary), the incision around the nipple (periareolar), and the incision under the breast fold (inframammary), each about 4–5 cm in length. Each method has its own advantages and disadvantages. Before the operation, the surgeon determines the placement site based on the patient's body structure, breast tissue amount, and skin elasticity.

How long does the operation take and where is the implant placed?

The surgery is performed under general anesthesia in a hospital environment and takes approximately two hours. Silicone implants can be placed between the chest wall muscle layer and the breast tissue (subglandular), under the fascia covering the muscle (subfascial), or directly under the muscle (submuscular). The placement location is determined according to the structure of the breast tissue, skin quality, elasticity, and thickness of the breast tissue. In some cases, the implant may be placed partly under the muscle in the upper part and under the breast tissue in the lower part, known as the dual-plane technique.

When can normal life be resumed after surgery?

The postoperative period is usually comfortable and pain is minimal. Arm movements may be restricted for about two weeks. Supportive dressings similar to a bra are applied over the breasts for the first five days. This helps stabilize the implant position and reduce pain. Patients can return to sedentary social life and desk work within 3–4 days and can start showering. The special support bra can be removed after the third week, and special massages are recommended to prevent capsule formation around the implant. Returning completely to normal life and heavy sports activities may take 3–6 weeks depending on the patient. In some cases, wearing a support bra during the daytime until the sixth week is recommended.

Can silicone breast implants cause deformity in the future, and what is capsular contracture?

In these surgeries, a foreign material is used to enlarge the breast. Around the implant, the body forms a healing tissue reaction as part of the immune response to a foreign object, which eventually develops into a membrane-like capsule. Postoperative infections (especially those related to biofilm formation), seroma (fluid accumulation), and hematoma (blood accumulation) can increase capsule formation. This capsule may vary in thickness. A thin capsule does not cause problems, while a moderately thick capsule may lead to mild hardness and the implant becoming more noticeable. In rare cases, a thick capsule (grade 3 capsular contracture) may form, causing hardness, distortion, pain, indentations, and asymmetry.

What can be done to prevent capsule formation?

To prevent capsule formation, it is important for the patient to perform the massage recommended after the third week regularly and take certain medications. Mild capsular contracture can usually be prevented or softened with massage. Your surgeon may also recommend additional medical treatments such as vitamin E.

What can be done if capsular contracture occurs?

In moderate cases of capsular contracture, the surgeon may manually break the capsule tissue through external capsulotomy. However, if performed too forcefully, it may damage the implant. In cases where pain and stiffness are severe, surgical intervention becomes necessary. The implant may need to be removed or replaced, the capsule tissue cleaned, and a new implant placed. In some cases, the capsule may be released (capsulotomy) and a new implant placed. However, capsular contracture may recur in some patients.

Can silicone implants rupture or burst?

Silicone implants are highly resistant to external impact. Pressure, compression, or massage applied from outside does not damage the implant. Patients can lie face down two months after surgery. Implant rupture is rare and usually occurs due to severe trauma such as traffic accidents, falls from height, or injuries caused by sharp objects. In such cases, the implant must be removed.

Do silicone implants affect mammography or radiological imaging?

Digital mammography and MRI used in breast screening do not produce incorrect results in breasts with implants. In other words, implants do not interfere with imaging. Implants do not hide or mimic cancer in mammography. However, patients over the age of 40 should inform their doctor and the technician that they have silicone implants when undergoing routine mammography.

Can silicone allergy occur?

Allergic reactions can develop in some people against various substances, although this is rare. Silicone is one of the substances that can rarely cause allergic reactions. However, it is important to note that people are already exposed to silicone in daily life through items such as sunscreen, waterproof plastic containers, soap, antiperspirants, and chewing gum. Therefore, silicone allergy is extremely rare.

Do silicone implants need to be replaced after a certain period?

No, silicone implants can remain safely in the body for many years without causing problems and do not require replacement. However, implants may need to be removed in cases of severe capsular contracture that causes pain, deformity, or asymmetry. This condition may occur in some women after a few years and in others after 10–20 years, although the rate is very low (about 2%). Other reasons for replacement may include breast sagging, a desire to change implant size or type, implant deflation, or displacement.

Can I use a solarium or sunbathe with silicone implants?

Solarium use and sunbathing are not directly related to implants, but UV rays may darken the surgical scar and make it more noticeable. Therefore, solarium should be avoided during the first year and high-SPF sunscreen should be used during the summer.

Can I scuba dive or travel by airplane with silicone implants?

Silicone implants do not prevent scuba diving or air travel. When flying, air pressure decreases as altitude increases, which may slightly relax the capsule around the implant and create small air bubbles. Conversely, during diving, increased pressure may compress the implant slightly. These pressure-related changes usually resolve within 24–48 hours and are not noticeable to the patient.

When can I wear underwired or push-up bras?

The first three months are important for wound healing and proper positioning of the implant. During this period, wearing underwired or push-up bras may put pressure on the newly formed breast fold and cause indentations or visible scars. Therefore, such bras should be worn only after three months.

Can implants cause tension or stretch marks on the breasts?

This may occur if very large implants are chosen. Implant volume is directly proportional to weight. For example, a 300 cc implant weighs approximately 300 grams, meaning both breasts together may carry about 600 grams. This weight may lead to stretch marks due to gravity. However, stretch mark formation also depends on the patient's skin elasticity and quality, so it cannot be said that everyone will develop them.

Does smoking affect recovery?

Smoking causes blood vessels to narrow and reduces blood flow to the surgical area. Oxygen and nutrients required for wound healing are carried through the bloodstream, so smoking can delay healing. It may also increase the risk of capsular formation and tissue necrosis. Therefore, patients are advised to stop smoking at least two weeks before and after any plastic surgery procedure.

Will nipple sensitivity be lost?

If silicone implants are inserted through the nipple, changes in nipple sensitivity may occur. These changes can range from mild decrease in sensation to complete loss, or from increased sensitivity to discomfort. These changes may be temporary or permanent. This issue is generally not seen when implants are placed through the breast fold or the armpit.

Do weight changes affect implants?

It is important to be at your ideal weight before implant surgery. When you gain weight, fat tissue in the breast increases and the breasts become fuller. When you lose weight, breast tissue decreases, which may lead to sagging even with implants.

Is age important for breast implant surgery?

No, anyone who has completed puberty and is healthy can undergo breast implant surgery at any age.

Do breast implants affect pregnancy or breastfeeding?

A woman with silicone implants can become pregnant and breastfeed after pregnancy. Changes in breast size and sagging depend on weight gain during pregnancy and skin elasticity. If the implant is placed through the nipple, there may be slight damage to the milk ducts, which may slightly affect breastfeeding ability. The amount of silicone found in breast milk is not different from that in mothers without implants. However, breastfeeding-related nipple cracks or damage may lead to mastitis (breast infection), which can increase the risk of capsule formation around the implant. Early antibiotic treatment after consulting a doctor can reduce this risk.