The body’s appearance is important not only for women but for men as well. We live in a society where there is a lot of value put on the physical appearance of people. Do you remember how it is said that first impression counts? In other terms, it means that if you don’t look a certain way, the chances are higher for you to be judged. There are also multiple studies attesting the fact that people with beautiful appearances tend to be more successful at their jobs. There is no questioning this result as the jobs in the modern world are more about engaging with other people. When it comes to the appearance of women, there is no denying that the breasts and buttocks play a tremendous role. Women want to have breasts that are proportionate to the rest of their anatomy and many times even bigger than what they currently have. Big, round, and full breasts translate into sex appeal and attractiveness. The breast augmentation with implants allows the patient to achieve bigger breasts while maintaining its natural look. Breast implants can also be used to restore a breast after surgery for the treatment of cancer, malformation, or deformation due to several other factors such as pregnancy, breastfeeding, and the natural aging process. It is often that the patients have a high satisfaction rate when it comes to the breast augmentation surgery and most of them notice a significant improvement in the quality of their lives from multiple aspects including professional, social and personal. Overview of the breast augmentation procedure The principle of the intervention is to introduce a flexible prosthesis via an incision made in the breasts. This will supplement the volume of the breasts while also reshaping its contours. Breast implants are available in different sizes, shapes, textures, and profiles in order to achieve a natural result in line with the patient’s aesthetic goals and her expectations after the surgery. To achieve the best results when performing the breast augmentation with implants surgery, the plastic surgeon needs to assess the anatomical characteristics of the patient properly to be able to recommend the most suitable surgical plan. Both the desires of the patients and her physical particularities must be taken into consideration before deciding upon the operative plan. The plastic surgeon must ensure that the wishes and the current anatomy of the patient are compatible to obtain a result that meets both their expectations with the fastest recovery period possible. The role of the plastic surgeon is to help the patient understand the characteristics of her tissues and the options that are best suited for her to achieve the desired result. When it comes to breast augmentation with implants, there are many options available. First, the patient together with the plastic surgeon must choose the right type of implants. Implants can be made out of silicone gel or saline solution, and they come in different volumes. Once the decision for the type of implants to be used has been made, there are others parts to be discussed, such as the location of the incisions and the positioning of the implants. When it comes to the position of the implants, there are multiple options that can be discussed. First, we have the under the mammary gland placement. This is where the plastic surgeon will insert the implant into a pocket created in between the mammary gland and the pectoral muscle. The recovery time for this type of procedure is usually shorter, and the pain and discomfort are also less significant. However, it is not preferred by all patients and plastic surgeons, nor suitable for all cases. This leads us to the placement of the implant behind the pectoral muscle. This translates to a better coverage of the implant and a reduced risk for the edges of the implants to become visible. But it can also mean a longer recovery period and pain and discomfort for a week or so after the procedure when ample arm movements are performed. A new method that combines the two techniques discussed above involves placing the implant in a position called the “dual plane”. The implant will be placed with one part of it behind the gland and the other part behind the pectoral muscle. Many plastic surgeons started using this technique and it produces impressive results so far. Types of incisions performed during breast augmentation We have discussed the placement of the implant, but how does the implant get inside the breasts? The incisions are necessary and, as we have mentioned before, the location of the incisions is also very important and can determine the success or failure of the breast augmentation surgery. There are three types of incisions performed for breast augmentation with implants, each of which has its advantages and disadvantages: an incision under the breast, in the inframammary fold, a circular incision at the level of the areola or an incision under the arm, also called a “trans axillary”. A plastic surgeon who has an experience with doing all three types of incisions will be able to offer the patient the best options depending on her anatomy and her goals. However, it is not often the case that a plastic surgeon performing the periareolar and inframammary incisions to also opt for the trans axillary incision. The incisions around the areola and in the inframammary fold not only heal very well, but they are also almost invisible once the cicatrization process is completed due to their position in the natural folds of the body or around the edges of the areolas that are darker in color. Many patients tend to choose the periareolar incision or the trans axillary incisions because they believe that these are the incisions that are not visible after surgery. But before making a decision, we need to discuss all types of incisions. For example, to be considered a good candidate for the breast augmentation with periareolar incision you need to have areolas wide enough to allow the plastic surgeon control over the implant and enough space to insert it through. Patients with small areolas and nipple complex are not good candidates for the procedure with the incision around the areolas, especially if they want to have the large volume silicone implants. The incision placed in the inframammary fold is probably the most often performed incision for breast augmentation currently. There are many reasons why many plastic surgeons choose to perform this incision. Among them, we can mention the fact that it offers the best level of control for the plastic surgeon performing the procedure. Having control while performing the breast augmentation means improved aesthetic results with less asymmetry or other imperfections. Many patients are considering undergoing the procedure with a trans axillary incision as it is the only one that leaves no marks at the level of the breasts. The breasts will have no scars on them, and the only scar will be at the level of the underarms where it is almost impossible to see unless the patient stands with their arms raised above their head. Now, you probably understand the appeal of this method and why many patients are keen on it. But the patients interested in the trans axillary incision should know that it is also called the “blind method” as it allows the surgeon little control over what’s going on during the intervention. Of course, the plastic surgeon will use a medical device such an endoscope to maintain some level of control; however, the truth is that it can’t be compared with other types of incisions. Another significant disadvantage when it comes to the trans axillary incision is that if an additional intervention needs to be performed at the level of the breasts to change or replace the implants or correct a complication, another incision will have to be made. Keep in mind that each and every surgical option that can be used for breast augmentation with implants has its own advantages and disadvantages and that you should always ask and listen to the recommendation of your plastic surgeon. Conclusion During the initial consultation for breast augmentation, the plastic surgeon uses different measurement systems to evaluate the elements of the patient’s breasts: its shape and size, the proportion of the silhouette, shape of the thorax, elasticity, density, and thickness of the mammary gland and the tonus of the skin envelope. A thorough examination of the patient’s anatomy allows the surgeon to define and formulate the operative plan that will be performed during the surgery. Among the details to be discussed during this pre-operative consultations are the placement of the implants and the location of the incisions. Many patients tend to believe that the trans axillary incision is the best choice for breast augmentation as it leaves virtually no scars on the breasts. The scar is located at the level of the underarms and practically impossible to see. But this technique is also called the “blind method” as it also allows little control for the plastic surgeon. If a patient is confronted with a breast ptosis as well, it is impossible to correct the sagginess using this method.