It’s baking season – Christmas is around the corner. Many are reaching for piping bags (pastry bags for Americans) to craft delicious treats. But there’s also a lot of chatter on social media about another kind of «piping bag», small scars, and sedation – all in the context of the (allegedly) best recipe for a breast augmentation.

Winter is a popular time for women to opt for this most sought-after aesthetic surgery. The colder weather makes it easier to wear a support bra day and night for the required six weeks post-surgery. Winter is breast augmentation season.

There are, apart from the less common fat transfer method, three primary approaches to breast augmentation. A small, well-shaped breast can usually be augmented relatively straightforwardly with silicone implants. A sagging breast may achieve the desired result with a lift alone. However, sometimes a lift combined with implants is necessary.

The first approach typically leaves a scar up to 5 cm long in the breast fold. The second and third approaches also leave scars around the areola and a vertical scar from the lower edge of the areola down to the breast fold.

Some plastic surgeons emphasise the minimal size of the scar left in the breast fold, referring to «very small» or «ultra-short» scars of 2.5 to 3.5 cm in length. This is achieved by using a kind of piping bag to insert the implant through the small incision into the pocket.

Interestingly, women rarely ask me about the size of the scar before a breast augmentation – and rightly so, in my opinion. First, because the scar in the breast fold is already well-hidden. Second, because even a small scar is still a scar, visible enough to indicate surgery.

A slightly larger incision also has a significant advantage: it allows me to see more clearly into the pocket prepared for the implant during the operation. This visibility helps me detect potential bleeding or complications. A smaller incision provides less visibility, while a larger one offers more. For maximum safety, I usually prefer a slightly larger incision.

In connection with small incisions for «minimally invasive» breast augmentation, it’s often stated that general anaesthesia isn’t necessary. The buzzword here is sedation. Unlike general anaesthesia, sedation allows the patient to breathe independently. It’s essentially a step below full anaesthesia. Both types of anaesthesia require monitoring by an anaesthesia team.

I generally prefer general anaesthesia. Under general anaesthesia, the patient experiences absolutely no pain – even subconsciously. Thanks to modern techniques, patients recover quickly, even after general anaesthesia.

One aspect I feel isn’t discussed enough in breast augmentation is the use of drainages. I insert drainages on both sides for my breast augmentation patients. These silicone tubes carry bodily fluids into small external containers post-surgery. For me, they’re a critical indicator tied directly to patient safety – an early warning system, if you will.

Like canaries in mines once warned of dangerous gases, a high amount of blood or wound fluid in the containers can signal complications after breast augmentation. If fluid levels are low, I remove the drainages a few days after surgery.

Surprisingly, women rarely bring up concerns about nipple sensitivity after breast augmentation. The fact is, sensitivity in the nipples and areola can sometimes decrease following surgery. I make sure to inform my patients about this.

However, two questions are frequently asked: «Will I still be able to breastfeed?» and «Can I still have regular breast cancer screenings?» The answer to both is yes. This is because, during surgery, I don’t interfere with the breast as an organ. Its integrity as a skin appendage, a special kind of organ, remains completely intact.

I usually place implants over the pectoral muscle. There are medical reasons for this. When implants are placed under the muscle (mainly for aesthetic reasons), the muscle can be weakened by up to 50%. Regardless of the procedure, my principle is this: an aesthetic solution should never create a health problem.

Most breast augmentations are performed on an outpatient basis. Women undergoing breast augmentation at my practice can leave two to three hours after surgery. I remain available 24/7 for my patients. Drainages are removed after two to three days, and follow-ups take place at six weeks, 12 weeks, and one year post-surgery.

Breast augmentation is particularly popular this time of year. However, it’s not a casual leisure activity like attending a concert. A breast augmentation is, at its core, voluntary and controlled bodily harm. That’s why you should only entrust yourself to a board-certified specialist in Plastic, Reconstructive, and Aesthetic Surgery (FMH). As such, I carefully consider your individual situation and weigh your aesthetic desires against your safety and health. Together, we’ll agree on the best approach tailored to you. That’s the best recipe for a successful breast augmentation.

Dr. med. Borut Banič

Board-certified Specialist in Plastic, Reconstructive, and Aesthetic Surgery (FMH)
Fellow of The European Board of Plastic, Reconstructive and Aesthetic Surgery (FEBOPRAS)