Breast augmentation

Breast augmentation, technically known as augmentation mammoplasty, is a surgical procedure to enhance the size and shape of a woman’s breast for a number of reasons:

• To enhance the body contour of a woman who, for personal reasons, feels her breast size is too small.
• To correct a reduction in breast volume after pregnancy.
• To balance a difference in breast size.
• As a reconstructive technique following breast surgery. By inserting an implant behind each breast, we are able to increase a woman’s bustline by one or more bra cup sizes. If you’re considering breast augmentation, this will give you a basic understanding of the procedure -when it can help, how it’s performed, and what results you can expect. It can’t answer all of your questions, since a lot depends on your individual circumstances. Please ask us if there is anything you don’t understand about the procedure.

THE BEST CANDIDATES FOR BREAST AUGMENTATION

Breast augmentation can enhance your appearance and your selfconfidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with us. The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you’re physically healthy and realistic in your expectations, you may be a good candidate.

TYPES OF IMPLANTS

A breast implant is a silicone shell filled with either silicone gel or a saltwater solution known as saline. We are using the textured silicone filled implant. The results with this are superior to saline implants. The silicone can be gel or cohesive. The type of implant depends on the goal to be achieved and approach chosen.

ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

Breast augmentation is relatively straightforward. But as with any operation, there are risks associated with surgery and specific complications associated with this procedure. The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or “scoring” of the scar tissue, or perhaps removal or replacement of the implant.

As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood.

A small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery.

In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted.

Some women report that their nipples become oversensitive, undersensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients.

There is no evidence that breast implants will affect fertility, pregnancy, or your ability to nurse. If, however, you have nursed a baby within the year before augmentation, you may produce milk for a few days after surgery. This may cause some discomfort, but can be treated with medication prescribed by your doctor.

Occasionally, breast implants may break or leak. Rupture can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the man-made shell to leak. If a saline-filled implant breaks, the implant will deflate in a few hours and the salt water will be harmlessly absorbed by the body. If a break occurs in a gel-filled implant, however, one of two things may occur. If the shell breaks but the scar capsule around the implant does not, you may not detect any change. If the scar also breaks or tears, especially following extreme pressure, silicone gel may move into surrounding tissue. The gel may collect in the breast and cause a new scar to form around it, or it may migrate to another area of the body. There may be a change in the shape or firmness of the breast. Both types of breaks may require a second operation and replacement of the leaking implant. In some cases, it may not be possible to remove all of the silicone gel in the breast tissue if a rupture should occur. A few women with breast implants have reported symptoms similar to diseases of the immune system, such as scleroderma and other arthritis-like conditions. These symptoms may include joint pain or swelling, fever, fatigue, or breast pain. Research has found no clear link between silicone breast implants and the symptoms of what doctors refer to as “connective tissue disorders,”. While there is no evidence that breast implants cause breast cancer, they may change the way mammography is done to detect cancer. When you request a routine mammogram, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast with an implant. Additional views will be required. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant.

PLANNING YOUR SURGERY

In your initial consultation, we will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. If your breasts are sagging, maybe a breast lift is indicated.

PREPARING FOR YOUR SURGERY

We will give you instructions to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.

ABOUT THE OPERATION

I prefer to do the procedure in a clinic with general anesthesia. You will be one night in the clinic. The method of inserting and positioning your implant will depend on your anatomy and our recommendation. The incision can be made either in the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple), or in the armpit. Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible. Most of my patients choose the axillary approach, because the scar is completely hidden and the breast tissue and areola are not disturbed. I never do the crease incision. However some women prefer to have the incision in the areola rather than in the armpit. Working through the incision, the breast tissue is lifted to create a pocket, either directly behind the breast tissue or underneath your chest wall muscle (the pectoral muscle). The implants are then centered beneath your nipples. Putting the implants behind your chest muscle may reduce the potential for capsular contracture. Drainage tubes may be used for several days following the surgery. This placement may also interfere less with breast examination by mammogram than if the implant is placed directly behind the breast tissue. Placement behind the muscle however, may be more painful for a few days after surgery than placement directly under the breast tissue. The surgery usually takes one to two hours to complete. Stitches are used to close the incisions, which may also be taped for greater support. A gauze bandage is applied overnight and substituted for the bra before you leave the clinic.

AFTER YOUR SURGERY

You’re likely to feel tired and sore for a few days following your surgery, but you’ll be up and around in 24 to 48 hours. Most of your discomfort can be controlled by medication. The bra has to be worn day and night for one month. The bra helps the implant to rest within the pocket and to enhance the new inframammary fold. It has to be a sport bra with straps to regulate chest width and shoulder height. You may also experience a burning sensation in your nipples for about two weeks, but this will subside as bruising fades. Your stitches will come out in a week to 10 days, but the swelling in your breasts may take three to five weeks to disappear.

GETTING BACK TO NORMAL

You should be able to return to work within a few days, depending on the level of activity required for your job. I recommend not to do exercise in 10 days. You can resume your work in 3- 4 days. Your breasts will probably be sensitive to direct stimulation for two to three weeks, so you should avoid much physical contact. After that, breast contact is fine once your breasts are no longer sore, usually three to four weeks after surgery. Your scars will be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely. Routine mammograms should be continued after breast augmentation for women who are in the appropriate age group, although the mammographic technician should use a special technique to assure that you get a reliable reading, as discussed earlier.

YOUR NEW LOOK

For many women, the result of breast augmentation can be satisfying, even exhilarating, as they learn to appreciate their fuller appearance. Regular examination by your plastic surgeon and routine mammograms for those in the appropriate age groups at prescribed intervals will help assure that any complications, if they occur, can be detected early and treated. Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it. If you’ve met your goals, then your surgery is a success.

A video showing how the procedure is performed (axillary approach with cohesive anatomic implants):

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Post comments This post comment feed

1. 25 / Mar

   Valeria said…

   Hola Dr. Benito,
   Que probabilidad hay de que un implante anatómico se gire?
   y, qué diferencia existe entre prótesis anatómicas o redondas y el perfil moderado plus? esta última que diferencia concretamente tiene con las dos anteriores?
   Qué medidas tengo que tener para poder ponerme implantes a partir de 400cc?
   Con esto del tamaño me siento muy liada, ya que el tamaño imagino que dependerá de muchos factores para que quede “natural”. Pero una piensa, ya que me pongo… no me quiero quedar corta…jeje
   Muchas gracias!

   Reply

   1. 26 / Mar

      AGB said…

      Estimada Valeria
      La estadística general de rotación de un implante anatómico es de un 3%. Nosotros tenemos menos de 1% y se ha tratado siempre de situaciones muy particulares. No es nada habitual. Existen numerosos tipos y tamaños de implantes y hay que ver el contorno del tórax y la forma de la mama para ver cuál es el que mejor queda. Cuanto más grande, menos natural. Lo más natural es el implante cuyas medidas corresponden a la anchura de la mama y al contorno. A partir de ahí perdemos naturalidad. Cuando más grande se quiera el implante, más indicación hay para el anatómico (en mi opinión).
      Saludos cordiales
      Dr. Benito

      Reply

2. 17 / May

   Mª Isabel Folch said…

   Tengo 51 años , llevo protesis desde hace 25 años y no he tenido nunca ni el minimo problema, ahora sale en la resonancia que hay rotura-yo no noto nada-, parece que la rotura es interna, querría saber si debo cambiarlas, si la operación es fácil, tiempo,etc. y posible precio. Imagino que es mejor cambiarlas ahora antes de que puedan romperse externamente?? es que me da una pena operarme sin notar nada, en fin, gracias de antemano, iré a su consulta

   Reply

   1. 17 / May

      AGB said…

      Estimada María Isabel,

      En primer lugar, agradecerle su visita a nuestra web.
      En cuanto a su caso, decirle que se trata de lo que llamamos una rotura intracapsular. Efectivamente la
      recomendación es el recambio. Aunque no es urgente es aconsejable hacerlo antes de que la rotura sea extracapsular.
      En el caso de rotura intracapsular la operación es relativamente sencilla y el postoperatorio es llevadero. Entendemos que da mucha “pereza” hacerlo, pero los implantes son dispositivos que pueden requerir recambio. La mayor parte de roturas son asintomáticas y son un hallazgo casual.

      Espero haber resuelto su duda. Recuerde que estamos en Madrid y en Barcelona, puede pedir cita online desde cualquiera de las dos páginas.

      Reciba un cordial saludo.
      Dr Benito.

      Reply