In the past, silicone is used to the mass majority of the patients but currently FDA forbids its usage except for particular patients of breast cancer with doctor's application. The reason is that some silicone will stick to breast tissue, creating membrane contracture, leaking or breaking on the breast. However, in Europe or Japan, silicone is still used because it has more satisfactory outcome in spite of having more side effects.

Another choice for patients is saline solution, which is injected into a bag made of silicone. For most clinical reports, it will not lead to any sequelae, or post-operative problems except that of membrane contracture. However, in this option, the breasts feel harder with bags of saline solution, and they don't look as natural as those using silicone.

There are also some other materials to use for mammoplasty, but they have been gradually displaced recently. FDA proposes studies, which show that using silicone to perform mammoplasty will not increase the rate of breast cancer or immune diseases. Therefore, there is a possibility that the U.S. will pass the usage of silicone again.

First, incision from the IMF (Infra-mammal-fold); either implant under the IMF or under the pectoral muscles. Patients who have drooping or larger breast tissue can choose to implant it under the IMF; those who have little mammal tissue can choose to put it under the pectoral muscles.

Second, incision from just below the halos; for Asian people, this method will leave noticeable scars, because at the border of two colors around the halos, the scars usually expend; and such scars are often complained by patients.

Third, to have a T-shape incision between the nipples and the halos; this method produces very small wounds, but like the second method, the scars are noticeably shown especially in Asian patients while they have darker nipples.

The fourth is to incision under the armpits; the scars produced by this surgery will be hidden in the folds. Therefore, it has a satisfactory outcome, even though scars can be seen in some cases.
As to the area to implant ( IMF or pectoral muscles ), it depends on the patients' figure or needs.

The fifth is to resort to the help of endoscopes, used to facilitate the separation of pectoral muscles or the IMF so that the saline solution can be implanted more easily. Another use of the endoscopes is to seize bleeding after the separation.

The last is to incision from the navel; this is not employed as mainstream because of the distance between the navel and the breasts, technically it is more difficult to implant the saline solution bag from a small incision in the navel. The advantages of this method comparing with the others mentioned above, it has smaller and less noticeable scars.

After having an idea how mammaplasty can be done with different approaches, the patients should be careful in choosing plastic surgeons before undergoing the surgery. A well-qualified plastic surgeon should have a full knowledge of the areas to be dissected and a good sense of aesthetic.
Patients' post-operative massage is another important factor to a successful mammaplasty.
An ideal mammaplasty, the breasts should naturally move to the two sides when lying down and slightly hanging down when sitting up. If not so, the implants will merely make the breasts look unnatural. Therefore, to perform a mammaplasty successfully is a big challenge for plastic surgeons.

To perform a microscopic surgery, the surgeons require a special training. In addition to general surgical techniques, exquisite surgical movements and impeccable coordination between eyes and hands are essential. Before the trainee surgeons can perform actual steps on patients, there is a training course for connecting blood vessels on animals like guinea-pigs or rats.

Like some other countries, Chang-Gung Memorial Hospital runs such training courses for microscopic surgery researchers. In general, after the training of resident doctor and chief doctor, an additional one-year training of microscopic surgery is required for the researchers in order to be a well-qualified surgeon of microscopic surgery.

It is a great innovation that mammaplasty can be done as a way of reconstruction by microscopic surgery instead of using traditional surgery techniques. Adopting microscopic surgery to perform breast reconstruction offers fewer side effects and greater rate of success, and it produces more natural breasts. This is a blessing for many patients of breast cancer.