Surgical specialty

Breast surgery.

Breast surgery includes both elective aesthetic procedures and reconstructive operations with clear medical indications. Both demand the same standard of safety — hospital operating theatre, specialist anesthesia, inpatient observation — and the same respect for breast anatomy and function.

Sizing is not arithmetic.

One of the most common misconceptions is that breast augmentation can be "decided in cc." In practice, implant volume is a single variable in a complex equation: existing tissue thickness, chest wall height and width, skin distensibility, rib cage anatomy, and the result the patient is seeking.

A responsible surgeon will not propose a specific volume in the first five minutes. The final decision is made after measurement, tissue assessment, and clinical sizing with implant test sets.

Procedures.

Breast augmentation with implants

Placement of implants (silicone gel or saline) through a concealed incision to increase volume and refine breast shape. Decisions about size, implant profile, plane of placement, and incision are a sequence of clinical choices discussed with each patient — not a uniform "augmentation package."

Suitable for

  • Congenitally small breast volume
  • Volume loss after pregnancy or weight reduction
  • Significant asymmetry between the two sides

Technique

Common incision sites: inframammary fold, periareolar, or transaxillary (endoscopic). Placement planes: subglandular, subpectoral, or dual-plane. The specific choice depends on tissue thickness, skin envelope, and aesthetic goals.

Anesthesia

General anesthesia

Inpatient stay

One-night inpatient

Expected recovery

Discomfort and limited shoulder motion for 7–14 days; avoid strenuous exercise for 6 weeks; final breast shape settles by 3–6 months

Mastopexy (breast lift)

Surgery to raise the position of the nipple-areolar complex, remove excess skin, and reshape the breast parenchyma. Indicated when breast tissue has lost volume and ptosed — typically after pregnancy, weight loss, or aging.

Suitable for

  • Nipple position below the inframammary fold
  • Skin laxity and loss of firmness
  • Asymmetry from uneven ptosis

Technique

Incision pattern varies with the degree of ptosis: periareolar (mild), vertical (moderate), or inverted-T (severe). Implants may be combined when additional volume is desired.

Anesthesia

General anesthesia

Inpatient stay

One-night inpatient

Expected recovery

Surgical support bra for 4–6 weeks; scars take 12–18 months to fade; avoid heavy lifting for 6 weeks

Breast reduction

Removal of excess breast tissue in cases of breast hypertrophy that produces mechanical symptoms (back pain, neck pain, shoulder grooving from bra straps, intertrigo in the inframammary fold). This is one of the cosmetic procedures with the clearest functional indication.

Suitable for

  • Back, neck, or shoulder pain related to breast weight
  • Recurrent intertrigo or fungal infection in the inframammary fold
  • Limitation of athletic activity and daily function

Technique

Removal of breast tissue, fat, and skin in an inverted-T or vertical pattern; preservation of nipple-areolar blood supply; reshaping of the remaining breast tissue to a natural contour.

Anesthesia

General anesthesia

Inpatient stay

1–2 nights inpatient

Expected recovery

Surgical bra for 6–8 weeks; nipple sensation may change transiently; future breastfeeding is a specific issue to discuss before surgery

Post-cancer breast reconstruction

Reconstruction of the breast following mastectomy for cancer treatment. May be performed immediately (at the same operation as the cancer surgery) or delayed (after completion of adjuvant therapy). This is multidisciplinary surgery requiring coordination with oncology.

Suitable for

  • Patients who have undergone or are scheduled for mastectomy
  • A preference for reconstruction with implants or with autologous tissue
  • Significant asymmetry after unilateral mastectomy

Technique

Two main pathways: (1) implant-based reconstruction with a tissue expander followed by exchange to a permanent implant; (2) autologous tissue reconstruction using DIEP, TRAM, or latissimus dorsi flaps. Selection depends on patient anatomy and the broader treatment plan.

Anesthesia

General anesthesia

Inpatient stay

2–5 nights inpatient depending on technique

Expected recovery

Complex; often staged in multiple operations 3–6 months apart; coordinated with oncology throughout

On implants: material choice and long-term follow-up.

Modern breast implants use silicone gel or saline, with smooth or textured shells depending on the design. Each option has trade-offs in feel, capsular contracture rates, and long-term surveillance characteristics. We discuss the options approved by the Ministry of Health and which choice is appropriate for the individual case.

An important point: breast implants are not permanent devices. Per international guidelines, patients require periodic surveillance, and implants may need to be replaced after 10–15 years or when clinically indicated. This is discussed before surgery, not after.

Risks to understand in advance.

  • Capsular contracture. A tissue response around the implant that produces firmness and distortion. Incidence varies by study; may require corrective surgery.
  • Changes in nipple sensation. May be transient or persistent; specifics depend on the surgical approach.
  • Impact on breastfeeding. Depends on the technique and incision. Discuss in advance if future pregnancies are planned.
  • Imaging considerations. Implants can affect mammographic interpretation; inform any future imaging team of your surgical history.
  • Long-term surveillance. Periodic ultrasound or mammography per current recommendations.

What a consultation looks like.

  1. Medical history and goal discussion. Including family history of cancer, pregnancy plans, and athletic activities.
  2. Measurement and tissue assessment. Chest wall dimensions, skin and parenchymal thickness, symmetry.
  3. Sizing trial. External sizers help visualize possible results.
  4. Presentation of options and risks. Including technique, materials, planned inpatient stay, and surveillance requirements.
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