Breast augmentation remains one of the most requested plastic surgery procedures. Over the years I have made important changes to my technique, and I want to explain what they are and why I made them.
I stopped using textured implants.
Textured implants were useful: their rough surface helped keep the implant in place. But in 2019 France banned macrotextured implants because of their association with a rare type of implant-associated lymphoma. Since then, I have not used textured implants.
Implants with a 4-micron surface texture
The alternative was implants with a nanotextured surface of around 4 microns, classified as smooth. Research into implant surfaces has found that this minimal roughness produces the least inflammatory response in the body.
These implants have been on the market for sixteen years. During that time, they have been associated with very thin capsules — exactly what we want to see. A thin capsule is a sign that the body is tolerating the implant well.
Adapting was not easy. A smooth implant does not stabilize in the same way as a textured one and requires a very precise placement technique. Once mastered, however, it allows the same stability.
Why I do not use anatomical implants
Anatomical implants are teardrop-shaped, with more volume at the bottom and less at the top. In theory they better imitate the natural breast shape, but they have a drawback: if they rotate inside the pocket, the shape changes and the teardrop turns sideways.
For years, texture kept them in place by adhering to the tissue. Without texture, an anatomical implant depends on additional fixation to prevent rotation, and any failure of that fixation becomes visible.
Today, round implants with new-generation gel take on a natural teardrop shape when standing and become round again when lying down. They provide the shape sought with an anatomical implant without the risk of visible rotation. That is why I use them.
Always behind the muscle
Today, I am more convinced than ever of the benefits of placing the implant behind the muscle: greater long-term stability, an implant that is less noticeable to the touch, and a more natural appearance.
The internal bra
Perhaps the most important change. It involves joining two layers of tissue at the fold beneath the breast to support and stabilize the implant, like an internal bra. Many patients do not want to rely on a bra, and this technique provides that support.
Combining implants with fat transfer
I have always been cautious with new techniques because I do not like experimenting on my patients. Hybrid augmentation appealed to me, but I had a question: could calcifications left by fat transfer be mistaken for cancer on a mammogram?
I took time to study it. Evidence shows these calcifications are uncommon and radiologists can generally distinguish them from those suggesting malignancy. Fat is placed only beneath the skin, in the subcutaneous tissue, never inside the gland. This improves cleavage contours and the transition between implant and chest, especially in very slim patients.
Lower profiles
An implant's profile describes how far it projects forward. Early in my career, I used high-profile implants to fit more volume into a smaller space. Today, I use low and moderate profiles. I came to understand that my patients were not looking for very large breasts. They wanted to wear a backless dress without a bra and look natural.
What these choices have in common
Low- or moderate-profile implants, behind the muscle, with an internal bra and fat transfer to the cleavage area. The aim is a stable, lasting result that withstands pregnancy, weight changes and intense exercise. Having implants is a long-term commitment; my job is to make that commitment require as few operations as possible.
References
- Doloff JC, Veiseh O, de Mezerville R, Sforza M, Perry TA, Haupt J, Jamiel M, Chambers C, Nash A, Aghlara-Fotovat S, Stelzel JL, Bauer SJ, Neshat SY, Hancock J, Romero NA, Hidalgo YE, Leiva IM, Munhoz AM, Bayat A, Kinney BM, Hodges HC, Miranda RN, Clemens MW, Langer R. The surface topography of silicone breast implants mediates the foreign body response in mice, rabbits and humans. Nat Biomed Eng. 2021;5(10):1115-1130.
- ANSM. Implants mammaires. Comunicación del 4 de abril de 2019.
- Hanson SE, Kapur SK, Hwang RF, Dryden MS. Autologous fat grafting in breast reconstruction: implications for follow-up and surveillance. Gland Surg. 2021;10(1):487-493.
- Motiva. Con Motiva, la elección del implante de pecho para cualquier forma y tamaño nunca ha sido tan fácil.