An underdeveloped breast or a reduction in volume after slimming or after pregnancy can be corrected through augmentation mammoplasty. It is one of the most popular and among the most widespread cosmetic surgery procedures among women.
Mammoplasty can be performed through multiple techniques, each of which presents advantages and disadvantages, therefore it is advisable to identify the most suitable choice according to the specific needs of the patient. It is necessary to evaluate where to locate the incision that will allow the introduction of the prosthesis. Access from the axilla has the advantage of not leaving scars in the mammary region but leaves obvious sequelae in the axillary cavity. Access from the inframammary fold involves an incision that can turn out to be rather unsightly but is most suitable for the large volume implant. Access from the areola is the most practised because it leaves a scar that is not very visible but it can cause temporary alterations to the skin’s sensitivity in this area. Access from the navel requires a very small cut but does not allow for the implantation of silicone implants.
Where should the prostheses be placed? There is the possibility of placing the implant in a superficial position with respect to the muscular plane or in a deeper space. Supramuscular implants are surgically simpler and less painful in the postoperative period but are not very suitable for thin patients because the prostheses are quite evident. Sub-muscular or partially submuscular implants require greater effort, but often result to be more stable and pleasant.
There is also some variability between breast implants. Almost all implants are made of silicone but there are also implants filled with physiological saline solution or coated with polyurethane while, as regards the shape, round and anatomical prostheses are available.
A patient with a breast implant can undergo diagnostic tests such as ultrasound or mammography and can breastfeed without any limitation. Prostheses do not need to be replaced after a few years. Surgery can be performed under general anaesthesia or under sedation in a day-hospital setting or with a 24-hour admission.
The history of augmentation mammoplasty dates back to the middle of the last century. In fact, the first attempt to beautify the breast with the addition of a foreign body dates back to 1942 when a surgeon performed, for the first time, paraffin injections into the breasts with the sole intent of increasing their volume. Between the 1950s and the early 1960s, further attempts were made by surgically implanting spongy or liquid silicone materials, but the first real breakthrough occurred in 1962 when the first silicone implants were introduced. It was a system consisting of a silicon gel mass wrapped in a silastic membrane with encouraging results, however, it presented a significant percentage of complications with the need to replace the prostheses after a short period of time in many cases. In 1965 the inflatable prostheses were introduced and in 1974 so were the double-lumen implants, but a significant step forward occurred in the 80s with the introduction to the market of silicone gel implants with a reinforced and textured surface. A further improvement occurred in 1992 with the appearance of anatomically shaped prostheses on the market; these are silicone gel implants that best reproduce the shape of a natural breast.