Breast augmentation: surgical approaches and their impact on healing

Written by: Dr. Ramón Calderón Nájera
Edited by: Top Doctors®

Historically, the operation of breast augmentation can be made from three main approach routes: route submammary, via areolar or axillary. In FEMM three paths are used, since each of them has some advantages and. The surgeon must be versatile, and adapted to each case. The decision to place the scar in one place or another depend on various factors, so it did not make a single type of incision.

However, the majority option is the way submammary. The main reason is that the scar, about four centimeters, is hidden in the crease of the union between chest and thorax, becoming imperceptible. The route of the areola has its indication when it is a case where it is also necessary to work the same areola, either because there is breast asymmetry in height and you have to raise them, or if we are facing a prominent areolas of which should reduce its diameter or shape. The route of axillary approach has the advantage that the main scar that is concealed in the fold of the armpit.


The appearance of the scar resulting from a breast augmentation surgery improves with time up to a year and a half after surgery. It is important to follow individualized indications, the most usual care by hydrating oils such as rose hip or healing patches. There are other treatments such as laser early application of CO2, erbium, Pulsed dye or application of carboxiterapia once spend six months in operation.


Breast augmentation: the way submammary

Submammary route option is mostly chosen by FEMM, unless there are asymmetries or alterations in mammary areola. From the viewpoint of visibility, it is hidden under the fold at the junction between chest and thorax. Thus, through submammary can comfortably and not traumatic lift the pectoral muscle, to create the hollow under the same. In addition, it can isolate the depth of the implant mammary gland because the gland is not opened, thus eliminating the risk of contamination of the prosthesis with the mammary gland and the possibility of developing capsular contracture future decreases.

In turn, another advantage is that from the point of view gynecological and oncological not any scar to confuse or alter the outcome of mammography or other future testing occurs.

The incision, about four centimeters, is matched to the new submammary, and attached to the depth to remain just then fold. If this is not fixed, it will be visible instead of staying in the groove, hence the importance of setting depth if we want the scar go unnoticed. Fixing is carried through resorbable internal points, also help the final scar is thinner, to avoid stress and drive the same.

When the patient has some chest before the operation and this is well formed, you can make the incision, and therefore the scar in the original submammary already has the patient. However, on other occasions where the patient has very little breast or high submammary, measure the patient and create lower than the original one groove, matching the scar with the groove. In addition to fixing, from scar tissue depth a close planes is performed, to prevent tension that might widen. Finally, a resorbable suture intradermal keeps the wound edges together during the first months without the need of points is performed.


Breast augmentation: the areolar route

Its main advantage lies in the color change between the areola and breast skin, clearer, conceals the presence of the scar, performing the areola-skin transition. When the patient presents asymmetries nipple height in FEMM is chosen in this way, since making the incision through the areola can raise or lower the same to symmetrize nipple height.

This route is also ideal for placing implants in patients with breast asymmetries lower poles or height of the submammary furrow. Thus, from this incision you can access the plane and work Subpectoral grooves. In other cases, it is necessary to cut the mammary gland to remove its conical appearance, or when the areolas project out in a pyramid, which is common in patients with tuberous breast. Also via aerolar can reduce its diameter or raising the chest in cases of mastopexy or breast lift.

However, areolar pathway may lead to a slight increase in the chance of developing an encapsulation or capsular contracture, since the implant is in contact with the mammary gland. To reduce that possibility, washings are performed with antibiotic in the hole where the implant will be placed, in addition to introducing the prosthesis through an insulating film which prevents contact between the prosthesis and the contaminated area of ​​the areola.


Breast augmentation: the axillary

It is customary to introduce implants. The incision is placed hidden in the crease of the armpit and across it is accessed both Subglandular planes, ie above the muscle, as the subpectoral. Sometimes, in addition to four centimeters small incision in the armpit a small incision is made against the inframammary fold, with which releases on the bottom insertion greater control of the pectoralis.

The axillary approach has been criticized because it increases the likelihood of capsular contracture as areolar access. It has to choose carefully the patient, because if the selection process is not adequate, the implants remain high and the prosthesis filled the lower pole of the breast.


The scar on breast augmentation

Regardless of the path, cutaneous scar should be maintained. From the standpoint of tissue analysis, it is considered that the scar is mature at six months after surgery. From the standpoint of visibility, the scar remains red for longer due to the new capillaries.

After the operation, the first care is by specialists who apply a dressing that protects the scar during the first three weeks. You will then be given to the patient kit moisturizing oils with rose hips to apply directly to the scar, as well as a moisturizing and firming cream that the patient should be applied elsewhere in the chest to prevent stretch marks.

The rose hip oil should not be applied too early, as it can cause the appearance of cysts in the area. In specific patients where the scar begins to thicken or suspected difficult to heal, patches that protect and press are placed, improving the appearance of the two or three months. It is important to be consistent with the application of these patches if you want to succeed. Sometimes rose hip patch is altered.

The scar should be protected with high sun protection factor (50) for at least one year. A certain patients suffering too much pigment is applied carboxiterapia six months, and sometimes is used precociously CO2, Erbium or pulsed dye laser, although these treatments will be indicated by the specialist in Plastic Surgery as they evolve each case .

*Translated with Google translator. We apologize for any imperfection

By Dr. Ramón Calderón Nájera
Plastic surgery

Dr. Ramón Calderón Nájera, currently president of SECPRE (Spanish Society of Plastic, Reconstructive and Aesthetic Surgery) is one of the most prestigious plastic surgeons in Spain, highlighting in the surgeries of Rhinoplasty and Buttock Augmentation, fields in which he is an eminence and in which it spreads its knowledge by countries like Poland, Italy, Brazil, Colombia or Argentina. Participate in congresses and symposia as a speaker explaining their innovative techniques.

*Translated with Google translator. We apologize for any imperfection

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