Breast augmentation with prosthesis

Written by: Dr. Pedro Darnell Buisán
Edited by: Top Doctors®

Breast augmentation, technically known as augmentation mammoplasty , is a surgical procedure to improve the size and shape of a woman's breast in different situations:

  • To improve the silhouette of the woman who thinks that her breasts are too small
  • To correct the reduction of the breast that occurs after some pregnancies
  • To correct a difference in size between both 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 introducing 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 through the implantation of a breast prosthesis behind the existing gland. There are other methods that use tissues of the body and that are used, above all, in Reconstructive Surgery. The breast implant can be placed behind the gland itself and in front of the chest muscle, or behind the muscle, depending on each case. Normally, the incision to implant the prosthesis is located in the areola, in the armpit or in the submammary groove, performing the operation under general anesthesia.

The prostheses that are used in almost all cases are cohesive silicone gel wrapped by a rugged silicone membrane. The shape can be round or anatomical (in the shape of a tear) depending on the case and needs of each patient.

The information contained in this page can not, nor does it intend, to substitute the information provided during the informative visit.

Am I a good candidate for a breast augmentation?

The ideal candidates to undergo breast surgery are those healthy, emotionally stable people who understand the results that can be obtained after surgery. Many women want an increase after a pregnancy or breastfeeding that has left empty and chest. Although there is no risk that the increase will alter future pregnancies, you should know that the breasts can regain something 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 their general state of health. You will be taken measurements and photos. There will also be a breast examination and in some cases a mammography study will be requested. The different surgical techniques will be explained, the size and shape of your breasts and the options or the combination of procedures that are best for the patient will be discussed.

Breast augmentation for aesthetic purposes is not included in the catalog of Social Security benefits; nevertheless, the important mammary asymmetry and the reconstruction after surgery for breast tumors are.

Do not forget to tell if you are a smoker or take any medication or vitamin, the number of previous pregnancies and if you plan to become pregnant again or breastfeed. Do not hesitate to ask any question that may arise, 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 taking food and liquids, smoking or taking or suppressing medications, hydration of the skin of the breasts prior to surgery, vitamins and iron supplements. Any medication that may alter the clotting of the bleeding should be suppressed including aspirin and derivatives. In breast augmentation it is not necessary to transfuse blood during surgery.

What will be the day of breast implant surgery? What can I expect?

Breast surgery is done in the operating room. Entry and discharge are required the following day. Breast augmentation surgery is performed under general anesthesia, while the patient remains asleep during the operation. Once the intervention is over, you will be in a resuscitation room controlled by an anesthetist and under the care of a nurse until it is considered that you are in satisfactory conditions to be in your room.. Some very specific cases can be performed under local anesthesia plus sedation. You can start your fluid intake between 4 and 6 hours after the end of your intervention. Usually after one day of admission the patient can leave the hospital.

Where will my incisions be made to practice breast augmentation?

Breast augmentation is done through a small incision that is placed, depending on the anatomy of the patient, around the areola, in the armpit or in the groove under the chest. 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 pectoral muscle or sometimes under the fascia of the pectoral muscle.. They are placed in most cases a drain tubes that will be removed the next day and a dressing or a bandage on the breasts until discharge. The procedure lasts between 1 and 2 hours.

Both the approach and placement should be treated with the patient at the time of the first interview.

The areolar route 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 route avoids opening the mammary gland and the submammary route is the most direct.

What type of prosthesis will they place? What are the best prostheses?

The prosthesis can be round or anatomical (teardrop shaped), smooth or rough and low, medium or high profile. Smooth prostheses, although cheaper, can cause a higher incidence of capsular contracture. The evaluation of the prosthesis follows many parameters: shape of the body, width of the thorax, position of the breast, skin elasticity and consistency of the mammary gland are the main factors to be taken into account to look for the prosthesis with the ideal and proportioned dimensions. It is necessary to look as harmonious as possible and that the body can tolerate so that the result lasts over time. All breast prostheses are composed of two elements: a silicone wrap and a content. So much for the similarities. The interior can be cohesive silicone gel or physiological saline; the silicone envelope also varies and it is possible to use smooth implants or prostheses with some type of roughness. Rough implants are textured prostheses that produce less strange sensations, less discomfort and complications.

Regarding their shape, the implants also offer variety: they can be anatomical or round. The anatomical prosthesis owes its name to its ability to adapt 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. Due to this characteristic, they are the most suitable for cases of empty breasts with moderate ptosis - breast drop - without having to perform a more invasive surgery that could cause scars difficult to disguise. They are also recommended in cases in which the patient wants 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 find something tired a few days, but the patient can make life almost normal at 24-48 hours. You can shower in 48 h. Most discomfort is well controlled with the prescribed medication (an antibiotic, an anti-inflammatory, an analgesic and a gastric protector), although the breasts may hurt 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 must wear for 1 month 24 hours a day and that 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 between 7 and 14 days; the edema does not completely subside until 3 or 6 weeks. At the beginning the scars will be pink, aspect that will improve continuously from the 6 weeks.

The appropriate mammographic controls for each woman according to their age can be continued, although the existence of the prosthesis should be noted.

The views are usually carried out weekly during the first 3 weeks, after the month, at 3 months and thereafter once a year.

When can I resume my normal activities after a breast augmentation?

After a breast augmentation you can return to work in a few days, depending on the activity you perform. Follow your surgeon's instructions about what exercises you can perform; Avoid lifting objects over the head 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 or 4 weeks.

What risks are there?

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 common 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 various ways, sometimes requiring removal of the internal scar, and even, to replace the prosthesis.

Another complication, typical of any surgery is the hematoma that only in specific cases requires a new intervention to eliminate 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, and even without 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 extraordinarily rare that the prosthesis can break, causing the content to come out of its capsule. When the prosthesis is filled with serum, the fluid reabsorbs quickly 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, it will not notice any change; if it has broken, especially when it has been subjected to a lot of pressure, the silicone comes out by decreasing the volume of the breast. With both types of prostheses a new intervention will be necessary to replace it.

What results can I expect?

The results after a breast augmentation are usually very pleasant for the patient. It will be explained in the first visit that can be obtained depending on its anatomy. Regular check-ups by your plastic surgeon and periodic mammograms (if appropriate for your age) will ensure that if any complications are detected early and solved. The decision to undergo a breast augmentation is something very personal that not everyone has to understand; if the patient is satisfied, the intervention will have been successful.

What technical differences exist between breast augmentation today and 5 years ago?

One of the most important differences is in the quality of the prosthesis. Currently we usually work with cohesive gel prostheses and this means that they do not have to change at 10 years, only control. Currently 95% of the implants chosen by our patients and preferred by ourselves are the anatomical implants, because nowadays the woman looks above all for the naturalness of her breast.

When working with anatomical prostheses the placement technique has also changed. Five years ago, all plastic surgeons indicated high profile round prostheses placed submuscularly to conceal 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:

  • Top pole very padded, but progressively, without projections.
  • The mammary gland is joined by Cooper's ligaments to the pectoral fascia and if the implant is placed underneath, we do not break these ligaments and your chest will drop less.
  • By not cutting the pectoral muscle, the postoperative period is "painless", the 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 route of entry for the placement of the implant, of choice, via periareolar, because it is the scar that is least seen 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.
*Translated with Google translator. We apologize for any imperfection

By Dr. Pedro Darnell Buisán
Plastic surgery

Specialist in plastic and restorative surgery, master in senology and microsurgery. His training and career have made him an expert in cosmetic surgery and breast repair as well as facial and body aesthetic surgery. Currently we can find it in the University Institute Dexeus of Barcelona, ​​one of the most prestigious and technologically advanced clinics in Catalonia.

*Translated with Google translator. We apologize for any imperfection

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