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What is breast augmentation surgery?

Breast augmentation surgery, also known as augmentation mammaplasty, sometimes referred to as a "breast aug" or "boob job" by patients, involves using breast implants or fat transfer to increase the size of your breasts. This procedure can also restore breast volume lost after weight reduction or pregnancy, achieve a more rounded breast shape or improve natural breast size asymmetry. When fat from another part of the patient's body is used to create improved breast volume, the procedure is referred to as fat transfer breast augmentation. Breast augmentation surgery is often part of a mommy makeover surgery.

Silicone gel-filled breast implant has been under scrutiny for years, but after gathering detailed and meticulous research and data, it was approved for use in cosmetic breast enhancement surgery, finding no link between silicone gel implants and connective tissue disease, breast cancer, or reproductive problems.  Surgical techniques for breast augmentation and all breast implants are continually being refined, increasing the safety and reliability of the procedure.

 “Breast augmentation surgery is a highly individualized procedure. You should do it for yourself, not to fulfil someone else's desires or to try to fit any sort of ideal image, especially those coming from social media. Choosing a procedure based on “what’s new” is never a medically sound decision. Hearing about a procedure on television, through an advertisement or online does not necessarily mean it is the best procedure for you”.

Who is a good candidate for breast augmentation surgery?

In general, you may be a good candidate for breast augmentation surgery If pregnancy, weight loss, or ageing has affected the size and shape of your breasts, one of your breasts is smaller than the other, your breasts are fully developed and are asymmetrical, you are unhappy with the upper part of your breast appearing "empty", you want a better proportioned or more appealing figure, you clothes that fit your hips are too large at the bust line, you are physically healthy and at a stable weight, nonsmoker or have stopped smoking recently, you have realistic expectations of the outcome of your surgery and If you believe you might gain self-confidence or self-esteem from such a procedure.

What breast augmentation surgery can't do?

Breast augmentation does not correct severely drooping breasts. A breast lift may be required along with a breast augmentation for sagging breasts to look fuller and lifted. Breast lifting can often be done at the same time as your augmentation or may require a separate operation. Dr Ricardo will assist you in making this decision.

What should I expect during a consultation for breast augmentation surgery?

During your initial consultation, you will have the opportunity to discuss your cosmetic goals.  Dr Ricardo will evaluate you as a candidate for breast augmentation surgery and clarify what approach is best for you. Alternative and additional treatments may be considered, once he understands your goals and medical condition. It is important to be completely honest during the consultation and be prepared to discuss your medical conditions, drug allergies and medical treatments, current medications, vitamins, herbal supplements, alcohol, tobacco and drug use, previous surgeries, family history of breast cancer, and results of any mammograms or previous biopsies and why you want breast augmentation surgery, your expectations, and desired outcome

Dr Ricardo will also evaluate your general health status and any pre-existing health conditions or risk factors, examine your breasts, take photographs, discuss the approach to your surgery, including the type of procedure or combination of procedures and tell you whether your expectations are in line with typical results, discuss any risks or potential complications and share before-and-after photos of cases similar to yours.

The success and safety of your breast augmentation surgery depend very much on your complete candidness during your consultation. It's very important to understand all aspects of your procedure. It's natural to feel some anxiety, whether it's excitement about your anticipated new look or a bit of preoperative stress. Don't be shy about discussing these feelings with Dr Ricardo.

How should I prepare for breast augmentation surgery?

In preparing for breast augmentation surgery, you may be asked to get lab testing or a medical evaluation, get a baseline mammogram before surgery and another one after surgery to help detect any future changes in your breast tissue (if you're over forty years of age), take certain medications or adjust your current medications, stop smoking in advance of surgery and avoid taking aspirin, anti-inflammatory drugs, and herbal supplements as they can increase bleeding.

Your surgery will be performed in an accredited hospital and is usually performed on an outpatient basis unless you and Dr Ricardo have made other plans for your immediate postoperative recovery. You must arrange for a friend or family member to drive you to and from surgery and to stay with you the first night following surgery.

Dr Ricardo and the entire staff will provide thorough preoperative instructions and answer any questions you may have. The goal is to help you achieve the most beautiful and natural-looking results, as well as to make your surgical experience as easy, comfortable, and safe as possible.

What are the steps of a breast augmentation procedure?

Step 1 – Anaesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anaesthesia. Dr Ricardo will recommend the best choice for you.

Step 2 – The incision

Incisions are made in inconspicuous areas to minimize visible scarring. Dr Ricardo will discuss which incision options are appropriate for your desired outcome. Incision options include: along the areolar edge (peri-areolar incision) and in the fold under the breast (inframammary fold). A belly-button approach and the armpit (axillary incision) are associated with a higher complication rate and unpleasant results.

Step 3 – Inserting and placing the breast implant

After the incision is made, a breast implant is inserted into a pocket either under the pectoralis muscle, a submuscular placement, or directly behind the breast tissue, over the pectoralis muscle, a subglandular placement. Dual plane or partial submuscular involves placing the upper portion of the implant under the pectoral muscle, while allowing the lower half of the implant to sit directly under the breast tissue, over the pec muscle. It is neither completely ‘under the muscle’ nor 'over the muscle,' but a combination of both.

Why keep implants on top of the muscle? Let me count the reasons:


  • Implants placed on top of the muscle have a more natural look in most cases.

  • Placing implants on top of the muscle preserves the function and normal anatomy of the pectoralis major muscle.

  • Implants in the subglandular position or subcutaneous (“pre pectoral”) location avoid the “animation deformity” or flexion deformity that occurs anytime the pec muscle is flexed. 

  • Recovery after breast augmentation in the subglandular position is much faster and much less painful than when the muscle is stretched out over an implant.

  • Not having implants under the muscle avoids several specific complications such as the “double bubble” deformity, and “Snoopy or waterfall deformity” which only occur with submuscular implants.

  • It just makes sense to preserve the major chest muscle anatomy and function.

In breast augmentation surgery, there is no definitive surgical technique or right or wrong decisions. The Incisions and the method for inserting and positioning breast implants depend on the type of implant, degree of enlargement desired, your body type, and Dr Ricardo's recommendations.  ​​

Step 4 – Choices for breast augmentation

Currently, there are three methods for performing breast augmentation:

Breast implants are used to increase the size of your breasts. The outer layer of breast implants is made of silicone or, in some cases, polyurethane. Inside this, there is either silicone gel (most common) or saline. Generally, silicone breast implants are preferred as they feel more natural. Dr Ricardo utilizes silicone breast implants from Motiva, Polytech, or Sebbin. These implants are available in both teardrop (natural anatomy shape) and round shapes.

Factors that influence the size and type of breast implants recommended for you include your medical history, your goals for breast enhancement, your existing body frame and mass, your existing breast tissue, and preferences related to size and incision placement.

Autologous fat transfer removes fat through liposuction from an area of your body in which there are abundant fat cells, such as your thighs, abdomen, and hips. After a process of preparation, the fat is re-injected into the breast. Usually, 100-300 cc can be injected at one session, allowing for about one bra cup increase in size. This is a highly technique-dependent procedure, so the experience and skill of the surgeon play a crucial part in determining the survival of the fat cells.

A hybrid (or composite) breast augmentation refers to a breast enlargement procedure using both implants and your fat.  This is now considered the “Gold Standard” for women who want a substantial increase in breast volume but who do not have sufficient fat to achieve the result by fat transfer alone. The hybrid breast augmentation is especially suitable for women who have asymmetry, who are thin, have a bony chest, have a chest wall deformity such as an indented or prominent sternum, and for women who want the more natural look that fat transfer provides but desire more volume than can be achieved by fat alone.

The main advantage of adding fat to a breast implant in a breast augmentation procedure is that the fat can be placed strategically in the cleavage and around the implant to “soften the edges” and give a far more natural look, preventing animation deformity (caused by contraction of the pectoral muscle against the breast implant that occurs when implants are placed under the muscle) and rippling.

"Internal Bra Technique": What patients need to know?

The inner bra concept has been around since the early eighties. It refers to a myriad of different surgical techniques. “Internal bra” is an umbrella term including techniques intended to strengthen the lower pole of the breast. The idea of this technique is twofold. Firstly, to reinforce the inframammary fold. And secondly, to strengthen the lower portion of the breast. In tandem, this provides a more supportive foundation for a breast implant. The most common technique used for the internal bra is additional suturing. Sutures create a more secure and stable breast fold and a stronger lower pole of the breast.


A rarer option used in more severe cases is the use of a surgical mesh that can be placed around the entire breast or around the lower pole of the breast to maintain shape and position. Recently, after good experience with human and animal dermal grafts in reconstructive breast surgery after cancer, plastic surgeons started using acellular grafts in the form of a support bra for cosmetic breast surgery. Known by the acronym ADM, Acellular Dermal Matrix eventually gets integrated into the body and may be completely replaced by the patient’s collagen resulting in a thick and stronger layer of tissue.

Placing foreign materials in your body may increase the chance of infection, scarring, and deformity and, although the "Internal Bra Lift technique" with a surgical mesh looks like a miracle procedure and maybe an appealing concept to the patient who wants breasts to stay perky, there is no evidence that this procedure works and what is its complication rate. It might be indicated for extreme cases of cosmetic breast deformities or patients of breast reconstructions despite its use still remains controversial. The prophylactic use of Acellular Dermal Matrix graft as an inner bra in breast augmentation surgery is absolutely contraindicated.

Step 5 – Closing the incisions

Incisions are closed with layered sutures in the breast tissue and sutures, skin adhesives (glues), or tapes close the skin incisions

Step 6 – See the results

The results of breast augmentation surgery are immediately visible. Satisfaction with your new image should continue to grow as you recover.

What should I expect during my breast augmentation recovery?

During your breast augmentation recovery, your breasts will be wrapped in gauze dressings and an elastic bandage or support bra will minimize swelling and support the breasts as they heal. You will be given specific instructions on how to care for the surgical site, medications to apply or take orally to aid healing and reduce the potential for infection, specific concerns to look for at the surgical site or in your general health, and when to follow up with Dr Ricardo. Remember to always follow his instructions to ensure the success of your surgery.

Because it is possible to bleed into the pockets around the breast implants for the first days, take it easy until you have permission to increase your activity level. Acute pain typically subsides after one to five days, but you may experience soreness and swelling for two weeks.

The surgical incisions mustn't be subjected to excessive force, swelling, abrasion, or motion during the time of healing. Sutures will be removed when it is appropriate. You should be ready to return to work and normal activity after 5-7 days. However, you must realize that the amount of time it takes for recovery varies based on what your surgery entails.

What results should I expect after my breast augmentation surgery?

While a breast augmentation yields larger breasts right away, the final results may take a few weeks as the swelling subsides and the skin stretches. Breast implants are not considered to be lifetime devices, and they may need to be replaced. You can see Dr Ricardo for an annual examination to evaluate your breast health and implant integrity.

Satisfaction with your new image should continue to grow as you recover from surgery. The final results of your breast augmentation surgery will appear over the next few months as breast shape and position continue to settle. You'll be able to retain your new look longer if you maintain your weight and keep a healthy lifestyle.

One of the most popular and frequently performed aesthetic surgery procedures, breast augmentation has a long and successful track record in satisfying women who wish to enhance, regain or restore balance to their figures.

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