An augmentation mammoplasty is an increasingly safe procedure. However, it is very important to make a thorough study of the patient, the result you want to achieve and where to place the prosthesis.
Preoperative augmentation mammoplasty
The first step to carry out an augmentation mammoplasty is the realization of a meticulous assessment and clinical examination by means of a personal interview in which the patient expresses her wishes and expectations. Only then we can advise you individually about the suitability of the intervention for your particular case. If it is indicated, we proceed to assess with the patient the shape and volume of the implant using two innovative tools:
- A system of external testers
- A computer program that allows us to simulate the result on the patient with the selected implant.
In this way, the patient, having understood the anatomical characteristics of her case, is also involved in the final choice of shape and volume. Once the decision to carry out the intervention has been made, we will perform the pertinent medical tests and set a date for the intervention.
In the exploration we analyze the anatomical and tissue characteristics of the patient, assessing:
- Desires and expectations of the patient
- Measurements of the breast and chest.
- Amount of tissue provided by the patient’s breast, which will provide adequate coverage of the breast implant.
- Degree of sagging of the breast
- Existence of asymmetries, malformations and malposition of the areolas.
These are the factors that, according to the specialists in Plastic and Aesthetic Surgery, influence the shape, dimensions and volume of the implant to be used, as well as its position and the approach (or scar).
Placement of the prosthesis and approach in an augmentation mammoplasty
In a woman’s breast we can find the following layers: skin, subcutaneous cellular tissue, mammary gland, fascia, pectoralis major muscle and ribs. There are three types of pocket or place where the prosthesis can be placed:
- Subglandular: between mammary gland and fascia.
- Subfascial: between the fascia and the pectoralis major muscle.
- Submuscular: under the pectoralis major muscle.
In general, the most advisable pocket is the submuscular pocket, as it has a lower rate of capsular contracture and facilitates gynecological revisions and imaging tests. The only drawback is that the immediate postoperative period is a little more uncomfortable. The choice of one pocket or another depends, fundamentally, on the characteristics of each patient.
To make this pocket and thus be able to introduce the prosthesis, the incision or scar can be made in:
- Submammary sulcus (lower breast fold).
- Inferior hemiareolar (lower half of the division line between the areola and the normal skin).
- Axillary (axillary hollow)
Of the three incisions the most recommended is the sulcus incision. It is the cleanest route with less bacterial load of the three and, therefore, with less probability of capsular contracture. It is also the one that produces the least alterations in sensitivity and, given that it is located in the fold of the breast, it is the one that in the medium and long term is the least visible.
The lower hemiareolar is usually used in certain cases, such as in replacements (if the scar was positioned there), in asymmetries and in ptosis or sagging breasts, if it is necessary to remove some skin around the areola. Finally, the axillary approach, given the high bacterial load in the area, which hinders the correct execution of the surgery and the correct positioning of the implants that we normally use, we do not recommend it.
In the operating room, once the pocket has been made by the approach agreed with the patient, and before the implantation of the prosthesis, we proceed to check the definitive volume and shape, by means of the use of sizers or intraoperative gauges. These sizers are test prostheses equal in size and shape to the definitive implants and that, placed intraoperatively, allow us to adjust to the maximum the final choice of the volume and shape of the prosthesis.
It should be noted that augmentation mammoplasty is always performed under general anesthesia and only in certain situations -such as minor touch-ups and prosthesis replacements- local anesthesia with sedation can be considered. The duration of the intervention is around two hours although, on certain occasions (correction of asymmetries, malformations, such as tuberous breast, etc.) the surgery can take us around an hour or two hours more.
Postoperative period and recovery from augmentation mammoplasty
The patient will remain in the hospital overnight and will be discharged the following day. At discharge under normal conditions we will remove the drains except when the intervention has been more complex as in cases of tuberous breast or mastopexy with prostheses. In addition, they will also be kept more days if we have used prostheses with polyurethane cover.
Between the fourth and fifth day, we will carry out the first revision, using the sports bra without underwire. The patient will be able to get the wounds wet and apply the care that we will indicate. Between the 7th and 10th day, the patient will be able to return to her daily activities, avoiding physical effort and work that involves carrying weight.
Other recommendations to be followed during the first month are to wear a bra all day, not to massage the breast and to sleep facing upwards.
During the second and third month, you will be able to do light sports, although you should sleep with the sports bra and continue without massaging the chest until three months, at which point you will be able to lead a normal life as if you had not had surgery.
The revisions that we recommend are quarterly until the first year, and then annually, in order to monitor and verify that everything evolves correctly. This is the only way we will be able to advise the patient the most correct attitude in case of suspicion or any alteration or doubt.