Additive Mastoplasty

The increase in volume of the breasts (or breast augmentation) is aimed at increasing the breast volume and the size of the breasts by implanting suitable breast implants.
Additive mastoplasty is one of the most frequent operations requested in Aesthetic Surgery. This considerable increased popolarity is due to the remarkable results that can be obtained thanks to the most recent techniques and the very high quality achieved by the most modern prostheses. Breast augmentation (breast augmentation with breast implants) is much in demand by those women with insufficient breast development at the time of puberty or women with fine breasts who, after pregnancy or after a slimming diet, had an excessive reduction in the volume of the breasts making them become emptied, flattened and pendulous. It is also possible to improve an asymmetry of the volume of the breasts with the use of breast implants.
The result of a breast augmentation is very natural because the breast implant is inserted deeply, behind the breast tissue. In practical terms all the breast tissue remains directly under the skin and feels very natural at palpation, because the prosthesis is deep, hidden beneath all the glandular tissue.

How to choose the Breast Prosthesis?
Depending on the amount of breast present before surgery, the shape and the size of the patient’s chest and the final result that she wishes to achieve, the patient, together with the surgeon, chooses the most suitable type of breast implant and the plane in which to place it. The careful choice of these parameters influences the final aesthetic result: you can use round or anatomical breast implants (“drop shaped”), low-profile or high-profile prostheses (of greater or lesser projection, i.e. more or less protruding from the thorax), of smaller or greater volume, of soft texture resembling as much as possible the consistency of a natural breast.
Today prostheses are universally constituted by very pure “Medical Grade” silicone gel enclosed in a casing, always of completely sealed solid but soft silicone,. This gel represents a material with a density similar to that of a natural breast.

In this regard it should be noted that in the last forty years in-depth studies and verification of the biocompatibility of Medical Grade silicone breast implants have been performed, both by the F.D.A. (Food and Drug Administration (the American Body of Control for the commercialization of drugs and devices for medical use) and by many other prestigious World Scientific Institutes, on huge international case studies. The results obtained gave a favorable outcome, disproving the fears of possible damage to health that some in the past had hypothesized.The silicone breast implants are those that have, by far, the widest and most widespread clinical control in the world, having been implanted in millions of women all over the world. Silicone has a very wide diffusion and is also used for products of common use in body care, lipsticks, lip gloss, hand creams, tanning creams etc. (For more information it is also possible to consult the FDA website).

Furthermore, the external surface of the latest-generation silicone implants has a characteristic “Textured” shape, that is, with small, minute reliefs, like velvet that make it very biocompatible. The characteristic “textured” or “corrugated” surface and no longer smooth like those of previous generations, makes the implants even more stable, preventing them from moving or rotating. The particular outer wrinkled surface (Textured surface) increases the degree of acceptance by the body, reducing the incidence of deformations and hardening of the breast due to the retraction of the capsule (the fibrous shell that the body creates around foreing bodies).
The new prostheses undergo a series of rigorous quality controls in order to offer a product as reliable as possible.

One of the most important innovations of recent times is the new generation of breast implants that modify their shape in relation to the posture that the patient takes. They make the breast look very natural.

All prostheses used for breast augmentation by Prof. Bracaglia in his cosmetic breast surgery at the Villa Stuart Clinic in Rome, are only of the highest quality.

How do I choose the Volume of the Prosthesis?
The prosthesis is chosen according to multiple parameters. The size of the woman’s chest, the size of the natural breast volume, is very important. The volume of the prosthesis is added to that of the breast and the final result of the breast augmentation is the sum of the two volumes. In order to allow the Woman to visualise the result she can obtain, a highly valid is test performed in the Surgeon’s studio.

A very important innovation is the advent of the Virtual Reality CRISALIX that offers the Patient the opportunity to better understand what results can be expected with the operation. This method allows to obtain a digital photo of the breasts to which changes are made depending on the type of prosthesis that is chosen. The patient can therefore see a very effective simulation of what will be her appearance after the operation. She may choose to see what the changes to her appearance may be with anatomical, round, various-sized or varied projection or measures. This image generated by the computerized digital system of Virtual Reality Crisalix can be viewed not only on the monitor, but also through the Virtual Reality viewers Oculos. The images are very effective and helpful in order to approach the operation in the most serene and informed way possible. In the Aesthetic Center of Prof. Bacaglia, the CRISALIX Virtual Reality system is regularly used during the patient’s examination for a breast augmentation.

As the Patient nears the operation, she will be increasingly aware of what choices to make in order to reach full satisfaction.

How can we choose the Technique of Breast Augmentation and the plane where the prosthesis will be positioned?
The choice of the plane where to place the breast implant varies depending on the abundance or lack of the mammary gland.

Surgery must be performed after a careful check of the characteristics of the mammary region and based on the result to be achieved.

It is also important to have a thorough discussion between the Plastic Surgeon and the Patient in which all the aspects of the procedure are carefully examined.

The additive mastoplasty with introduction of the prosthesis in the retro glandular plane, i.e. in the plane above the pectoral muscle, is recommended in slightly overweight patients in which the thicker tissues entirely cover the prosthesis hiding it. This choice is suitable for women who already have a sufficiently developed breast. This was the technique that was adopted when the first breast implants appeared in the 60s. It is a technique that can be performed with access either through an incision around the areola or in the inframammary fold.
In the case of thin women or with poorly represented breasts the sub glandular technique is not an optimal choice but it is better to further cover the prosthesis in order to better dissimulate it to an external observation or palpation. In these cases, the most experienced international aesthetic surgeons universally consider to be the best choice to place the breast implant in a deeper plane: in the plane below the Pectoralis Muscle. In these cases the prosthesis is placed so that only the highest pole of the prosthesis (i.e. the one most in the direction of the neckline) goes into the plane below the muscle, while the rest of the prosthesis (the most part) is in the retro glandular plane that is directly under the breast. To better understand, the prosthesis placed in the sub-muscular plane is only partially covered by the pectoralis major muscle at its highest point towards the upper part of the thorax (Dual Plane partial submuscular technique according to Tebbets). This technique could be more easily defined as a combined submuscular / subglandular technique. In this case we have the advantages of the sub muscular technique in which the prosthesis in the neckline cannot be seen and the advantages of the sub glandular technique with an attractive forward projection of the central pole of the breast.

The Dual Plane partial sub muscular technique for implanting breast prostheses in thin women offers the advantages of the submuscular technique and those of the subglandular technique. It is the most popular with specialists and is also used in Rome by Prof. R. Bracaglia. This solution is recommended for leaner women in order to better cover the edges of the prosthesis. This allows a very natural additive mastoplasty result because the upper pole of the prosthesis is less visible and palpable as it is concealed not only by the thickness of the skin and mammary gland, but also by the thickness of the pectoralis major muscle. It has the following advantages:

1 – The upper edge of the breast implant is placed partially under the Large Pectoral muscle, and is therefore covered not only by the thickness of the skin but also by the muscular plane. In particular it covers very well the upper portion of the prosthesis and is not distinguishable. This surgical choice is often used with anatomical prostheses that create a natural shape of the breast.

2 – The breast implant is placed partially below the muscle and this also facilitates the execution of future mammograms for breast checking.

In the case of skinny women or women of regular weight who undergo breast augmentation, but who have a small mammary gland, even Tebetts Dual Plane technique, while offering valid advantages, may still not completely solve their problem. In this category of women a small breast and the thinness of the subcutaneous tissues could leave the lower edge of the prosthesis along the inframammary fold quite palpable.
In order to better solve these particular cases, the “Triple Plane” partial sub muscular technique is of great help. For these thin women it is particularly advantageous as it also provides a valuable coverage to the lower pole of the prosthesis at the level of the inframammary fold. This additional coverage of the implant lower pole is achieved by the fascial connective tissues and Serratus muscular plane. It better covers the lower edge of the prosthesis. The excellent results obtained with this technical variant developed in Rome by Prof. R. Bracaglia, together with his team, were published by the American scientific journal AESTHETIC PLASTIC SURGERY in 2011 and 2013. This is a well-known and famous American Scientific Journal of Aesthetic Surgery, the official body of ISAPS (International Society of Aesthetic Plastic Surgery) of which Prof Bracaglia has been an active member for over 20 years. ISAPS is an International Society that brings together all the most qualified and experienced Cosmetic Surgeons worldwide.
The excellent results of the “Triple-Plane Tecnique” have been published by the “Aesthetic Plastic Surgery ” magazine as an” Innovative Technique ” spreading it to the Specialized Scientific Community. (
Prof. R. Bracaglia has also been invited to many Specialist Congresses of Aesthetic Surgery in recent years to illustrate this technique. The magazine “Aesthetic Plastic Surgery” has also published a further article illustrating this technique and its advantages with a new report on the excellent results obtained in hundreds of operated patients ( pubmed / 23657723).

To briefly explain the improvements achieved by the Triple Plane technique in thin or flat breasted women, we can summarize them briefly:

The “Triple-Plane” technique offers an excellent coverage allowing the breast implant to be better concealed. It creates an optimal projection of the areola-nipple complex, and a reduction of the dynamic deformities during the contraction of the pectoral muscle. It also ensures a very natural durable result . It also especially recommended in thin women for a more natural result than the Dual Plane technique.
The use of three different planes to cover the lower central and upper portion of the prosthesis offers, in short, multiple advantages:
– the prosthesis is deep and optimally covered in its upper pole (under the Pectoral muscle) and lower pole (under the plane of the Serratus fascia)
– provides an excellent projection of the central portion of the breast, where there is the areola and the nipple, because in this region the prosthesis is placed directly under the gland
– the dynamic displacement and palpability of the prosthesis is reduced
– better support and coverage of the prosthetic system improves the projection of the Breast at the level of the nipple-areola complex.

How is the Breast Augmentation procedure performed?
The intervention of breast implants (or breast augmentation) is performed by Prof Bracaglia in Rome under local or general anaesthesia, and lasts about an hour and a quarter, and it usually needs one day of hospitalization. The residual scar is very often small in size and generally not very visible. It can be placed in the lower edge of the areola, or in the inframammary fold or in the axillary cavity, depending on the preference of the patient. The breast implant is introduced through the selected access path. From an aesthetic point of view, the lesser evidence of the scar is with the point of access placed in the lower half of the edge of the mammary areola, on the line of passage between the dark and light skin. The incision around the areola provides excellent results: it is, in fact, not very evident. In the pictures in the Photogallery of Additive Mastoplasty you can see how this periareolar scar is almost invisible.
An alternative to this is the scar in the armpit, whereas the scar in the inframammary fold may in some cases remain more visible. The post-operative period in which the physical activities must be more limited is about 7 days: physical activity is allowed but limited to a reduced daily physical activity with no driving or too wide movements of the arms.
After the first week, the patient resumes driving and a normal physical activity. After a month, sports activities such as tennis, gym and swimming are also resumed. In the first four weeks after surgery a containment bra should be worn. After spending the first month, the patient will be free to wear the bra and choose the model most pleasing to her.
Breast implants have an undefined duration in time and the patient will have undergo regular examinations of her breasts like all women.

What are the complications of breast augmentation?
Complications of breast implants (or breast augmentation) are infrequent and, in any case, all treatable. They may occur immediately after surgery and include the possibility of haematoma, or very rarely, infection or displacement of the prosthesis. The hardening of the prosthesis is considered a late complication, but thanks to modern breast implants and to present-day surgical techniques this has become an infrequent event. It is very rare that, due to violent trauma, the prosthesis can be broken; if this happens, it does not involve any health risk because the prosthesis is made of very pure “Medical Grade” materials and can be removed and easily replaced.

Is it possible to increase breast volume with the patient’s own adipose tissue?
Professor Bracaglia, Aesthetic Surgeon in Rome at the Villa Stuart Clinic, increases breast volume with the autotransplant of adipose tissue taken from the subcutaneous fat of the same person. This technique was developed by the very famous American Surgeon Sidney Coleman. It has been used for many years both to generally increase the volume of the breasts or to increase the volume of one or more breast quadrants selectively: for example the medial or upper quadrants.
With the autotransplant it is also possible to improve the symmetry of breasts of different volume or asymmetric in shape.
The technique involves the removal of the adipose tissue from an area of the body that possesses it in excess by means of an atraumatic technique that uses tiny cannulae. This adipose tissue is implanted in the breast quadrants by means of thin cannulae. The autotransplant technique is performed in Rome by Prof. Bracaglia in sedation in a day hospital regime.
The technique of breast augmentation with autologous adipose tissue is increasingly used to increase breasts that have already had surgery with breast implants and that require a further increase in volume.

Some of Prof. Bracaglia’s scientific publications on his techniques of Aesthetic Breast Surgery and in particular on the Triple Plane which are presented at international level by the National Institute of Health – National Center for Biotechnology Information – USA
Personal BIBLIOGRAPHY by Prof Bracaglia: Specialist books on the mastoplasty of which Prof. Bracaglia has created the Italian edition:
Book of surgical technique in Italian edition of 154 pages published by Marrapese Editore of Rome translated from the French text “Prothesis Mammaires” of Jean-Saveaur Elbar and Jaques Ohono, published by “Medsi-Medicine et Sciences Internationales” of Paris.

Book on surgical techniques – Italian edition of 739 pages of the American text “Aesthetic and Reconstructive Breast Surgery” by John Bostwick, Ed. The Mosby Company – St. Louis, This Italian Edition was published by the Editor Capozzi of Rome

Some of the Scientific Publications on Additive Mastoplasty realized by Prof Bracaglia:
2013 Technique for Breast Augmentation: Solving Animation Deformities.