Breast Augmentation: How prosthesis or lipofilling?

Breast augmentation is the most plastic surgery defendant in Spain. We interviewed Dr. Enrique Bassas Mercader, a plastic surgeon, to respond to some of the most common questions that women do before this intervention. Dr. Bassas has over 30 years experience in plastic surgery, is a benchmark in the specialty after training at New York Medical Center and the Jackson Memorial has been clinical chief of Plastic and Reconstructive Surgery at the Hospital de Sant Pau of Barcelona and the Hospital del Mar in Barcelona. Currently he leads one of the teams of plastic surgery at the Teknon Medical Center in Barcelona.

Doctor Bassas. Before surgery breast augmentation, women have two options: increase by prosthetics or augmentation with own fat, the 'lipofilling'. What is each?

Lipofilling is a natural filler is performed with the patient's own fat. It involves the removal of fat from another area with excess fat, being abdomen, buttocks or legs, the most common areas of extraction, and is used to fill and increase breast size. The main advantage is that the figure remodeling lipofilling breast in a minimally invasive intervention also performed under local anesthesia. By not wearing dentures is faster postoperative. The only disadvantage compared to breast augmentation with implants is that some of the fat is reabsorbed in different ways and at different periods of time depending on each patient, so it is difficult to predict the final size. Lipofilling is usually more suitable for small breast enlargements, to correct a sagging or to fill the empty chest.

In increasing prosthetic implant silicone cohesive gel under the chest muscle is placed. With this intervention we know exactly the volume and the result we will get and the patient can choose the size you want. The procedure is performed under general anesthesia and for safety reasons must stay 24 hours in the hospital. The results are immediately visible.

What do you recommend to women?

It depends, of course, the result you want to achieve. Today we use the lipofilling for women who want small increases, which have fallen a little chest or flabby and want to fill. Lipofilling provides excellent results to correct sagging and has become fashionable for women who have been mothers and notice your empty chest or flabby. It is what is known as "Mommy Makeover". After childbirth or breastfeeding past, this procedure is performed to remove belly fat remaining after giving birth and placed in the chest that falls after pregnancy. There are patients who apply this technique in the same delivery, which I discourage and recommend waiting at least six months. If the patient has little breast or want to increase it, the best option is the prosthesis.

What types of prostheses are used?

There are three types of prostheses: round-more planas- low profile, high-profile round and anatomical. According to the expectations and the patient's chest, we choose one or the other. Now, if a woman has a small but proportional chest, we place a low profile prosthesis round. If the woman has a breast or very low level, we opted for a rather small at the top and bottom larger anatomical prosthesis, which give a very natural result. Most important in the choice of prosthesis is to be a premium brand.

Doctor Bassas, is the breast enlargement is compatible with elevation?

Yes you can perform a breast augmentation with lift in the same operation, but they are different operations. If there are fallen chest should be performed mastopexy, we must reshape the chest, tight and raise. If the patient has a small chest it can also put a prosthesis to increase it. However, if the woman is happy with her breast size and just want to correct the fall, rise unused breast prosthesis.

When is it not appropriate to face a breast operation?

In general, surgery is appropriate if the person is physically and mentally healthy. Therefore, it is important to perform a preoperative tests before each operation. If there is any disease or contraindication, cosmetic surgery must wait.

What remains after the operation scar breast augmentation?

Current incisions are strategic for the scars go unnoticed. Today you can carry out three types of incisions depending on where the prosthesis is introduced: in the armpit, around the nipple or below the breast. After intervention advise the patient to use patches, creams and clips that help you and minimize postoperative scars. The type of intervention is decided with the patient. For example, if the areola is small it is not recommended to put the prosthesis in that area, but we recommend doing so in the submammary. Thus, surgery is faster and less traumatic and, therefore, postoperative is much more comfortable. Through the armpit or areola, operations are more traumatic but the scars less visible; therefore, the patient of the pros and cons of each are reported and decided jointly.

After surgery, what care should follow the patient?

The patient is in the clinic 24 hours; then, if everything is normal, you can go home and spend a few days resting in a calm life without lifting. A week later you can lead a normal life and return to work. Of course, for a month or month and a half you can not gain weight or going to the gym or make an effort involving overloaded arms. Moreover, the first two weeks you have to wear a special bra without rings, sleeping well and care for the scar silicone patches, special creams for healing and rosehip.

Doctor, there are centers that perform surgery like outpatient surgery, without an overnight stay in the clinic and at very low prices. What are the differences?

In these centers reduce the costs of the intervention, but in my opinion they do at the cost of safety. The first quality of the prosthesis, a prosthesis as the first level that we use are more expensive but offer more guarantees. Lower the intervention price by sacrificing the quality of the prosthesis. On the other hand, if they send the patient home to sleep after surgery also save and can lower the price of the intervention, but if during the first 24 hours there is a problem, such as internal bleeding or complications of any patient I would not be controlled, is a risk that I would never run with a patient.

How long they will last the prosthesis? Should women be monitoring controls?

The duration has evolved over the years. Today laboratories have succeeded in making prostheses that exceptions are for life. The prosthesis currently performed with seven layers, the material does not deteriorate and how they are constructed of a cohesive gel, no leaking material. The monitoring patients should be are the usual annual gynecological check. Only if you have discomfort or changes must come to us to check that all is well. Through a mammogram can detect if the prosthesis is in disrepair.

Finally, doctor, perhaps what most women ask before surgery: how will the breast after surgery?

The most important thing when it comes to get a cosmetic surgery, whatever it is, is the previous conversation between surgeon and patient dialogue between the two to meet the desires of women and the possibilities. If communication between doctor and patient is good and both are realistic expectations of the outcome it is usually good. In addition, we now have computer programs that allow us to recreate the outcome, and have several prostheses of different sizes in the consultation so that women can see them and try them to feel comfortable with the size and shape you have chosen.