The size of the breasts can be a great procupación for women. Not have beautiful breasts and in good position produces, in many cases, difficult to treat complex. However, a breast augmentation operation must be performed by a skilled surgeon in the art to avoid unsatisfactory results, such as set forth below.
It presented below case of a patient operated breast augmentation on two previous occasions the third operation, which solved the above errors, bringing satisfaction. In Figure 1 a front image of the patient is shown before surgery.
In Figure 2 shows the result of a year of the first breast augmentation: We were implanted silicone implants, round, low profile, 280cc, smooth, level to Subpectoral. Note the poor positioning of the prosthesis in both breasts, placed in the upper pole, and how the left pocket invades the midline.
The patient was very satisfied with the result, so the two years of the initial intervention was undergone a second operation by the same surgeon, who tried, unsuccessfully, to lower the positioning of the prosthesis. The result of this second year operation can be seen in Figure 3.
Without evaluating the transareolar incision, as shown, it remained malpositioning both breasts: the right breast had lost the spherical shape (square circle) and also had a double left clear sulcus. Nor it had corrected the invasion of the midline of the left breast. After three years of primary intervention the patient came to my office of Plastic, Reconstructive and Aesthetic as it continued showing unsatisfied with the result.
How to improve breast augmentation and breast deformities
To correct these deformities, and improve the external appearance of the breasts, reoperation intended to reposition the prosthesis, remove remains of capsule and correct the midline was proposed, all through placement of prostheses high profile and larger in the subfascial, as shown in figure 4A.
Moreover, the patient also wanted to know if there was any technique to remove scar transareolar. It is difficult to understand why there had previously opted for a periareolar approach, since the woman had right areolas for that incision.
On the operating table include squaring the side of the right breast pole and double groove on the left disappears supine position (face up), hence the importance of their Predial (Figure 4B).
This is a technically more complex intervention, due to previous surgeries. It was decided to implement two prosthetic 450cc, high and rugged profile.
To correct the invasion of the left breast in the midline, when operative was observed that, with abrasions on both sides of the pocket and placing a prosthesis high profile, with a diameter less than the low profile wearing implemented, is would correct this invasion.
The patient, at four months is very happy. Note the change in the profile of the breast (Figure 5), which has gone the way "cascade", typical of the sub pectoral implant, the way more natural "slide" which is achieved with the subfascial position, much more flattering at the same time less invasive for the patient.
Why there was a malposicionamiento of breast implants
First, the supine position inherent in the traditional way to operate and edema that occurs during surgery causes 90% of the double rows are only detectable when the edema has decreased circumstance occurs towards the month or three months after surgery. Also, it notes that most double rows occur in patients with sub pectoral implant.
In some of these patients, as is the case, also there was a component of the prosthesis malposicionamiento, secondary to a too large pocket subpectoral. The prosthesis by muscle action, tends to rise, leaving a lower pole without projection (trend malposicionamiento). The solution is quite simple, change background and use prosthesis volume between 400 and 450cc high profile for that project.
Breast augmentation with subfascial technique, the most recommended
It should be leaving the i Subpectoral mplante for several reasons:- The pectoral muscle tear inherent to the technique it is painful for the patient.- Trend malposicionamiento prostheses in the upper pole.- Trend double groove.
Conversely, subfascial position:- Provides a way to "slide" more natural.- If we place the implant in the suprapectoral space, it is less subject to muscle movements and suffers less fatigue.- It is a meticulous surgery slightly, the pocket can be controlled perfectly, like hemostasis, so the patient does not require drainage.- The recovery is much faster.
Edited by Patricia Crespo Pujante