Adding volume while respecting the existing breast and the proportions of the body.
Breast augmentation can increase volume, alter breast shape and restore fullness that has changed with pregnancy, weight loss or time.
I plan augmentation around the patient's existing breast, chest dimensions and soft-tissue envelope rather than beginning with a predetermined implant size.
Three questions are particularly important.
Chest width, breast base dimensions and overall body proportions help define implants that can sit naturally on the chest.
Existing breast tissue, skin quality and soft-tissue coverage influence implant choice and position.
The desired change in fullness, projection and proportion is considered within the limits of the anatomy.
Implants differ in dimensions, projection, surface and gel characteristics. I use these characteristics to select an implant that fits the breast and produces the intended change rather than relying on volume alone.
Motiva Ergonomix is my principal implant option, with Mentor available as an alternative where its dimensions or characteristics better suit the individual patient and operative plan.
The consultation includes the advantages, limitations and long-term implications of breast implants.
Where the soft-tissue envelope provides appropriate coverage, I generally favour a subglandular position, with the implant behind the breast tissue and in front of pectoralis major.
This preserves normal muscle anatomy and avoids movement and distortion associated with an implant beneath an actively contracting pectoral muscle.
No implant plane should be applied indiscriminately. Tissue thickness, breast anatomy, previous surgery and the coverage required all influence the decision.
I avoid submuscular placement where possible, but the plan must ultimately suit the patient's anatomy rather than follow a rule for its own sake.
I use an inframammary fold incision for primary breast augmentation.
This provides direct, controlled access to the implant pocket and allows the scar to be positioned within the natural fold beneath the breast.
Its position is planned in relation to both the existing fold and anticipated postoperative breast shape.
Modern augmentation increasingly focuses on precise pocket creation and minimising unnecessary disruption of breast tissues.
An implant adds volume, but it does not reliably correct significant breast descent or an excessive skin envelope.
If the breast and nipple have descended substantially, using a larger implant simply to fill loose skin can create an unnecessarily large breast without adequately correcting its position.
In these circumstances, a breast lift may be required—with or without an implant—depending on the desired volume and shape.
Recovery varies with implant position, the extent of surgery and whether augmentation is combined with another procedure.
Swelling, tightness and discomfort are expected. A supportive postoperative bra and prescribed pain relief are generally used early in recovery.
Comfort and mobility progressively improve. Activity is increased gradually while strenuous upper-body exercise and heavy lifting remain restricted.
The breast shape continues to settle as swelling resolves and tissues accommodate the implant. Scars mature progressively over subsequent months.
Breast implants are medical devices and augmentation has both surgical risks and longer-term considerations. These are discussed in detail during consultation and informed consent.
Consultation begins with the existing breast, your proportions and what you would like to change. From there, we can determine whether augmentation is appropriate and discuss implant dimensions, position, scars, expected shape and the long-term implications of living with breast implants.
Arrange a consultation →Written and reviewed by Dr Constant van Schalkwyk, Specialist Plastic Surgeon ·
