Breast augmentation, technically known as augmentation mammoplasty, is a surgical procedure to improve the size and shape of a woman’s breasts in different situations:
- To improve the silhouette of the woman who thinks her breasts are too small.
- To correct breast reduction that occurs after some pregnancies.
- To correct a difference in size between the two breasts.
It is one of the most common procedures performed in cosmetic surgery. It is possible to increase the size of the breast one or several sizes by inserting a prosthesis under the breast.
What method is used to perform breast augmentation with prosthesis?
The only definitive method to achieve an increase in breast volume is by implanting a breast prosthesis behind the existing gland. There are other methods that use the body’s own tissues and that are used, above all, in Reconstructive Surgery. The breast implant can be placed behind the gland itself and in front of the pectoral muscle, or behind the pectoral muscle, depending on each specific case. Normally the approach incision to implant the prosthesis is located in the areola, in the armpit or in the submammary groove, and the operation is performed under general anesthesia.
The prostheses used in almost all cases are made of cohesive silicone gel wrapped by a rough silicone membrane. The shape can be round or anatomical (tear-drop shaped) depending on the case and needs of each patient.
The information contained in this page in no way can, nor is it intended to, replace the information provided during the information visit.
Am I a good candidate for breast augmentation?
Ideal candidates for breast surgery are healthy, emotionally stable individuals who understand the results that can be achieved after surgery. Many women desire augmentation after a pregnancy or breastfeeding that has left the breast empty and sagging. Although there is no risk that augmentation will alter future pregnancies, you should be aware that the breasts may sag somewhat again after a new pregnancy.
How will the plastic surgeon evaluate me for breast augmentation surgery?
During the first consultation, the plastic surgeon will evaluate the size and shape of the breasts, the firmness of the skin and your general health. Measurements and photos will be taken. A breast examination will also be performed and in some cases a mammographic study will be requested. The different surgical techniques will be explained, the size and shape of your breasts will be discussed, and the options or combination of procedures that are best for the patient will be discussed.
Breast augmentation for cosmetic purposes is not included in the Social Security benefits catalog; however, significant breast asymmetry and reconstruction after surgery for breast tumors are.
Do not forget to tell us if you are a smoker or take any medication or vitamins, the number of previous pregnancies and if you plan to become pregnant again or breastfeed. Don’t hesitate to ask any questions you may have, especially those related to your expectations about the results.
How should I prepare for breast augmentation?
There are instructions on how to prepare for surgery, including rules on food and fluid intake, smoking or taking or suppressing medications, hydration of the breast skin prior to surgery, vitamins and iron supplements. Any medication that may alter the coagulation of bleeding should be suppressed including aspirin and derivatives. In breast augmentation is not necessary to transfuse blood during surgery.
What will the day of breast implant surgery be like? What can I expect?
Breast surgery is performed in the operating room. You will be admitted and discharged the next day. Breast augmentation surgery is performed under general anesthesia, with the patient remaining asleep during the operation. Once the operation is over, you will be in the recovery room under the supervision of an anesthesiologist and under the care of a nurse until you are considered to be in satisfactory condition to be in your room. Some very specific cases can be performed under local anesthesia plus sedation. Fluid intake can be started between 4 and 6 hours after the end of the operation. Usually after one day of hospitalization the patient can leave the hospital.
Where will the incisions be made to perform the breast augmentation?
Breast augmentation is performed through a small incision that is placed, depending on the patient’s anatomy, around the areola, in the armpit or in the groove under the breast. The incision is designed so that the resulting scar is almost invisible. Through this incision the breast tissue is lifted, a pocket is created and the prosthesis is placed directly under the breast tissue, under the pectoralis muscle or sometimes under the fascia of the pectoralis muscle. In most cases, drainage tubes are placed, which will be removed the following day, and a dressing or bandage is placed over the breasts until the time of discharge. The procedure lasts between 1 and 2 hours.
Both the approach and placement should be discussed with the patient at the time of the first interview.
The areolar approach allows to change the size or position of the areola and modify the shape of the breast prior to the insertion of the prosthesis, the pectoral approach avoids opening the mammary gland and the submammary approach is the most direct.
What type of prosthesis will I have? What are the best prostheses?
Prostheses can be round or anatomical (teardrop-shaped), smooth or rough, and low, medium or high profile; smooth prostheses, although less expensive, can cause a higher incidence of capsular contracture. The assessment of the prosthesis follows many parameters: body shape, chest width, breast position, skin elasticity and consistency of the mammary gland are the main factors to be taken into account to find the prosthesis with the ideal and proportionate dimensions. It is necessary to look for the most harmonious possible and that the body can tolerate so that the result lasts over time. All breast prostheses are composed of two elements: a silicone shell and a content. So much for the similarities. The interior can be made of cohesive silicone gel or physiological serum; the silicone shell also varies and it is possible to use smooth implants or prostheses with some kind of roughness. Rough implants are the textured prostheses that produce less strange sensations, less discomfort and complications.
As for their shape, implants also offer variety: they can be anatomical or round. The anatomical prostheses owe their name to their ability to mold to the anatomy of the breast, so the result is a very natural breast, one of the main demands of women who undergo an intervention of this type. Because of this characteristic, they are the most indicated for cases of empty breasts with moderate ptosis -the drooping of the breasts- without having to perform a more invasive surgery that could cause scars difficult to disguise. They are also recommended in cases where the patient desires a large increase in size being in these cases the most natural result.
What can I expect during the recovery process?
After breast surgery it is normal to feel a little tired for a few days, but the patient will be able to lead an almost normal life after 24-48 hours. You will be able to shower in 48 hours. Most of the discomfort is well controlled with the prescribed medication (an antibiotic, an anti-inflammatory, an analgesic and a gastric protector), although the breasts may be sore for a couple of weeks. The bandage or dressings will be removed the day after the operation, being replaced by a special bra, which the patient will have to wear for 1 month 24 hours a day and which will only be removed for the daily shower. It is normal to have a burning sensation in the nipples during the first two weeks. The stitches are removed after 7 to 14 days; the edema does not subside completely until 3 to 6 weeks. Initially the scars will be pink, an aspect that will improve continuously from 6 weeks.
Mammographic controls appropriate for each woman according to her age can continue to be performed, although the existence of the prosthesis should be noted.
The visits are usually performed weekly for the first 3 weeks, then monthly, after 3 months, and then once a year thereafter.
When can I resume my normal activities after a breast augmentation?
After a breast augmentation you can return to work within a few days, depending on your activity. Follow your surgeon’s instructions about what exercises you can do; overhead lifting should be avoided for 2 to 3 weeks. Your breasts will be more sensitive than normal for 2 to 3 weeks, so it may be wise to avoid excessive physical contact until 3 to 4 weeks.
What are the risks?
Breast augmentation surgery is a safe technique, as long as it is performed by a qualified plastic surgeon and in a satisfactory hospital center. However, as in any operation there can always be complications and associated risks. In breast augmentation, the most frequent complication is capsular contracture, which occurs when the internal scar that forms around the implant contracts excessively, causing the breast to become harder. It can be treated in several ways, sometimes requiring the removal of the internal scar, and even the replacement of the prosthesis.
Another complication, typical of any surgery is the hematoma that only in specific cases requires a new intervention to remove the accumulated blood. A small percentage of women may have an infection around the prosthesis, usually in the first weeks after surgery. Some women notice more or less sensitive nipples, or even no sensitivity. These changes are usually temporary, although in a few cases they will be permanent. There is no evidence that breast prostheses affect fertility, pregnancy or lactation.
It is extremely infrequent that the prosthesis can break, causing the content to come out of its capsule. When the prosthesis is filled with serum, the liquid is quickly reabsorbed without causing any damage, decreasing the breast volume in a few hours. If it is filled with silicone, two scenarios can occur: if the capsule formed by the organism does not break, you will not notice any change; if it has broken, especially when it has been subjected to a lot of pressure, the silicone comes out decreasing the volume of the breast. With both types of prosthesis a new intervention will be necessary to replace it.
What results can I expect?
The results after breast augmentation are usually very pleasing to the patient. It will be explained in the first visit that can be achieved depending on your anatomy. Regular check-ups by your plastic surgeon and periodic mammograms (if applicable due to your age) will ensure that if there are any complications, they will be detected in time and solved. The decision to undergo breast augmentation is a very personal one that not everyone needs to understand; if the patient is satisfied, the procedure will have been a success.
What are the technical differences between breast augmentation today and 5 years ago?
One of the most important differences is in the quality of the prostheses. Nowadays we usually work with cohesive gel prostheses and this means that they do not have to be replaced after 10 years, only controlled. Currently 95% of the implants chosen by our patients and preferred by ourselves are anatomical implants, because nowadays women seek above all the naturalness of their breasts.
Working with anatomical prostheses has also changed the placement technique. Five years ago all plastic surgeons indicated high profile round prostheses placed submuscularly to disguise the protrusion of the upper pole of the prosthesis.
Today, we prefer without any doubt the placement of anatomical prostheses in a SUBFASCIAL plane because the aesthetic result is the same or better and we have the following advantages:
- Very full upper pole, but in a progressive way, without protrusions.
- The mammary gland is joined by Cooper’s ligaments to the pectoralis fascia and if the implant is placed underneath, we do not break these ligaments and your breast will sag less.
- By not cutting the pectoral muscle, the postoperative period is “painless”, immobility of the arms is not required and the return to work is almost immediate.
- The muscle will never displace the prosthesis, and in fact anatomically your chest should be above the pectoral muscle.
- The entry route for implant placement, of choice, periareolar route, because it is the scar that is less visible and because it allows us to place the anatomical implant perfectly, seeing that the marks of the prosthesis coincide with the direction of the nipple of the patient.