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Breast Augmentation: Surgical Secrets

By Manuel Lazzaro, M.D., Plastic Surgeon
Posted: 13th April 2016 08:35
Mammoplasty or breast augmentation is the surgical procedure performed to improve the size and shape of the breast. This surgical procedure is often completed for one of two reasons. Firstly, aesthetical or cosmetic surgery is often performed on those patients who want to improve their body or who do not like the size of their breasts. Secondly, reconstructive surgery is undertaken secondary to a mammary cancer surgery or to balance mammary asymmetry situations. The Plastic Surgeon inserts an implant behind the mammary gland thus increasing the size and projection of the breast to reach one or two sizes more in their bra. If you are considering an augmentation mammoplasty, this information provides you with basic concepts that you must know, nevertheless, many details, questions and expectations that would remain unanswered will depend on the individual evaluation of the patient and the criteria of each Plastic Surgeon. Thus it is important that the patient personally consults with the Plastic Surgeon on any question or concern they may have.
The Best Candidate for augmentation mammoplasty
To be a good candidate for augmentation mammoplasty the patient must have realistic expectations regarding the surgical procedure that can be achieved. Augmentation mammoplasty may improve the physical appearance and self-esteem, but remember that a change of “look” does not guarantee the ideal result or even change the way other people respond to the patient. Therefore, before having an augmentation mammoplasty surgery, think carefully about your expectations and discuss it with your Plastic Surgeon.
The best candidates for an augmentation mammoplasty are women who wish for an improvement but do not necessarily expect perfection from a mammary aspect. They must be physically healthy, psychologically stable, and certain of their expectations regarding what the mammary surgery can do for them.
Many women want to undergo an augmentation mammoplasty after pregnancy due to the reduction of the volume and size of the mammary glands, nevertheless, if the patient is planning or wants to have more children in the short term it is advisable for her to postpone the notion of having this surgery. The reason is that pregnancy may again repeat the cycle of enlarging and reducing the volume and size of the breasts voiding the results obtained by an augmentation mammoplasty. Likewise, it is important to emphasize that there are no risks that may affect future pregnancies because augmentation mammoplasty does not interfere with breast-feeding.
Usually augmentation mammoplasty is performed to balance the size of the breasts, to aesthetically improve the body contour and to reconstruct the breast in cases after oncological mammary gland procedures.
Types of implants
Currently there is a wide variety of implants with different volume, shape and characteristics that vary according to the needs of each patient, the preference and surgical technique of each Plastic Surgeon. Mammary implants can be prosthesis filled with silicone gel, cohesive gel or hydrogel. There are also the inflatable prostheses that are filled with saline solution during the surgery. There are implants or smooth and textured prostheses. The first type is placed behind the pectoral muscle due to its easiness for insertion. The second, the textured prostheses, is placed in front of the muscle and this characteristic of external texture has shown to diminish the possibility of developing a capsule or contracture of the prosthesis, which is one of the most common complications in this type of surgery.
Every surgery carries a certain degree of risk and complications
Augmentation mammoplasty is a generally safe procedure as long as it is performed by qualified and trained Plastic Surgeons. Complications are usually minor and, luckily, they are not frequent. Nevertheless, as with every surgery, there is always a possibility.
The most common problem is the capsular contracture or the hardening that occurs around the prosthesis that causes the mammary gland to feel hard during palpation. As with any surgery, there can be excessive bleeding that causes an increase in volume and pain. If it continues it may require another surgery to control it and drain it.
Another small percentage of patients develop an infection around the implant, sometimes the implant must be removed for some time until the infection gets controlled. Later, a new implant can be placed.
Some women state that their nipples become more sensitive or less sensitive, and in some cases, they refer that they are not sensitive or that they feel numbness in the area.
Sometimes the mammary implant may break. This rupture may occur as the result of an impact or hit (car accident, direct trauma) that goes beyond the normal compression that the mammary space that the prosthesis can resist. If it is a saline solution implant, it will progressively deflate and the body will absorb the liquid. Lastly, there is no evidence that the mammary implants can cause or predispose mammary cancer. The only thing that is modified is the manner to perform a regular mammographic study.
Be sure to inform the radiologist or radiology technician that you have a mammary implant prior to the mammography because there are special techniques required to obtain radiological studies of breasts with implants. The Eco sonogram is another useful study to evaluate the conditions, not only of the breast but also of the implant.
Since most women do not experience complications, the patient must discuss each complication with the medical doctor. The patient must be sure that she has understood the risks and consequences of the Augmentation Mammoplasty.
All risks and complications can be reduced by closely following the Medical Doctor’s recommendations before and after the surgery.
Planning the Surgery
Augmentation Mammoplasty must be an individual procedure for each patient. The initial consultation with the Surgeon is very important. It will evaluate the medical history and complete medical background. Therefore, be sure to inform you Surgeon about any particular allergies, if you are taking any medication (for example, aspirin), including vitamins or other drugs that may affect coagulation, and above all, your tobacco consumption background.
During this initial consultation, you must set your plans and expectations for this surgery. Remember that each patient and each medical doctor have different points of view about the desired shape and size of the breasts.
Be open to discuss this with the Plastic Surgeon, who must also be direct with the patient by describing and explaining the procedure and all its details, as well as the risks and limitations. Make sure that you understand the explanation on the final results and the after surgery stage. You must also discuss the anesthesia that will be used, the place and the costs required for this surgery.
The Plastic Surgeon must examine the breasts and measure them while sitting and lying down. Later, you will discuss the variables that may affect the success of the surgery such as the age of the patient, skin conditions, size and shape of the breasts.
Lastly, the Mastopexy or Mammary suspension together with the Augmentation Mammoplasty will be offered for those patients with sagging or flaccid breasts that might need them.
Finally, do never forget to ask your Surgeon regarding any doubts you may have, especially surrounding expectations, wishes and expected results.
Preparation for the Surgery
Depending on the age and family background of the patient, the Plastic Surgeon will request a mammography before the surgery. He will also give specific instructions on how to prepare you for the surgery’s day, including provisions regarding the type of food, drinks, tobacco consumption, and the intake of some vitamins and specific medicine, or not.
If the patient develops a flu or skin infection, the surgery would need to be rescheduled.
If you smoke, it is particularly important for you to stop smoking at least 2 weeks or more before and after the surgery. Tobacco inhibits and blocks healing of the wounds. Follow the instructions carefully because they will help you experience a better evolution of your surgery.
Be sure to count on a family member or on a companion for your return home after the surgery.
Where can the surgery take place?
Augmentation Mammoplasty can be performed at a hospital or at an outpatient centre.
Types of Anesthesia
Augmentation Mammoplasty is usually performed under general anesthesia but it can also be performed under local anesthesia or intravenous sedation, depending on the scope of the surgery and, of course, on the patient’s and medical doctor’s preference and tolerance. With the use of local anesthesia, the patient is conscious during the surgery but sedated and relaxed without feeling pain. Cases without complications of very well qualified patients are generally performed under local anesthesia. With the use of general anesthesia, the patient will be asleep during the entire surgery and will feel more security and control.
The Surgery
The time required to perform an Augmentation Surgery is between 1 and 2 hours. It may last more if it is combined with other surgical procedures such as Mastopexy (mammary suspension), local liposuction and mammary contour. Some surgeons prefer not to perform combined surgical procedures, but to perform individual surgeries to avoid lengthy surgeries. The method and the surgical technique to insert and place the mammary implant will depend on the patient’s anatomy and on the Surgeon’s criteria and recommendation. The incision can be done on the submammary fold (where the breast and the chest meet), around the areola and at the level of the underarm.
The incisions are made at an almost unnoticeable location on the submammary fold around the areola and at the level of the underarm. Through the incision, the tissue of the mammary gland is lifted thus creating a “pocket” or space that can be placed before the pectoral muscle, i.e., behind the mammary gland or also behind the pectoral muscle. The implant is placed in the centre in relation with the areola and the nipple. The mammary implant is placed directly under the tissue of the mammary gland or behind the pectoral muscle.
Some researches show that placing the implant behind the muscle may reduce the capsular contracture. Also, this location behind the muscle interferes in a minor degree with the performance of the mammography than when the implant is placed directly behind the mammary gland. Incisions are closed with fine non-visible suture under the skin. Then, the post op. treatment is done with gauzes and bandages to help immobilize the breast. After the surgery, the breasts look high and projected, firm and natural to the body contour. The scar of the incision vanishes with time.
After the Surgery, the Post Op. Treatment
After the surgery, the medical doctor uses an elastic bandage or a post op. bra on the patient’s wounds. Then, he substitutes the surgical elastic bandage or the post op. bra for a sports bra that the patient must use and maintain during 3 to 4 weeks. The suture may begin to be removed after the seventh day after the surgery. Usually, there is no significant discomfort after the surgery. If there would be any discomfort it would be minor and would be easily treated with an analgesic or anti-inflammatory medication prescribed by the medical doctor. The presence of severe or persistent pain, as well as any inflammation or a sudden increase in the volume of the breast must be immediately reported to the Surgeon. The medical doctor must also prescribe antibiotics to prevent any infection. The patient may experiment loss of sensibility on the areola and nipple caused by the inflammation or edema. This sensation generally disappears and the sensibility is recovered progressively within 4 to 6 weeks after the surgery.
It is recommended to apply a humectant cream several times a day if the skin looks dry or dehydrated without applying it directly on the wounds and suture areas.
Back to Normal
The healing process is gradual. The Plastic Surgeon will instruct the patient to walk as soon as possible. In addition to being good for the health, it helps to diminish the edema and swelling. The patient will start to feel better after 1 or 2 weeks. A post op. control must be followed to verify and closely watch the evolution. In the event of a sudden unusual increase of the breast volume, the patient must call the specialist immediately. On the third week after surgery, the patient will feel and look considerably better.
Your New Look!
For many women, the results of an Augmentation Mammoplasty are very satisfactory. If the expectations of the patient are real, she will feel good and she will like the results of the surgery. The patient must be aware that Augmentation Mammoplasty will not maintain the breasts firm and high forever due to the effects of gravity, pregnancy, breast feeding, skin conditions and weight changes. These are the factors that may have an effect on the breasts. The decision to undergo an Augmentation Mammoplasty is very personal even to the point that perhaps other people may not understand it. The important thing is how the patient feels. If real expectations are met, then the surgery will be a success.
Manuel Lazzaro, M.D., Plastic Surgeon
Centro Medico Docente La Trinidad
Edif Gonzalez Rincones Piso –1. Servicio de Cirugía Plástica
Caracas, Venezuela.
Telf +58-414-2770252

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