An Innovation in Breast Augmentation
MIA (Minimally Invasive Augmentation) breast augmentation represents a recent evolution in the field of aesthetic breast surgery. Developed by Establishment Labs in collaboration with aesthetic surgeons, this technique is distinguished by its minimally invasive approach that preserves natural breast tissues.
Unlike conventional methods, the MIA procedure uses an axillary incision of less than 3 cm and a patented injection system to place specifically designed implants, without using a scalpel on the breast. This innovation addresses frequently expressed patient concerns: visible scars, prolonged recovery time, and the use of general anesthesia.
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Clinical Indications for MIA Breast Augmentation
The MIA technique is intended for patients meeting specific criteria. It is particularly suitable for women seeking a moderate and harmonious increase in breast volume.
Ideal candidate profile:
- Women over 18 years seeking an increase of 1 to 2 cup sizes
- Patients with a BMI between 18.5 and 24.9
- Breast width less than 14 cm
- Intermammary distance less than 3 cm
- Absence of significant breast ptosis
- No history of breast or axillary surgery
Appropriate clinical situations:
- Breast hypoplasia (underdeveloped breasts)
- Volume loss after breastfeeding or weight loss
- Mild to moderate breast asymmetry
- Seeking a discreet result proportional to body type
The technique is not indicated for patients seeking a significant increase (more than 2 cup sizes), presenting severe ptosis, major chest wall malformations, or tuberous breasts.
In practice: MIA is not suitable if you...
- Seek an increase of more than 2 cup sizes (>200 cc)
- Present breast ptosis requiring a lift
- Have wide breasts (>14 cm) or very separated (IMD >3 cm)
- Wish to combine augmentation with a lift in a single procedure
- Have a BMI outside the range 18.5-24.9
- Have a history of breast or axillary surgery
These strict criteria mean that only a minority of breast augmentation candidates will be eligible for the MIA technique. During consultation, your surgeon will assess whether your anatomy and objectives are compatible with this approach or if a conventional technique would be more appropriate.
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How MIA Breast Augmentation Works: Mechanism of Action
Tissue Preservation Principle
The MIA procedure is based on three innovative concepts that differentiate it from traditional breast augmentation.
Tumescent Hydrodissection
The procedure begins with the infiltration of a tumescent solution into the prepectoral space. This solution, composed of physiological saline, lidocaine, epinephrine, and sodium bicarbonate, allows tissues to be separated by hydraulic pressure rather than by sectioning. This technique minimizes tissue trauma and reduces intraoperative bleeding.
Nesting Effect
An inflatable balloon is introduced into the created space to form the implant pocket. The radial expansion of the balloon pushes breast tissues without cutting them, creating a "nest" around the implant. This approach preserves the circummammary ligaments and natural support structures of the breast, unlike conventional techniques that section these structures.
Tenting Effect
MIA implants use a bi-convex diamond-shaped geometry (Motiva Ergonomix2 Diamond) that optimizes projection with reduced volume. This shape allows a 22% increase in projection compared to round implants of the same volume, thus reducing the amount of silicone needed to achieve the desired result.
Prepectoral Placement Plane
Implants are positioned in a tissue preservation space located between the corpus mammae (glandular tissue) and the posterior lamella, thus preserving breast sensitivity and the integrity of the pectoral muscle.
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MIA Procedure Steps: Stages and Operative Time
Preoperative Phase
Preoperative evaluation includes a thorough clinical examination and 3D imaging (Divina system) to measure existing breast volume and projection. High-resolution ultrasound assesses available tissue coverage. Implant selection is based on patient wishes and anatomical landmarks.
Anesthetic Protocol
The majority of procedures (90% according to the Chacon-Quiros et al. prospective study) are performed under conscious sedation with local anesthesia, thus avoiding the risks associated with general anesthesia. Premedication with acetaminophen (750-1000 mg) and cephaloporin is administered.
Operative Time
In the prospective study of 100 patients followed for 3 years, the mean times recorded were:
- Tumescent solution infiltration: 6 minutes
- Pocket creation and implant placement: 11 minutes
- Total operative time: 27 minutes
- Immediate recovery: 42 minutes
Surgical steps:
- Preoperative marking in standing position with arm raised
- Axillary incision of 2 to 3 cm in the natural fold
- Creation of a tunnel to the prepectoral space
- Introduction and inflation of the balloon to form the pocket
- Injection of the implant via the patented system
- Position verification by ultrasound
- Two-layer closure with skin glue
The study demonstrated a progressive reduction in operative time with experience, from 38 minutes at the beginning of the series to 22 minutes after 70 cases, demonstrating a rapid learning curve.
MIA Breast Augmentation Results: Timeline and Efficacy
3-Year Efficacy
The prospective controlled study published in Aesthetic Surgery Journal reports the following results on a selected cohort of 100 patients meeting strict eligibility criteria:
Volume increase:
- 75.3% of patients achieved an increase of 1 to 3 cup sizes (according to volumetric measurements and clinical evaluation)
- 24.7%: 1 cup size increase
- 19.1%: 2 cup size increase
- 31.5%: increase of more than 2 cup sizes
- Mean breast volume: increased from 218.8 cc to 388.7 cc
- Breast projection: increased from 4.2 cm to 5.8 cm
The most commonly used implant volumes were 140 cc (38% of cases) and 165 cc (35% of cases), representing together 73% of the devices implanted.
Recovery Timeline
Postoperative data demonstrate particularly rapid recovery:
- 76% of patients resumed daily activities within 2.8 days (average)
- 61% resumed physical activity within 20.1 days (average)
- Same-day discharge for 100% of patients
- No prolonged hospitalization required
This accelerated recovery contrasts significantly with the 2 to 4 weeks typically recommended after conventional breast augmentation.
Results Stability
Magnetic resonance imaging performed on a subcohort of 33 patients at 18-21 months postoperatively confirmed:
- 100% implant integrity (no ruptures)
- Correct positioning in the prepectoral plane for all cases
- Preservation of surrounding breast tissues
- No gel leakage or fractures
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MIA Breast Augmentation Pricing in Belgium
Price Range
In Belgium, MIA breast augmentation prices vary according to facilities and surgeon experience:
MIA technique:
- In specialized centers in Belgium, prices start at approximately €8,260 excl. VAT (≈ €10,000 incl. VAT with 21% VAT)
Comparison with conventional techniques:
- Classic augmentation with Motiva implants: €4,100 to €5,000 excl. VAT
- Augmentation with MIBIS technique: €3,295 incl. VAT
- Premium Motiva Joy implants: €4,950 excl. VAT
Price Inclusions
Prices quoted for the MIA procedure generally include:
- Surgeon and anesthesiologist fees
- Operating room and day hospital fees
- Motiva Ergonomix2 Diamond implants
- Patented MIA injection system (single-use devices)
- Postoperative follow-up and control consultations
- Support by a dedicated MIA concierge
Cost Factors
The MIA procedure is more expensive than traditional augmentation due to:
- Patented technology and single-use instruments
- Specific next-generation implants
- Specialized training required for surgeons
- Optimized anesthetic and recovery protocol
An initial consultation (€50 to €100) is recommended to obtain a personalized quote adapted to your anatomical situation.
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Complication Rates and Safety Profile of the MIA Procedure
3-Year Safety Data
The Chacon-Quiros et al. prospective study reports a remarkably low complication rate according to Kaplan-Meier analysis:
Overall complication rate: 3.2%
Specific complications recorded:
- Capsular contracture (Baker III/IV): 0%
- Implant rupture: 0%
- Infection: 0%
- Seroma: 0%
- Hematoma: 0%
- Superior malposition: 1% (1 case requiring revision)
- Inferior, lateral, or medial malposition: 0%
- Rippling: 0%
- Nipple sensitivity loss: 0%
- Breast sensitivity loss: 0%
The overall reoperation rate was 1% at 3 years, corresponding to the case of superior malposition requiring implant repositioning.
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Comparison with Conventional Breast Augmentation
To contextualize these results, data from the medical literature on traditional breast augmentation report variable complication rates depending on techniques, populations, and follow-up durations:
Capsular contracture:
According to a systematic meta-analysis, the overall incidence of capsular contracture after breast augmentation is 10.6%. Identified risk factors include smooth (versus textured) implants, subglandular (versus submuscular) placement, and silicone (versus saline) implants.
A systematic review published in PMC indicates that capsular contracture rates vary from 2.8% to 20.4% according to individual studies, with a combined rate of 3.6% after augmentation surgery. This variability reflects differences in surgical techniques, implant types, and follow-up durations.
General complications:
The most common complications after conventional breast augmentation are capsular contracture, asymmetry, implant malposition, hematoma, and infection. Capsular contracture remains the most common cause of reoperation within 4 years following primary augmentation.
It is important to note that these rates come from studies on non-selected populations and variable follow-up durations, which makes direct comparison with MIA results difficult.
Sensitivity Preservation
The absence of sensitivity loss in the MIA study (0% at 3 years) is particularly notable. Tissue preservation limits damage to the anterior intercostal nerves (4th and 5th) responsible for breast innervation, unlike conventional techniques that may compromise these structures.
Limitations of Current Data and Critical Perspective
It is important to contextualize these favorable results. The MIA technique is recent (commercialized since 2020) and available data come primarily from a prospective study of 100 patients followed for 3 years, conducted by surgeons trained in the technique and involved in its development. Patients were selected according to strict criteria (BMI 18.5-24.9, favorable anatomy, absence of ptosis), which limits the generalization of results to all breast augmentation candidates.
Long-term comparative data (beyond 5-10 years) are not yet available to assess the durability of results and the evolution of complication rates over time. Independent, multicenter, and comparative studies with conventional techniques remain limited. These elements must be taken into account when making a decision, and a thorough discussion with an experienced surgeon is essential to determine if this technique is appropriate for your individual situation.
Contraindications to MIA Breast Augmentation
Absolute Contraindications
- Ongoing pregnancy or breastfeeding
- Active infection or evolving tumor disease (breast cancer)
- Ongoing radiotherapy or chemotherapy treatment
- Known allergy to silicone or local anesthetics
- Uncontrolled coagulation disorders
Relative Contraindications
- Severe breast ptosis requiring a lift
- Tuberous breasts or major chest wall malformations
- Significant breast asymmetry
- History of extensive breast or axillary surgery
- Active smoking (risk of healing complications)
- Unrealistic expectations regarding the result
Technical Limitations
The MIA procedure has certain limitations compared to conventional augmentation:
- Limited augmentation volume (generally up to 195 cc)
- Not suitable for patients seeking an increase of more than 2 cup sizes
- Requires compatible breast anatomy (width <14 cm, IMD <3 cm)
- Does not allow combination with a breast lift in one stage
Preoperative Evaluation
During consultation, the surgeon evaluates:
- General health status and medical history
- Aesthetic objectives and their compatibility with the technique
- Thoracic and breast morphology
- Skin elasticity and available tissue coverage
- Individual risk factors
A thorough discussion determines whether the MIA technique is appropriate or if a conventional approach would be better suited to the patient's objectives.
Frequently Asked Questions About MIA Breast Augmentation
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