Breast augmentation is one of the most popular and requested procedures in cosmetic surgery. This is why patients must be well informed about the various approaches for implants placement. They influence the durability of the aesthetic result, scarring and the necessity of replacing the implants.

Jessica C. – Patient Testimonial regarding breast augmentation in Serdev Clinic [e-mail from October 2018]

“I am a past patient of yours, having undergone breast augmentation surgery in 2012. I must say, the procedure itself was fantastic, and I have not had any trouble since.” 

Placement Location of Implants

1. Under the pectoral muscle, without weighing on the skin (subpectoral implants)

We place the implants under the muscle and they do not drop, because the muscle holds them in place. Due to the larger “pocket”, the result is natural. The bust is soft to touch and takes the natural body movement. Regular movement of the implants maintains the free space (pocket) and when touched, they will feel and move as natural breast tissue.

NB!! Only the pectoral muscle can hold the heaviness of the implants! Implants should be smooth and able to move naturally, without irritating or hurting the muscle. Textured implants get blocked under the muscle.

2. Over the pectoral muscle and below the gland, adding heaviness on the skin (subglandular implants)

Many surgeons prefer placing the implants above the pectoral muscle (under the gland and skin). However, this approach has a major disadvantage – the implants are too heavy and the skin alone cannot support them. Thus, in a few years the skin loosens and lengthens, breasts sag. What could be done then? In most cases, surgeons propose replacement with bigger implants, scarring mastopexy, or both.

Mastopexy is a method for reduction (lifting) of the ptotic breasts by excising the excess skin. Patients, especially young women, should gather information about the disadvantages of subglandular breast augmentation and the subsequent, sometimes multiple surgeries!

3. Under the fascia of the pectoral muscle

This method was not able to achieve wide acceptance. It consists of placing the implants above the muscle, but under its facsia, which has to support the impltans’ weight. It is suitable when surgeon is introducing the implats via incision in the armpits.

4. Half under the muscle and half under the gland

There is also an approach for placing the implants from under the breast, half between the muscle and half between the gland (or even the skin, because the gland is often small). In these cases, when the muscle contracts, it squeezes the upper half of the implant while the gland and skin in the lower part do not offer stable support. Thus, the implants can move downward in another position. In some cases implants can prolapse though the infraglandular incision.

Composition of the implants

In our opinion, saline implants are the best choice – they consist of an absolutely harmless sterile salt water solution. This is the same solution, which is transfused to all patients. It is unclear why they are not always presented to patients, which is mandatory in the USA and saline implants are used in 52% of all cases.

According to a publication from the Amrican Society of Pastic Surgeons, FDA allows the use of saline implants for breast augmentation to all women over the age of 18, as opposed to silicone implants, where the minimum age is 22. Anatomycal (teardrop shape) implants are heavy in their wide lower part. They may rotate after a sudden push, which requires surgery for their repositioning. In addition, when lifted with a bra, their upper and narrower part may protrude unnaturally, unlike round implants.

Smooth saline implants placed in a wide pocket under the pectoral muscle are softer than silicone implants with cohesive matrix. As our patients say – they move quite naturally, as thout they are “alive”.

Breast augmentation surgery lasts about 40 minutes. The shape of the breasts remains permanent. Saline implants do not require replacement. In contrast, silicone implants may need to be removed or replaced periodically. Patients can safely travel by airplane, but should protect the breasts from injury, unnatural pressure etc.

It is not necessary to wear a bra when the breast implants are placed under the mucle. If the patient chooses to do so, she must remove the busks to avoid hurting the breast tissue and changing the form of the new infra-mammary fold.

Implant Placement Approaches

There are several approaches for breast augmentation. The incisions for placing the implants can be under the breast, in the armpit, around the lower half of the areola, or the navel.

Periareolar Approach

Most harmless and with least noticeable scars is the periareolar approach – incision on the border between the brown areola and skin. This is the most atraumatic access, going through the avascular plane (no blood vessels), without damaging any structures. The surgeon opens the muscle in its upper part, by separating its fibers without cutting. Therefore, there is no risk of postoperative prolapse (implant slipping out of position). The implants are placed in the free space under the muscle.

Surgery is bloodless and relatively fast. Due to the lack of trauma, pain is minimal and patients do not have social limitations. They can resume their regular daily activities on the day after surgery or within the following few days. Patients wear a tape in the wound between the areola and the skin for some days. Patients come for follow-up and post-op care, changing tapes and so on for 3-5 days. We recommend that patients do not wear bras, but rather elastic garments. in order the implants heaviness to keep and preserve the new lower folds of the pocket.

Incision under the breast

The approach with incision under the breast is most frequently used by the majority of surgeons. This is because the use of not sufficiently elastic, textured silicone implants requires a bigger excision. If the surgeon has to place the implants under the muscle with this approach, he must also cut the muscle. This makes healing more difficult, because the implant weighs on the stitches.

Incisions under the breasts and in the armpits are visible when the woman is in a laying position!

Possible complications

Rare complications, which you should be aware of, are the following:
– Early complications: bleeding around the area of the implant, infection, implant slipping under the incision or prolapse;
– Late complications: disturbances of touching sensation around the nipples, capsule contracture and dislocation of the implant (one-sided in most cases), implant rupture (in rare cases).

Breast Augmentation and Ptosis

In some cases of breasts ptosis after breast augmentation with implants, we can use scarless Serdev Suture method for Breast Lifting to elevate the breasts to a suitable level. The ptosis may be a result of giving birth and lactation, ageing etc. Dr. Serdev uses only a couple of skin puncture points to perform the procedure. There are no incisions and excisions of skin and therefore – no scars! In cases of more expressed ptosis, we may perform the procedure in stages.

The suture lift cannot be used however in patients with implants placed over the muscle (because of the implant heaviness), as well as in very large breasts.

Dr. Serdev’s method is also useful in corrections for treatment of Poland Syndrome, for lifting the developed breast and augmenting the underdeveloped breast.

Repositioning of Breast Implants in Symmastia and False Position

The Serdev Sutures method presents a new possibility for repositioning breast implants in cases of false position and symmastia. Symmastia is a condition defined as a joining of the breast tissue of both breasts across the midline anterior to the breastbone. It can be congenital or as a consequence of breast augmentation.

The surgeon performs this procedure through skin punctures only, in order to suture and fixate the stable fascias above and below the implant. Thus, we create a new, proper lower and medial line of the augmented breasts and also correct the implants’ position.

Wearing of elastic garments or a bra could be necessary for some weeks after surgery, in order to reduce the weight on the implants on the sutures.

Breast augmentation using fat transfer

This technique exists, but is not widely accepted.

Read more – Serdev Sutures Buttock Lift; Liftings of the body; Liftings of the face; VASER Ultrasonic Liposculpturing

Results

The accumulation of subdermal fat in the abdomen and lumbar region is due to poor diet and stagnant way of life. Once gained, these accumulations can not be eliminated through diet, because fibrous-degenerative processes arise. Typical male problems are the emergence of the so-called “beer belly” and gynecomastia. They are also hormonally determined.

Due to hormonal differences, women accumulate fat subdermally and men – in the abdominal cavity. For this reason, this procedure is more effective in women and they can more easily get a “flat stomach” (abdomen). Depots in the area of the “love handles” appear alongside accumulations in the belly area and must be removed together. Depots in the back area appear in a later stage and are a sign of overall gradual obesity. It rarely is only genetically determined.

Liposuction of the belly, love handles, breast and back is one way of approaching the problem and remove the accumulated fat depots. Diabetes (or predisposition to this condition) will improve, as well as high blood pressure.

Body contouring using VASER ultrasonic liposculpture: belly, love handles, breasts, and back in obesity and cellulite

The best method for removing the fat depots is VASER ultrasound liposculpturing. It is a form of liposuction where we liquefy excess fat using sound waves, which are harmless to adjacent tissues. These are blood and lymph vessels, nerve branches and connective tissue. Removing the liquefied fat tissue is smooth and without blood loss, under very low pressure. The fat cells cannot build up in the same places again, because they have been destroyed.

Traditional liposuction also cannot deal with these problems, due to the lack of precision, the trauma it can cause to neighbouring tissues and blood loss. It cannot easily treat fibrous areas, such as male breast, upper abdomen, back and buttock areas.

Here you can find a detailed description of VASER ultrasonic liposculpturing, as well as comparison with other liposuction methods.

VASER lipo is an outpatient procedure, done through skin puncture only, under local anesthesia. In addition, UAL has a lifting effect. It refreshes the skin, which tightens, while preserving its elasticity.

We treat Gynecomastia in men in the same way – through skin punctures in a hidden spot. Thus, we define chest muscles, which in combination with narrow waist and flat stomach, makes the male figure attractive. High definition six packs are also easier to obtain with this technology.

The atraumatic nature of VASER liposculpturing also makes possible to combine liposuction of the breast, back, belly and love handles with fat removal from other areas of the face and body, depending on patient characteristics.  We can also do various liftings using scarless Serdev Sutures Lifting method.

After the Liposculpturing Procedure

After the procedure, we prescribe antibiotics for 5-7 days and painkillers for the first night (and after, if necessary). We do daily follow-up sessions for 5 to 7 days. These sessions include showering, disinfection, bandages and change of elastic bandages.

Most important during the days in the early post-op period is the follow up for fluid retention or collection, so as to prevent formation of painful seroma and infection at a later stage. Daily follow-up is crucial in the first days and we have not observed late complications. Patients wear elastic garments 24/7 for a month, preferably a month and a half. Of course, during this time, they are free to follow their normal daily activities.

The result is durable. The immediate result shows much better form of the body and extremities. Swelling will be minimized in the next 3 months. VASER causes fat tissue to liquefy detach from the cells. Thus, the body treats it as a foreign body and fights its own fat tissue enzymatically. The vascular system generalises this process and as a result we observe weight loss during the first 6 months. After this period, patients must maintain their weight.  The final result becomes better and better during the course of the first year, along with losing weight and reduction of swelling.

Massages on the treated areas are strictly forbidden! This is because skin movement can break the newly formed capillaries! As a resutlt, there will be growing of edema, extension of the recovery period and loosening of skin fixation.

Results