Breast augmentation

Breast augmentation

all treatments

Why choose a breast augmentation?

If you are dissatisfied with the size of your breasts due to limited natural breast development, significant weight loss, or sometimes after pregnancy and/or breastfeeding, breast augmentation may offer a solution.

If there is also noticeable skin laxity, it may be necessary to combine the procedure with a breast lift (“mastopexy”). The plastic surgeon can advise and assist you in making this decision.

How does a breast augmentation proceed?

The consultation(s) before the procedure is a key factor in the success of your breast augmentation. During this appointment, the plastic surgeon will discuss your wishes and, based on your body type, suggest the best approach to achieve your desired result. This may involve breast implants, which come in a variety of sizes and also in different shapes (round or teardrop). Of course, your input is essential in this decision-making process.

The surgeon will also determine the access point for placing the implant—either through a small incision under the breast or at the edge of the areola—and whether the implant will be placed directly under the breast gland or one layer deeper, beneath the chest muscle. Both methods are effective, and your surgeon will explain which option is best suited for you and why.

The procedure is performed under general anesthesia and takes about an hour. During the operation, your surgeon will briefly bring you into a seated position to place the implant in exactly the right location. The incision is closed meticulously in three layers using absorbable sutures. At the end of the surgery, you will be fitted with a supportive bra, which we will provide.

If fat injection (lipofilling) is used, your surgeon will first discuss with you the areas from which fat can be harvested. This is done through one or two tiny incisions of 3–4 mm, which will become virtually invisible to the naked eye over time. The fat is removed in an aesthetically pleasing way, so you essentially receive a complimentary body contouring. The harvested fat is then filtered, separated from fluid, and reinjected through thin cannulas into numerous small channels within the breast tissue. This technique ensures that the fat remains stable and receives sufficient nourishment during the healing process. At the end of the procedure, you will also be fitted with a bra.

In most cases, a compression garment or “lipopanty” is also necessary. This is a supportive, elastic garment that you will need to wear for 4–6 weeks after the surgery to support the areas where fat was removed. You will need to purchase this garment yourself prior to the procedure.

What is a breast augmentation?

There are two methods to enlarge the breasts: using implants or using your own tissue.

Most implants consist of a silicone shell filled with a material designed to feel as natural as possible. Silicone gel is compressible, similar to natural breast tissue, which makes silicone-filled implants feel the most natural. There are also breast implants filled with saline (salt water), which is very neutral, but because water is not compressible, these implants often feel like a "bag of water." We do not recommend this type.

The surface of the breast implant plays an important role in both the short- and long-term outcomes. At Tonnard & Verpaele, we have been using implants with a micropolyurethane surface for over 25 years. A major short-term advantage of this type is that the implant immediately adopts a stable position during surgery due to a kind of "Velcro effect," and this position is maintained for many years. This means sagging, rotating, or shifting outward is virtually impossible. A second major advantage of micropolyurethane is its protection against capsular contracture (see section on complications), which occurs on average ten times less frequently than with most non-polyurethane-coated implants.

For breast augmentation with your own tissue, fat is usually used (lipofilling). Using fine cannulas, fat is carefully removed via liposuction. This is done with great precision, so you essentially get a free body contouring procedure as well.

The advantage of lipofilling is that once the desired result is achieved, no further follow-up is needed. The fat is your own tissue and naturally feels very soft. The biggest drawback is that about half of the transferred fat will be reabsorbed within the first four months. After that, the volume stabilizes and will vary with your body weight. To achieve a certain breast volume, you must have enough “excess” fat to harvest. For very slim individuals, this can be a limiting factor.

Complications

In the short term, complications are rare.

As with any surgery, a postoperative bleed can occur, which almost always happens while you are still in our recovery room. The surgeon can usually manage this without needing to reoperate, though in very rare cases, a patient may need to be briefly put back under anesthesia to stop the bleeding.

Superficial wound infections that are treated promptly are not a major issue. If the infection goes deeper, however, it can reach the implant, and in rare cases this may require temporary removal of the implant.

During the process of creating a pocket for the implant, small nerve branches can be damaged. This may result in at least a temporary loss of sensation in the nipple, areola, and/or breast skin. Sensation almost always recovers, but in about 2% of cases, permanent numbness may remain.

"Breasts are sisters, not twins." Two perfectly identical breasts are extremely rare, both naturally and after surgery. Nonetheless, we aim for the best possible symmetry. Small differences are normal and acceptable. Significant asymmetry in size or shape may require an additional correction. If the implant accidentally shifts in the first few weeks, this can also lead to a revision surgery.

Capsular contracture is a phenomenon that occurs in less than 2% of patients with micropolyurethane implants. This happens when cells in the membrane around the implant contract over the years, causing the membrane to shrink. As a result, the breast gradually feels firm. This is not dangerous, but it can deform the breast and may become unpleasant or painful, often leading to revision surgery. The manufacturer of our implants offers a 10-year warranty against this issue, provided you return for annual check-ups with your surgeon (free of charge).

One of the rarest complications is a seroma. This is a fluid reaction that usually occurs years after the procedure, presenting as a painless and slow enlargement of the breast. In the vast majority of cases, treatment is simple: the fluid is aspirated with a syringe, and after 2–3 attempts the issue is usually resolved.

BIA-ALCL is an even rarer phenomenon, where lymphoma cells are detected in this fluid. It is a malignant transformation of white blood cells. If this occurs, treatment is straightforward: the capsule around the implant is removed (and thus temporarily the implant as well).
You can find more detailed information on the website of the Belgian Society for Plastic Surgery (RBSPS) via this link.

Breast Implant Illness (BII) is sometimes mentioned as a complication. This term refers to a collection of vague symptoms that some believe may be caused by the presence of breast implants. While we always take such complaints seriously, there is currently no conclusive evidence of a causal link between BII and breast implants.
More information is also available via this link

Finally, it’s important to understand that breast implants do not last forever. The general consensus is that after 15 years, implants should either be replaced or thoroughly evaluated. Our experience shows that the implants we use often last much longer, and from year 15 onward, we perform regular High-Density Ultrasound scans to assess whether the implant is still intact. If not, it is recommended to replace the implant within a few months after the diagnosis.