Silicone Breast Augmentation

What is Silicone Breast Augmentation?

Silicone breast augmentation (breast implant surgery) is a procedure in which a medical-grade silicone gel-filled implant is inserted into the breast to permanently increase breast volume and contour. Unlike fat transfer or hyaluronic acid augmentation, it achieves significant and lasting bust enhancement in a single procedure, making it particularly suitable for patients who "desire a size increase of 2 cups or more" or "have limited body fat due to their constitution."

Our clinic uses the fourth-generation silicone implant "Motiva (Motiva) Ergonomics" manufactured by Establishment Labs. The design combines SmoothSilk® surface treatment, 6-layer shell structure, and SuperSilicones® gel, achieving both reduced capsular contracture risk and natural feel.

Medical Evidence: Long-Term Safety and Complication Risks

The 10-year follow-up results from the Natrelle core study published in Plastic and Reconstructive Surgery (2014) verified long-term safety in 715 subjects who received both smooth-surface and textured-surface implants. The most common late complications were "capsular contracture (Baker Classification Grade III/IV)" and "implant malposition" (doi:10.1097/PRS.0000000000000021).

A systematic review in Archives of Plastic Surgery (2015) identified "biofilm formation" as one of the primary causes in the pathogenesis of capsular contracture, and recommended prevention strategies including strict aseptic technique during surgery, use of the Keller funnel, and implant placement changes from subglandular to submuscular (doi:10.5999/aps.2015.42.5.532).

Regarding the association between textured-surface implants and BIA-ALCL (breast implant-associated anaplastic large cell lymphoma), a 3,546-subject prospective cohort in the Journal of Plastic, Reconstructive & Aesthetic Surgery (2020) reported risk; however, smooth-surface and microtextured-surface (SmoothSilk®) implants, which are now mainstream, are reported to have extremely low association with BIA-ALCL (doi:10.1016/j.bjps.2019.11.064). Motiva, which our clinic uses, features a microtextured design close to smooth surface, making it a safe choice from this perspective as well.

Procedure Flow

Consultation & Simulation

The attending physician measures the breast width (BWD), height, and existing skin volume, and selects the optimal implant from approximately 350 Motiva sizes. Pre-operative imaging can be confirmed through 3D simulation.

Incision Site and Implant Placement Layer Selection

The incision site is chosen from either under the armpit (axillary incision) or along the lower breast fold (IMF incision). The implant placement layer has three options: subglandular, dual plane, or submuscular, and the optimal layer is selected based on the patient's muscle mass, skin laxity, and desired size. Dual plane placement is frequently used at our clinic because it ensures upper pole coverage while reproducing natural lower pole ptosis.

Surgery & Anesthesia

The procedure is performed under general anesthesia or intravenous anesthesia, with a surgical time of approximately 60 to 90 minutes. By using the Keller funnel to insert the implant with no-touch or low-contact technique, bacterial contamination risk and capsular contracture risk during surgery are minimized.

Downtime and Post-Operative Course

Compression immobilization is required for 1-3 days post-operatively, and bathing and strenuous exercise are restricted for the first week. Swelling and bruising settle over 2-4 weeks, and the final result can be confirmed at 3-6 months post-operatively. Light exercise is possible starting from 1 month after surgery, and full exercise and massage can resume after 3 months post-operatively.

Regular follow-up appointments (1 month, 3 months, and 1 year post-operatively) assess implant status and presence of capsular contracture. MRI screening for silicone gel leakage is recommended following FDA guidelines at 3 years post-operatively and every 2 years thereafter.

Precautions and Risks

Main risks include capsular contracture (incidence rate approximately 10-15% over 5-10 years), infection, hematoma, implant displacement, and sensory changes. Textured surface implant patients have a risk of BIA-ALCL although rare, so please seek immediate medical attention if fever or unilateral swelling occurs. The Motiva we use has a smooth surface, so BIA-ALCL risk is considered extremely low, but regular follow-up observation is essential.