Breast augmentation increases the size of the breasts by using silicone implants, while at the same time achieves a small breast lift and improvement of the breast shape. Although today exists as option the autologous fat method, which promises a silicone free breast augmentation, it has to pass the test of time.

   Breast, as a symbol of femininity, eroticism and maternity, is the predominant feature of the female body. For this reason, breast augmentation is the favorite cosmetic procedure of modern women, offering solutions to their concerns about their appearance. The procedure is applied in cases where the size is small, it has been “emptied”, especially the upper pole, after childbirth or weight loss and when the shape is not normal (tuberous breasts). Personalization and naturality are the two factors that judge the successful aesthetic result of breast augmentation, since size increase is not in itself sufficient to make breasts beautiful. The ideal breast is what fits the woman’s body shape and its beauty is based largely on the aesthetic proportions. Therefore, the correct selection of breast implants results from somatic criteria (height, chest width, existing breast), the wishes of the woman and the experience of the plastic surgeon.

   There are various techniques for breast augmentation, but the dual plane technique that has been proposed by John Tebbets (I had the fortune to be taught by him during my stay in Dallas), combines in the same procedure the following criteria:

1. 1. The implant is placed partially behind the major pectoralis muscle and partially behind the mammary gland (in two levels simultaneously).
2. 2. A particular portion of neurite of major pectoralis muscle is divided in order to be modified by anatomical way the relationship implant-soft tissue (this criterion distinguishes this technique from the old partial under muscle placement).
3. 3. The relationship mammary gland-muscle changes, and this has as a result the change in the dynamic relationship implant-mammary gland.

   There are three (3) types of the technique, depending on the type of breast we have. The difference lies in the third criterion, i.e. in how much the mammary gland will be detached from the muscle.

In the first type (where there is no detachment) fit the normal breasts:

• Without ptosis
• Close adherence gland-muscle
• When the distance nipple-inframammary crease is 4.0-6.0 cm

In the second type (where the detachment reaches the lower limit of the areola) fit the following breasts:

• With a small ptosis
• Loose adherence gland-muscle (the breast is quite saggy and slack in relation to the anterior surface of the muscle)
• When the distance nipple-inframammary crease is 5.5-6.5 cm

In the third type (where the detachment reaches the upper limit of the areola) fit the following breasts:

• With greater ptosis or empty the upper pole (pseudoptosis)
• With very large sagging
• When the distance nipple-inframammary crease is 7.0-8.0 cm
• With tightened or distorted lower pole, such as tuberous breasts

The advantages of the technique are many:

• Reduces the likelihood of capsule contracture
• Reduces the likelihood of visibility or palpation of the implant
• Reduces the likelihood of displacement of the implant sideways
• Better control for normal viewing of the upper pole
• Better overall shape of the breast without being influenced by the muscle contraction
• Better viewing of the lower pole of the breast, as well as the inframammary crease
• It remains in full extent the potential for accuracy in mammography
• It is reduced the postoperative sensitivity and the recovery period with the right technique

   The inframammary incision for placement of the implants is superior to the other incisions (periareolar incision and transaxillary incision) because it reveals better the breast tissue, it offers unsightly scars –since it is just where the breast is creased- and it does not affect breastfeeding. The duration of the procedure is about 45-60 minutes, the woman leaves the clinic with only bandage a waterproof gauze in the incision of 3 cm length which lies in the inframammary crease. It is recommended to wear a sports bra without whalebone for a few weeks. Postoperative symptoms include transient mild pain, swelling, bruising, breast tenderness for a short period of time. Return to work is possible in a few days, while in full activity, like the gym, in 4-5 weeks. The final form of scarring is appeared in 3-10 months. The cost of breast augmentation depends on many factors, such as the technique, the hospital, breast implants etc. All of these will be discussed in the preoperative session, since breast augmentation is a very individualized procedure. The low cost, however, has to concern the women who are interested in breast augmentation, because the discount on the quality of the breast implants can be detrimental to their safety and the durability of the result.

   The result of breast augmentation is almost permanent, provided that the weight is stable.