Breast augmentation surgery involves placing breast implants to increase breast size. There are two main types of implants - silicone and saline. Implants can be placed above or below the chest muscle through various incision sites. Recovery takes 1-2 weeks with limited physical activity, though some discomfort may persist for 6-8 weeks. Potential complications include capsular contracture where scar tissue forms around implants.

1. Lotus Medical Int.
Breast Augmentation
The future of Medical Tourism

2. In this module
• Breast augmentation introduction
• Breast augmentation surgical procedure
• Different types of breast implants
• Breast implant placement
• Types of incision
• Round and Teardrop implants
• Implant profiles
• Recovery from breast augmentation
• Possible complications
• Other important information

3. Learning outcomes
By the end of this module you will:
• Understand the Breast Augmentation surgery
• Know the different types of implants available.
• Know some of the complications that may arise

4. Breast Augmentation

5. Surgical Procedure
• General Anaesthetic
• 1 - 2 Hours
• 1 night in hospital
• Minimum 10 day stay recommended, surgery in BHP can facilitate
shorter stays
• Implants placed through incision under the crease in the breast or
underneath the armpit.
• We do not offer surgery though the nipple as it can desensitise
the breast and stop the ability to breast feed.

6. Types of Implants
• There are two primary types of material used in breast implants,
silicone-filled and saline-filled.
• In both cases, the implants have a silicone shell, but while silicone
implants are also filled with a silicone material, saline-filled
implants are filled with a sterile and contained saltwater.
• Overall, silicone is lighter in weight than saline, and after proper
healing, they tend to have a more natural soft feel. Saline-filled
implants are generally lower in cost, and although they may sound
like they are simply filled with water, causing many women to
worry about leakage, in fact they are created from a gelatin-like
material that resembles a solid more than it does a liquid.

7. Types of Implants
• More rupturing with saline
• Years ago they were taken off the market now back
• Saline is filled once inserted so more likely to rupture

8. Breast implant placement
Breast implant can be placed by any one of four different methods:
• Sub-glandular Breast Implant Placement (also known as “Overs”):
The breast implants are placed below the breast gland but above
the muscle. The term ‘over’ derives from the placement of the
breast implant over the muscle.
• Partial Sub-muscular Placement (also Known as Dual Plane
Placement): This placement has many names, but essentially the
implant is placed partially below the muscle. This can also be
referred to as partial submuscular, partial subpectoral, and,
although it’s not really correct, submuscular and subpectoral.
Sometimes people even refer to this placement as ‘unders’, but
that term should really be used for complete submuscular
placement.

9. Breast implant placement
• Complete Sub-muscular Breast Implant Placement (also known as
“Unders”): Here the breast implant is placed completely below the
muscle. This is correctly referred to as submuscular or subpectoral.
• Sub-facial Breast Implant Placement: There is a thin layer of tissue
called the fascia covering the muscles of the chest. Some surgeons
will separate the fascia from the muscle and place the breast
implant under the fascia. Sub-fascial placement is offered by few
plastic surgeons.

10. Types of incision
There are four primary incision methods used to place the implant in
breast augmentation. These methods are:

11. Types of incision
• The most common is the inframmary incision. One benefit to this
method is that both silicone implants and saline can be placed
through the incision. Additional benefits include the greater
likelihood the procedure will not inhibit breast feeding along with
the reduction of possibility for breast asymmetry resulting from
inaccurate placement. Some women, however, are not fond of this
method in breast enhancement because of the noticeable scar it
leaves.
• The transaxillary and transumbilical methods are excellent methods
to hide the scar because both types are well away from the breast.
Due to the distance away from the breast, however, only saline
implants can be placed this way because they are not filled until
they are placed. One possible concern with either of these
methods is that the surgeon may have more of a difficult time to
place the implant in its ideal location for natural looking results.

12. Types of incision
• Under the breast is much less invasive

13. Round & Teardrop implants
Breast implants also vary according to shape, with the primary choices
being round or teardrop shaped.
Round breast implants
•Round breast implants are the most common choice for breast
augmentation surgeries, since they have the ability to create the
maximum amount of lift and fullness in the breast. They provide more
fullness on the top of the breast, which can enhance the appearance
of the woman’s cleavage.
•However, some women feel that round implants look artificial, and
prefer the less pronounced appearance of the teardrop implants.

14. Round vs. Teardrop
Teardrop Implants
•Teardrop implants create a naturally sloping breast contour, with the
majority of the breast volume being placed on the lower portion of the
breast as opposed to the top.
•Teardrop implants do not provide as much cleavage enhancement as
do round implants, but they can provide a more anatomically natural
appearance.
•Round implants are less expensive than teardrop implants.
•Additionally, using round implants eliminates the concern of the
implant slipping and changing position, since even if some rotation
occurs, the symmetrical shape will prevent an unnatural breast
contour. A consultation with the doctor can help determine which
type of breast implant is right for the patient depending on their
desired look.

15. Round vs. Teardrop
Teardrop Implants
•Teardrop offered in women with little breast tissue and a round
implant will not have an natural look.
•They are quite often offered to women with a VERY slight droop in
the breast as it can slightly raise the level of the nipple line
•They will not be offered to people who are highly active or do a lot of
sport due to the high risk of rotating.

16. Implant profiles

17. Implant profiles
• Profiles are available in either low, moderate, or high. The decision
upon which is right for the patient is going to be highly dependent
upon what the surgeon determines is necessary to achieve the
desired look.
• Lower profiles tend to be used for women with a wider breast
diameter, such as is normally the case for women with a bra band
size of 38 inches or greater.
• Higher profiles might be more appropriate for a woman with a
smaller breast width but who wants a larger breast size such as a D
cup or DD cup.
• The higher profile implant will have a smaller diameter so that it
can fit within the dimensions of the breast, but will offer a higher
projection so as to achieve the goal size.

18. Recovery
• This question depends upon a variety of issues, not the least of
which is the size of the implant. The larger the implant the greater
the skin tissue and muscles will need to stretch which can increase
the intensity and time to recover. Additionally, health, incision
method chosen, and attention to recovery instructions can impact
the length of the patients recovery.
• That said, recovery from Breast Augmentation Surgery is usually
very easy. Most patients describe a feeling of being
‘uncomfortable’ rather than being in pain.
• Patients can start non physical activities within a few days.
• Patients cannot swim until the incisions have healed over, usually
about 10 – 14 days..
• Patients can resume physical activities after 6 – 8 weeks

19. Possible complications
• The most common is capsular contracture. This occurs in less than
5% of patients. The body recognises the implant as a foreign object
and the immune system starts to attack it forming a capsule around
the implant. This can eventually lead to hardening of the Implant
which may after time mean that the surgery needs to be redone.
• Capsular contraction is twice as high in smokers as in non-smokers.
• Regular massage stops capsular contracture and textured implants
• If you have CC once its likely t happen again
• CC can only be corrected through the removal of the implant or
removal and replacement. Some surgeons will replace them some
will not, this is dependent and on the surgeon and the patient.

20. Other important information
Do I need a sports bra?
Surgeons suggest these some don’t. If you are sure about what size you
would like to be after your surgery then take a bra with you. Buy it at a
shop where you can return it just in case you do not use it. Otherwise we
can advise you on where to get one when you are here.
They are not included as part of the package and you can buy one from
your medical host of a sports store.
What is the difference between Breast Augmentation and Breast Lift?
Many women who want to change the shape of their breasts think that
Breast Augmentation is the way to do this. Breast Augmentation does not
alter the shape of the breasts it only makes them larger. If women are
unhappy with the shape of their breasts due to sagging then a Breast Lift or
possibly Reduction is required. This is where the level of the nipple is lifted
and it is much more inlvoled surgery than just Breast Augmentation alone.
Quite often Breast Lift Surgery is done in combination with Breast
Augmentation Surgery.

21. Should I go Over or Under the muscle
• The trend towards placing under the muscle developed in the early 1990s
as saline implants were the only choice for women to use. Prior to that,
silicone implants were placed over the muscle because they would create a
fuller looking breast and the implant would not show through the breast
tissue.
• If placed over the muscle, the saline implant can actually show a rippling
effect through the breast tissue creating an unnatural appearance.
• Now that silicon implants are back you may find more surgeons
recommending placement of the implant either over the muscle or only
partially under the muscle.
• Over or under will be decided during the consultation and depend on the
expected look the patient wishes to achieve.

22. How soon can I return to work
• Generally speaking it is advisable to take at least 7-10 days off work after
breast augmentation.
• Remember, in most cases the patient will be required to stay in Thailand
for 9 days after surgery. Meaning they should be fine to return to work
once they get back home.
• It would be advisable not to return to work while still taking prescription
pain medications.
• If you job involves heavy lift or physical activity you may need to discuss
your return to work with your surgeon.

23. How soon can I exercise
•There should be no physical activity for the first two weeks, with the
exception of static stretching.
•At weeks 2 – 6 The patient can add light cardio and lower body workouts but
be smart about impact! They won’t don’t want to be trying out their newfound
bounciness on the treadmill for at least the first four weeks.
•They should stick to low or non-impact machines like the elliptical or the
stationary bike. It’s ok to work hard. Remember it is only 2 weeks post op, and
the implants need time to settle and heal properly.
•At 6 weeks after surgery, they can start slowly back into resistance training
with low-weight, high-rep exercises designed to recondition the pectoral major
and shoulder girdles since they will be weak and tight. Put into practice, this
means starting with kneeling push-ups and light dumbbell bench presses.
These upper body exercises are not to be attempted until after 6 weeks in
submuscular patients and breast reconstruction patients.

24. I want to go from a B cup to a D cup
•Implants do not come in cup sizes it is not possible to ask for a D cup implant.
Instead, implants are available in sizes measured in cubic centimetres such as
250cc, 375cc, 450cc and so on. These differing sizes range from as small as
100cc to as much as 1200cc, with the average size measuring about 350cc.
•Since the body of each patient is different, the different implant sizes can look
quite different on each body. This is why it is important o focus on the
approximate size the patient would like to end up.
•They can communicate this accurately to the doctor during the consultation
so they can decide upon which breast implant size will achieve their desired
look.

25. Knowledge check
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26. Recap
By now you should:
• Understand the Breast Augmentation surgery
• Know the different types of implants available.
• Know some of the complications that may arise