AUGMENTATION MAMMAPLASTY
In 1962, at Jefferson Davis Hospital in Houston (Texas, USA), an American mother of six was the first woman to receive a silicone implant to increase the size of her breasts. From that time to the present day, the Augmentation Mammaplasty – the name given to the set of surgical techniques for the inclusion of breast prostheses – is one of the most performed and researched aesthetic procedures in the world.
Brazil is a reference and one of the world powers in this area. Worldwide, we observe constant advances in surgical techniques, suture materials, monitoring devices, surgical equipment, anesthesia, medicines, and in silicone breast prostheses.
WHAT IT IS AND HOW IT IS DONE
The breast implant prostheses we use today in plastic surgery Augmentation Mammaplasty have advanced technology, high durability and the best manufacturers give a lifetime warranty on their products. Of course, this time considering that you have not had any trauma to the breast region, do not practice high impact sports, have not had capsular contracture or some more serious health problem.
Once indicated for your case, we choose which prosthesis can be better indicated for your breasts to have a harmonic shape and according to your biotype. Factors such as your height, body structure, biotype, distance between trunk and hips, chest proportion, bone structure, skin elasticity and original breast formation are taken into consideration. It is worth emphasizing that your aesthetic preference is the most important in the choice process.
We take into account what material it is made of, what shape it is made of, and its profile. Regarding volume, each prosthesis varies from 150 to 600 milliliters.
The incisions of the Augmentation Mammaplasty are made in discrete areas to help hide the scar. We evaluate with the patient which sites are appropriate for the incisions keeping in mind the type of implant, the desired volume, the anatomical particularities, and most importantly, the desired result.
We can opt for the inframammary (breast base), transaxillary (below the axilla) or periareolar (areola contour line) incision. The type of incision also depends on where the prosthesis is positioned: whether under or over the pectoral muscle.
Breast implant surgery takes an average of 1 hour. General, local with sedation or epidural anesthesia is used.
PROSTHESIS CHARACTERISTICS REGARDING...
MATERIAL
Silicone Gel – It presents a consistency and texture close to the structure of female breast tissue. The cohesive gel silicone prosthesis presents no risk of leakage. It generates less risk of capsular contracture.
Polyurethane – Polyurethane coating with silicone gel filling. It is stable and has high adherence to the surrounding breast tissue, but this characteristic makes eventual new surgery difficult (exchange, for example), requiring larger incisions in the skin.
Saline – Allows the administration of the ideal dosage of liquid (saline solution) which provides a more symmetrical result. Allows smaller incisions in the skin. They are used for volume augmentation and in reconstructive plastic surgery of the breasts. They are common in countries like the USA, but are not commercialized in Brazil.
FORMAT
Round – Leaves the breasts in evidence and the neck with a well-defined outline. It is the most popular prosthesis.
Conical – It makes the breasts have a forward projection and become prominent. This prosthesis is indicated for women that present a slight degree of breast droop. Depending on the biotype of the woman, the result is not so natural.
Anatomical or Drop – Simulates the natural shape of the breasts. It is more discreet. Widely used in cases of breast reconstruction after mastectomy.
PROFILE
Low or Moderate – Detached implant width (diameter) and small projection (height). They make the neck less pronounced. They are more indicated for women who have a wider chest.
High or Extra-High – It gives projection and volume to the breasts. It is the ideal implant for women with little volume in the neck and narrower chest.
INCISION TECHNIQUES
Inframammary – The incision is made at the base of the breasts, right in the crease. This technique allows the implantation of large size prostheses and does not harm the mammary glands. The scarring is almost imperceptible, and is covered by the bra or bikini. It is the most popular incision among women.
Transaxillary or Axillary – The axillary incision is made below the armpit and a tunnel is created through which it carries the prosthesis to the correct location. When lifting the arm, the scarring can be visible. The mammary ducts are not harmed and, consequently, neither is breastfeeding, if the woman has child(ren).
Periareolar – The periareolar incision is made between the contour line of the areola and the breast, so it must have a good size for passage of the prosthesis. The scar originating from this technique may suffer more tension and widen more.
PROSTHESES POSITION
Submuscular – The prosthesis is placed between the pectoral muscle and the rib cage. Indicated when the woman has little breast tissue, very thin skin or the breasts are too close together. It is the position of choice for women with a significant history of breast cancer in the family.
Subglandular – The prosthesis is placed between the pectoral muscle and the mammary gland. It sits on top or in front of the muscle. The postoperative period can be more comfortable, because the muscle trauma caused by surgical manipulation is less. It is necessary to have adequate skin thickness to cover the implant.
CAPSULAR CONTRACTURE
Capsular contracture is the scar that forms around any breast implant. Capsular contracture is a complication arising from breast implant rejection, a chronic inflammatory reaction. In this condition, the body reacts by contracting the capsule through excessive fibrosis, making its healing abnormal.
It can occur either in the first months or years after surgery. Depending on the signs and symptoms presented, capsular contracture can be classified into 4 grades: soft or normal (1), minimally firm (2), moderately firm with visual deformity (3), and hard and painful (4).
The diagnosis is made clinically, and imaging tests may be requested. Treatment, in the vast majority of cases, is surgical with implant replacement and partial or total removal of the capsule.
The probable causes of capsular contracture are: contamination during surgery, excess seroma (accumulation of fluid near the surgical scar), hematoma formation (accumulation of blood), autoimmune disease (when the body without a specific cause reacts to the implant) and even leakage of the breast implant.
INDICATION
Augmentation Mammaplasty is the plastic surgery indicated to treat small, flaccid and poorly projected breasts. It aims to harmonize the contour, give firmness and symmetry to the breasts through the inclusion of prostheses.
The procedure has aesthetic objectives, but it is also recommended for cases of problems in size and shape that affect the female breasts over the years, such as: the total non-development of one or both (asymmetries), menstrual cycles, weight changes, pregnancy, trauma and post oncological surgeries. Situations like these affect a woman’s self-esteem and self-confidence.
There is no restriction on the minimum age for performing Augmentation Mammaplasty, but if the patient is young, the development of her breasts should be complete. If necessary, we request a release by the gynecologist. Having the support of the parents is fundamental.
The most important thing when making the decision to have surgery is to have realistic expectations. You have every right to change something that bothers you about your breasts and you must do it for you, neither to please someone else nor to conform to any kind of “ideal” image.
PREOPERATIVE
It is very important that you consult the SCHEDULED THE SURGERY? page which has a series of questions to talk about during the consultations, to help you with your doubts and where you will find recommendations for the day of the procedure.
If you have, it is important to talk about family history of breast cancer and bring the latest results of previous mammograms or biopsies.
Also, in the case of Augmentation Mammaplasty, the following is an checklist to help you get organized:
🅐 Spend a good moisturizing cream on the pre-op days (not the day before and not the day of surgery!) on the breast area to help the skin stretch and decrease the chances of stretch marks appearing.
🅑 Prior lymphatic drainage sessions help prepare the body for surgery and reduce the risk of post-surgical complications such as infection, excessive edema, bruising, and scar tissue.
🅒 Purchase surgical bra from a specialized company and take it with you on the day of surgery, as it is put on immediately at the end of the procedure. Choose a very comfortable model, tight fitting but not tight, considering the breasts augmentation.
🅓 Make sure that in this most critical period of recovery, 2 to 3 weeks, no one depends on you in the family or at work. Following the planning to the letter is intended to ensure the desired results.
POSTOPERATIVE
After the Augmentation Mammaplasty, hospitalization varies on a case-by-case basis and can be 12 hours (same-day discharge) or 24 hours (an overnight stay in the hospital). The pain is usually not very bothersome, but you will likely feel it for a few weeks while the swelling begins to recede. The first two days should be absolute rest, which is essential for healing and for eliminating the liquids (seroma) through the drain.
We usually change the first dressing and teach the others to be done by the patient at home. Wearing a post-operative bra helps to protect, hold and shape the breasts. It must be worn for a minimum period of 1 month, taking it off only for bathing and dressing. Sleep on your stomach, with your arms along your body and torso elevated to be more comfortable for at least 1 month.
Opt for lighter food on Day 1 (fruit, soup, gelatin, fiber, liquids, etc.). Starting on the 2nd day of the procedure, we suggest a balanced diet rich in fruits, vegetables and white meats. Avoid sweets, fried food, soft drinks and alcoholic beverages. Hydrate yourself a lot. Use minimal salt so as not to increase swelling.
In the first few showers after surgery, if you feel dizzy, opt to use a chair. Avoid getting the dressings wet, but if this happens, try to dry them carefully with a towel and/or a warm dryer at least 20 cm away. We give you a schedule for changing the dressing and removing the drain and stitches, which is done in the office in stages.
Between the 3rd and 7th day it is already possible to return moderately to daily activities, but without physical effort. Light walks from the 8th day on are allowed; more intense physical activities, after evaluation.
Avoid heavy lifting, do not raise your arms above your shoulders and do not open them too wide for at least 15 days, the same time without driving. Avoid exposure of the scars to the sun as much as possible for at least 6 months.
As with pre, schedule lymphatic drainage sessions every 4 to 6 weeks postoperatively. Besides eliminating fluid accumulation from the body, this treatment activates the immune system, helps reduce pain and discomfort, relieves bruising and swelling, and is effective in preventing and treating fibrosis and scar adhesions.
Over time, your breasts may continue to change due to aging and gravity. The results remain longer if you lead a healthy lifestyle, without exaggeration, eating properly, exercising and maintaining the ideal weight for your biotype.