• Transaxillary incision : recommended to primary surgery and young unmarried woman who has symmetric chest and inframammary folds
  Pros: concealed innoticeable scar, easy in submuscular implant insertion
  Cons: revealed in swim suit, difficult in revisional surgery, risk of sensory nerve injury, upward migration of implant
• Inframammary incision : recommended to secondary surgery and if the patient has asymmetric chest and inframammary folds
  Pros: easy pocket formation and more accrate positioning of implant, easy revisional surgery
  Cons: exposed scar
• Circumareolar incision: recommended in subglandular (above pectoral muscle) augmentation with saline implant and if patient has ptotic breast

Position of implant

• Subpectoral (submuscular) : recommended in thin, slender patients
  less demarcation of implant and less chance for contracture
• Subglandular (above pectoral muscle) : recommended in ptotic breast
  less pain and more projection

Size of implant
Deciding the exact size of implant is the key in patient's satisfaction.
According to patient's desired result, chest cage, skin envelope, skin thickness and breast parenchyma, appropriate size of implant can be judged.

Type of implants
The standard implant in the United States and Korea has been saline filled, ever since the FDA moratorium on silicone gel filled breast implants in 1992.
But nowadays, cohesive silicone gel implant becomes a standard because of its softness and durability.

Cohesive gel implant
The most distinguished features of cohesive silicone gel implant are its cohesiveness and soft solid gel feel.
If a cohesive implant is cut in half, there is no gross movement of gel, and the implant maintains its shape.
Pros :
- 1. It won't leak even after rupture because silicone is crosslinked firmly.
- 2. Feel softer than saline implant
- 3. Less chance of capsular contracture
- 4. Less folds or rippling and less chance of implant rupture
Cons :
- 1. Feel harder than previous silicone implant
- 2. Need more length of incision than saline implant
- 3. Expensive about 1,000 USD
- 4. Need MRI follow-up to detect implant rupture

A 26 year old female underwent breast augmentation using 230 cc cohesive gel implant.

Asian breast augmentation
Usually Asians have small chest cage, thin body, tight skin envelope, tough and inelastic inner structures and prefer modest natural result.
So , I prefer tranaxillary or inframammary incision, submuscular placement, moderate sized cohesive silicone gel implant.
Pocket dissection for implant in Asians is harder.

Endoscopic breast augmentation
Endoscope is a special viewing instrument that allows a surgeon to see images of the body's internal structures.
Because pocket dissection in Asians is harder, endoscopic breast augmentation is frequently employed.
The risk of sensory loss from nerve damage is decreased and bleeding, bruising and swelling may be significantly reduced.
In addition, more accurate pocket dissection is possible in tranaxillary approach.
This means you can recover more quickly and return to work earlier and has less risk of complications like asymmetry, improper positioning, hematoma and contracture than if you had undergone open surgery.

Surgery and Recovery
Under general anesthesia, it will take about 1 or 2 hours.
You're likely to feel sore for a few days following your surgery, but most of your discomfort can be controlled by medication prescribed.
The stitches will be removed after a week.
You should massage your breast by yourself for 3 months.
Recommended stay : 7 days

Risks and complications
Lack of implant permanence -- surgical removal or replacement of the implants may be required to treat problems such as deflation, capsular contracture, bleeding or infection. Increase or decrease in sensitivity of nipples or breast skin, occasionally permanent.