Mamaplasty/Breast Augmentation with Prostheses

General

24 hrs.

4 days

Breast Augmentation

Breast augmentation is the second most requested cosmetic procedure in Spain after liposuction.

One of the most important factors of femininity is breast aesthetics. Their shape and size condition women to a great extent and thus affecting their self-esteem and confidence.

There is no such thing as the perfect breast. But when it is too small or lacks volume due to breast-feeding of important weight loss, it can be corrected easily with a breast implant.

Breast aesthetics is one of the most important factors of femininity

Breast augmentation (augmentation mamaplasty) has become one of the most popular cosmetic surgery procedures in recent years especially among younger women. It is estimated that last year alone 20,000 pairs of prostheses were implanted.

The ideal woman of the 90´s had feminine and womanly curves and having small breasts was a defect that needed to be corrected. Fortunately, the procedure is becoming less and less complex and prostheses are safer and more durable. Surgery lasts less than an hour and the patient only needs to stop normal activity for three or four days. Breast enhancement is now easier than ever, for as long as the procedure is carried out by skilled surgeons and in fully accredited clinics.

"Instituto Médico Láser has been performing augmentation mamaplasties for quite some time. Lately, though, there has been a dramatic increase in the demand of this procedure, and by younger and younger women ", explained Ignacio Sanz, plastic and cosmetic surgeon at Instituto Médico Láser. "The medical industry is constantly studying new safer and more durable prostheses".

Breast implants come in different forms, shapes and sizes; although they are all enveloped in silicon filled with saline (water) or silicon gel. The silicon gel implants are the most reliable and render excellent and very natural aesthetic results.

• Implanting technique
• Implant types
• Procedure
• Post-operative care
• Results
• Complications
• Frequently asked questions

Implanting Technique

1. Access Routes:

The access routes for breast implants are three: Submammary, Axillary and Areolar. Each method has its advantages and disadvantages. The final choice depends on the personal experiences of the surgeon and the physical features of the patient.

• Submammary: The incision and resulting scar is located in the fold below the breast. This is a simple route and allows for the implantation of any type of prosthesis. It is a very safe method, but the scar will always be in a visible place, no matter how well sutured it is.
• Axillary: The scar is neat with no reference to the breast, but it is a problem route that can present complications. It is suitable only in certain cases.
• Areolar: Aesthetically, it leaves a very discreet, almost invisible scar. It is as safe as the submammary fold. A disadvantage of this method is that some implants are difficult to place correctly.

2. Implant Position:

In this case, there are also various options for the placing of the breast implant and the decision should be made based on the patient’s physical features.

• Retropectoral Position: The implant is placed in a “pocket” that is made between the pectoralis major and the pectoralis minor muscles and the ribs. This position has advantages when the top third of the implant should be covered to limit visibility of the top part of the implant. A disadvantage is that it is less natural and the pectoral muscle has to be cut. Additionally, some quite unnatural effects can come about with the muscle contractions. This was practically the most exclusively used method for older implants to cover up their capsular contraction.
• Retroglandular Position: The implant is placed between the mammary gland and the pectoral muscle in a more natural position to increase the gland’s volume. Results with cohesive gel implants are more natural and do not carry muscular or pectoral lesions or unnatural movements.
• Retrofascial Position: The implant is placed behind the fascia that covers the pectoral muscle. The result is better than if the implant is placed behind the muscle, although there is more profuse bleeding and increased pain. It is scarcely used.

Implant Types

Breast implants have gone through an important evolution process and the earlier silicon gel implants have been substituted by cohesive gels. Cohesive gel has many advantages over the previous type of gel used. Basically, it feels more “compact”, although not necessarily harder. The advantage of cohesive gel is its greater security:

1. If the implant breaks, the gel does not leak out of the wrapping.
2. The gel has a “memory”, so the shape does not change and the problem of rippling (creasing) that can occur with earlier implants and very slim patients is reduced.
3. The problem of micro-perspiration through the envelope has apparently disappeared; this means that the chronic inflammation that earlier models of implants caused has been reduced. Other problems, such as rejection, hardening and capsular contraction are also intensely reduced.

The comparison between earlier models and the newer ones can be related to that of a current car and one that is 15 years old.

Present-day implants are excellent and regardless of the brand, they all have similar features. The main differences are in the models and shapes. Each manufacturer markets an enormous selection of implants. The choice of responsibility of the surgeon, always assuring that it adapts to the patient’s thorax.

In order to obtain a natural result, it is vital to respect the natural aesthetic lines of the breast. The most important of these is the line from the collar bone to the nipple. This line must be straight given that no top bulging, causing a "ball" effect exists in nature in that area.

The shape of the implant is not important for this line to be straight (anatomical or round). What is important is that the vertical diameter of the prosthesis does not protrude or go beyond a certain point. This calculation is quite simple for an experienced surgeon and confirms that there are appropriate implants for every patient where volume and / or size have no relevance at all.

The most important factor is the diameter and if these are correctly calculated, more or less volume can be added y choosing different prosthesis models.

At present, the prostheses used are made of cohesive gel which is silicone gel, like the ones made some time ago, but with the difference that the gel has been treated to provide specific physical qualities. These qualities prevent the passage of the substance into other parts of the body should a rupture of the capsule occur. Future replacement of the prosthesis is also facilitated.

Is vital to respect the natural aesthetic lines of the breast

There are two types of cohesive gel prostheses: anatomical and round-shaped prostheses:

Anatomical Implants

These implants simulate the shape of the mammary gland in the vertical position. They were originally designed as implants for mammary reconstruction. The main advantage being that they best simulate the breast shape in extremely thin patients. Their features are:

1. They are firmer to the touch.
2. They bulge excessively on the top parte of the breast.
3. Mobility is limited.
4. They require a sub-mammary scar (not very aesthetic) for a correct placement.

Round Implants

The features of round implants are:

1. There is a wide variety of models and they render a much more natural result.
2. The gel is softer and takes the shape needed according to the position of each patient. In a drop form if they are vertical and rounded in a horizontal position.
3. They change with the patient's movements much like a normal breast.
4. They are softer to the touch and can be inserted using any method.
5. The ample variety of models makes them perfectly adaptable to any patient.

Procedure

1. General anaesthetic is recommended and much safer. The anaesthetic used is gentle and fast (1 hour).
2. The patient awakes without bandages and wearing a sports-type bra. Two fine drainage tubes should be inserted to avoid bruising.
3. In order to increase safety, the patient should remain in the clinic for 24 hours; the drainage tubes are removed the following morning and she can then be discharged.
4. The initial appearance of the breast is somewhat peculiar and unnatural. This is due to the inflammation and swelling.

Post-operative care

1. There is some discomfort for the first two days. This is caused by itching, skin dryness and to the weight of the implants, but no pain is experienced by the patient.
2. The first check up is held 48 hours after the procedure and at this time the patient can shower and use moisturising lotions. This eliminates almost all of the discomforts and the patient can resume her normal daily life. The sole exceptions are that she should wear the bra for 24 hours a day and avoid exerting her arms in excess for a fortnight.
3. The stitches do not need to be removed as absorbable sutures are used.
4. Exposure to the sun must be avoided during the first month. From then on, and especially in the case of areola scars, they should be exposed to UVA light to disguise them.
5. One month after the procedure the breast is soft and looks good but still has some slight swelling. The permanent state is reached after 4 to 6 months.

Results

The results of an augmentation mammoplasty are completely natural and aesthetically perfect if the size and final volume follow those appropriate to the patient’s thorax and physical features.

Complications

1. The standard complications of any surgery: Infection, hematoma, seroma, etc. Every effort is made to avoid these and they are infrequent, but zero risk does not exist in any type of surgery.
2. Capsular contraction: This is a normal occurrence and only in the event of extreme cases can it be considered a complication that requires treatment. Its incidence rate is less than 1% for cohesive gel implants.

Frequently Asked Questions:

1. Can a mammography be performed after a breast augmentation?

Yes. The physician should be informed that the patient has breast implants. Nevertheless, mammary ultrasounds are more advisable in these cases.

2. Is there a risk of cancer or breast disease?

Absolutely not. Every study ever carried out has shown no risk at all.

3. Can I breast-feed?

Yes. The implant does not affect the normal functioning of the mammary gland in any way whatsoever. In the event of pregnancy and breast-feeding, the aesthetic changes are those typical to any woman and have no relation with the prosthesis.

4. Is there a loss of sensibility?

No. There may be alterations in sensibility in the first few months, but these can increase or decrease but these are completely transitory since they are due to post-operative inflammation.

5. Will it be noticeable?

Yes. Those closest to you will notice the change, but the important point is that strangers will not notice that those beautiful breasts are the result of an operation. It must be natural and integrate perfectly with each patient's physical structure with the ability to move.

6. Do implants explode?

Absolutely not. It is advisable during the first month to avoid flights of over 6 hours since the cabin pressure can increase inflammation. Implants have been tested at NASA laboratories and they do not explode.

7. Should they be periodically replaced?

No. Mammary implants should be checked once a year but they do not need replacing unless a problem is detected. Manufacturers issue guarantees that cover a certain number of years, but this does not mean that they require replacing.

Breast prostheses can be inserted behind the gland (retroglandular) or behind the pectoral muscle (retropectoral). The advantage of positioning the prosthesis behind the muscle is that it looks more natural, as the pectoral muscle hides giving it shape. It is the best option in patients with small breasts.

The type of prosthesis can be: high profile, when the breast needs correction; low profile, when the breast cup is sufficiently big; and anatomical or tear-shaped.

In some cases, it can be combined with a reduction of the areolar size.

The approach route can be periareolar, through the submammary furrow or via the axilla.

For personalised information of mamaplasty, contact IML now and we will give you a free informative consultation with one of our surgeons experts.