Cirugía Estética Mamaria EN

Breast augmentation with prosthesis

The intervention of breast augmentation with prosthesis is indicated in those patients who want to improve the shape of the breasts either because they have an asymmetry, a loss of volume after pregnancy, a hypoplasia or simply because they want more volume.

The first visit:

In this first visit the doctor will assess your chest, take measurements and explain the necessary techniques to achieve a good result in your particular case. It will also assess together with you the most appropriate size for your profile. So that the patient and the doctor can get an idea of the final volume we have external prostheses, which chosen after taking measurements, allows us to see live what the final volume will be with the selected prostheses. For your part, it is important that you do not hide if you are taking a medication, if you consume any type of drug or if you suffer from any disease, since it is very important for the surgeon to have all the information before the intervention.

Preoperative:

The tests we will order before a breast augmentation will be an analytical, an electrocardiogram, a chest x-ray and a mammogram or breast ultrasound.

Hospital Admission:

You will enter the same day of the intervention. It is important that you are fasting a minimum of 8 hours before the intervention.

In the hospital you will be assigned a room where you can change, they will take you to the pre-operating room where you will see the surgeon, he will draw on you and before going to the operating room they will sedate you a little so that you are calm.

The method:

The intervention is performed under general anesthesia. Normally you stay one day admitted.

The approach routes can be through a small cut in the areola, the submammary fold or the armpit, the submammary fold is recommended, as it has been shown to reduce the incidence of some complications.

Placement in relation to the gland can be: below the gland, below the muscle fascia (the fascia is a very strong connective tissue structure that extends throughout the body) or below the pectoral muscle.

Currently the subfascial placement is reserved for patients in whom we would usually perform a subglandular implantation. That is, when the soft tissues that will cover the prosthesis you think will be enough for the result to be natural. (pinch test thickness greater than 2 cm). Subpectoral placement is what we use when the coverage of the upper pole of the gland is insufficient (that is, when the woman is thin) or for women who prefer or require round prostheses.

The prostheses we currently use are Politech or Motiva, they give a lifetime guarantee and have important safety controls.

The Politech brand has the widest variety of prostheses on the market: macrotextured, microtextured and smooth polyurethane or silicone prostheses. They can be round or anatomical, double gel (for cases of breast reconstruction by tuberous breasts), low weight for women athletes or who want a lot of volume.

Motiva prostheses are made of silicone and have a nanotextured surface. They can be round, ergonomic or anatomical (in the latter case they require extra fixation so that they do not rotate).

The postoperative period:

From the operating room you will leave with a bra and a band, only in some cases with bandages and drains, since the latter have shown increased contamination of the prosthesis and, as a consequence, increased possibility of capsular contracture.

We recommend a progressive return into normal life. We must avoid lifting weights and making efforts during the first three weeks.

Breast augmentation with own fat

The lipofilling of breasts or breast augmentation with own fat is indicating in patients who want a breast augmentation and do not want to be carriers of a breast prosthesis. We can achieve a discreet or moderate increase in breasts as long as the patient has enough fat in other parts of the body.

Breast augmentation with own fat is an ideal method, because it avoids the possible complications of prostheses or to correct some complications that they cause such as rippling or palpation of the prosthesis in patients with poor coverage.

Limitations of lipofilling or breast augmentation with own fat:

In very thin patients the technique cannot be performed.

When the breast has a deformity, it is sometimes not possible to solve the problem with fat tissue grafting alone.

The procedure:

It is a surgical technique that is normally done under general anesthesia.

The fatty tissue is obtained by liposuction with specific thin and non-traumatic cannulas. This tissue that we obtain thanks to liposuction must be purified before injecting into the breasts.

The procedure we use to purify the fatty tissue is through gentle centrifugation and washing with serum. We now know that using centrifugation alone increases the risk of fibrosis and fat cell loss from necrosis. So we currently use a system called “puregraft”, which allows us to wash the extracted fat to reduce the reabsorption of the fat graft.

The procedure of injecting into the breasts is through 6 – 7 punctures in each breast and with microcannulas carefully injecting the fatty tissue to favor integration as living tissue. It is very important to avoid excessive manipulation of this tissue so that it is not reabsorbed afterwards.

Sometimes an external device can be used to prepare the breasts for implantation.

The postoperative period:

From the day after the intervention you can live practically normal life, avoiding large efforts so as not to favor the reabsorption of fat.

We will wear a sports bra for 2-3 weeks.

We consider that the grafted tissue is stable at 4 months and, if the patient wants a greater breast augmentation, we can do it again in 6-8 months.

At 9 – 12 months after the intervention we recommend doing a control mammogram.

Reduction mammoplasty

Breast reduction, also known as reduction mammoplasty, removes excess fat from the chest, glandular tissue and skin to achieve a size of the breasts in proportion to the body and to relieve the discomfort associated with overly large breasts.

In addition to self-image problems, large breasts can also cause physical pain and limit an active life.

Indications for reduction mammoplasty:

Breast reduction is often done more to alleviate a physical problem than a purely aesthetic problem, although the ultimate goal is to have a beautiful and proportionate breast. In most cases it is waited until the chest has fully developed, although it can be done earlier if the physical problems are very important. There is a condition called virginal hypertrophy or nulliparous hypertrophy of the breast that causes excessive growth, diffuse in adolescents and that is surgical because of their disability.

Reduction mammoplasty is not recommended if you intend to breastfeed after pregnancy.

Breast reduction is a good option for you if:

You are physically healthy.
You have realistic expectations.
You don’t smoke.
You are upset by the feeling that your breasts are too big.
Your breasts limit your physical activity.
You experience back, neck and shoulder pain caused by the weight of the breasts.
You have skin irritation under the chest crease.
Your breasts hang and have stretched the skin.
The nipples rest below the breast crease.
You have large areolas caused by stretched skin.

The first visit :

You should be prepared to discuss your expectations and the desired outcome.

We will ask you about:

Medical conditions, drug allergies and medical treatments.
The use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs.
Previous surgeries.
Family history of breast cancer and the results of previous mammograms or biopsies.

During the first visit also the surgeon will examine your breasts, the shape, the quality of the skin, the placement of the nipples and areolas he will be taking measurements .

You have to leave the consultation with a clear idea of how the mammoplasty procedure will be, the scars that will remain in your specific case, possible side effects and possible complications.

Preparing for Breast Reduction Surgery:

Before surgery you should:

Have lab tests or a medical exam.
Perform an electrocardiogram and chest x-ray.
Take some medications or adjust your current medications.
Get a basic mammogram before surgery.
Stop smoking at least 20 days before surgery.
Avoid taking aspirin-type anti-inflammatory medications that may increase bleeding.

Steps of surgery:

Anesthesia: Medications are administered intravenously and surgery is performed under general anesthesia.
The incision: The incision options are: Racket-shaped pattern with an incision around the areola and vertically down to the chest fold or an inverted T (we add in this case an incision in the submammary fold)
Removal of excess: Tissue and replacement of the breasts.
Closure of the incisions: The incisions are joined to form again the now smaller chest. Sutures are placed in deep layers within the breast tissue to create and support the breasts and also in more superficial layers to avoid wide scars. The incision lines are permanent, although in most cases they will improve significantly and fade over time.
See the results: The results of breast reduction surgery are immediately visible. Over time, post-surgical inflammation will resolve and incision lines are concealed. Satisfaction with the result improves over time.

Recovery:

You will leave the operating room with a bandage or surgical bra and, on some occasions, with tubes to drain the bleeding in case it occurs. This drain is removed before leaving the clinic.
On the day of discharge you will come out with some tape on the wounds and the bra.
You can shower at 48 hours of the procedure.
Care consists of putting Betadine on the wounds every 12 h and taking some medications for the first 7-10 days.
It is recommended that you avoid making efforts for the first 2-3 weeks.
The first visit is usually made between 3 and 7 days after surgery.

Breast reduction results:

The results of breast reduction surgery will be long-lasting.

The new chest measurements will help relieve the pain and physical limitations experienced before mammoplasty, although there is never any guarantee that back pain will decrease if you have it, given that there are many factors that influence back pain regardless of the weight of the breasts.

Your most proportionate figure It is likely to improve your image and can also improve self-confidence.

Although the results of breast reduction are long-lasting over time, it is possible that over time your breasts will change due to aging, weight fluctuations, hormonal factors and gravity.

Breast Lift or Mastopexy

Breast Lift or Mastopexy is the surgical intervention that allows the rise of the breast and increase the size in the same procedure if the patient wishes.

The breast lift, technically called mastopexy, is a surgery that lifts and firms the breasts by removing excess skin and repositioning the tissues to form the new breast.

A woman’s breasts often change over time, losing their youthful shape and firmness. These changes and the loss of skin elasticity result in the sagging of the breasts (technically known as breast ptosis) These changes can result from:

Pregnancy
Breastfeeding
Weight fluctuations
Aging
Gravity
Inheritance

Sometimes, the areola enlarges over time, and a mastopexy also allows the reduction of them.

Breast lift surgery does not significantly change the size of the breasts. If you want the size of your breasts to increase, consider taking advantage of the surgery to do a prosthesis augmentation at the same time. To make breasts smaller, consider combining breast lift and breast reduction surgery.

Candidates for mastopexy or breast lift :

A breast lift is a good option for you if:

You are physically healthy and maintain a stable weight.
You don’t smoke.
You are upset by the feeling that your breasts have lost shape and volume.
When you can’t stand the nipples being below the breast fold.
The nipples and areolas point downward.
One breast is lower than the other.

What to expect during your consultation :

The success and safety of your breast lift procedure depends largely on your complete sincerity during the visit. We will ask you a series of questions related to your health and lifestyle:

Why you want the surgery, your expectations and the desired outcome.
The consumption of medicines, vitamins, herbal supplements, alcohol, tobacco and drugs.
Previous surgeries.
Family history of breast cancer and the results of previous mammograms or biopsies.

Your surgeon will also take measurements and examine your breasts, skin quality, nipple placement and areolas.

Take the opportunity to clarify doubts and possible results, risks and possible complications of surgery during the first visit.

Before surgery:

We will ask you for an analysis, electrocardiogram and chest x-ray.
We will also order a basic mammogram before surgery and another one year after surgery to help detect any changes in breast tissue.
Quit smoking 20 days before surgery.
Avoid taking anti-inflammatory medications such as aspirin and derivatives.

Breast lift surgery:

Mastopexy is performed in an operating room. Admission is required, discharged the next day or as determined by the doctor.
Breast lift is performed under general anesthesia, keeping the patient asleep during the operation.
Mastopexy lasts between 1.5 and 2.5 hours. Sometimes, whenever prostheses are not necessary, drains (tubes that are removed the next day before discharge) are left to prevent the accumulation of blood.
After surgery, a surgical bra is placed that it is advisable to use during the first month after surgery.

Postoperative:

You should wear sports bras without rings while your breasts heal.
You will be given specific instructions that may include: How to care for your breasts after surgery, medications to apply or take by mouth to help healing and reduce the risk of infection.
Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.

The results of mastopexy will be long-lasting. Over time, your breasts may continue to change because of aging and gravity. However, you’ll be able to keep your new look longer if:

You maintain your weight.
You maintain a healthy lifestyle.

Tuberous breasts

Tuberous breasts also called tubular or caprine are a non-hereditary congenital malformation although with a certain family grouping that affects a large number of women and manifests itself at the time that the breast develops in women.

Tuberous or tubular breasts are characterized by:

Tubular shape, large areolas, areolar hernia (protrusion of part of the gland in the areolar area), high submammary groove, breast separation and often breast asymmetry.

Many of the women who consult us have this type of deformity and although they are increasingly informed on many occasions they are not very aware of having this type of deformity. This type of breast is also called tubular breast, constricted breast or goat breast.

There are a wide variety of tuberous breast forms, ranging from mild to severe.

Tuberous breasts develop when the skin does not stretch properly during puberty. The result is a constricted breast that in the most severe cases comes to have a shape similar to a tube. Often, the breasts will have a pointed shape, rather than a pleasant round base. The areola is generally quite large and often looks like it is near the end of the breast. Women should know that tuberous breasts are more common than most people think.

Women with tuberous breasts are usually well aware of the “abnormal” appearance of their breasts. Although it is not normally noticeable a great asymmetry between the two breasts sometimes they are very different, being able to have a small tuberous breast and another normal or the two tuberous but of different size. In general, correction is done after puberty, once the breasts have fully developed. In severe cases, correction can be done earlier, but in general it is better to wait until the chest has had a chance to fully mature.

Characteristics of tuberous or tubular breasts:

Most of the characteristics of the tuberous breast are:

A restriction of the skin both horizontally below the breast and vertically on the inside.
A reduction in the volume of the breast parenchyma.
Abnormal elevation of the submammary groove.
Pseudohernia of the mammary parenchyma through the areola.
Large areola.

Some or all of these deformities may be evident on the patient’s first inspection.

Gynecomastia

It is the excess of breast in men, it is common in men of any age. It can be the result of hormonal changes, conditioned by heredity, by illness or the use of certain medications.

Gynecomastia can cause emotional discomfort and affect your self-esteem. Some men may even avoid certain physical activities and relationships in intimacy, simply to hide their condition.

Gynecomastia is characterized by:

Localized excess fat, excessive development of glandular tissue, or a combination of both.
Gynecomastia may be present unilaterally (in one breast) or bilaterally (both breasts)

Male candidates for breast reduction:

Surgery is a good option for you if:

You are physically well and at a relatively normal weight.
You have realistic expectations.
Breast development has stabilized.
You are upset by the feeling that your breasts are too big.

Male breast reduction surgery is best performed on:

Non-smoking and non-drug users.
Men with a positive attitude and specific goals in mind to improve the symptoms of gynecomastia.
Breast reduction for men is a highly individualized procedure.

Procedure to correct gynecomastia:

Plastic surgery to correct gynecomastia is technically called reduction mammoplasty, and it reduces the size of the breast, flattening and improving the contour of the chest.

Anesthetic options include intravenous sedation and general anesthesia.

Approach: In most cases subcutaneous mastectomy can be performed, meaning the partial removal of the gland without skin excision, through a small incision under the areola.

Sometimes there is an excess of skin and gland which forces to remove skin in addition to remove the excess gland.

There are also cases where the excess breast is due to an excess of fat (these cases are technically called pseudogynecomastia) and can be treated by liposuction. There are several liposuction techniques: Traditional liposuction, ultrasound, hydroliposuction and laser liposuction (the latter is the one we consider most effective in most cases because it improves the retraction of the skin).

Finally quite often we use the two techniques: gland excision and liposuction.

Recovery:

After surgery we apply dressings on the scars and a girdle to minimize swelling and improve skin adaptation.

A small tube may be temporarily placed under the skin to drain excess blood or fluid that may build up.

The stitches are usually removed in 7 days.

You can resume normal activity and exercise after a month.

Recommendations for after the operation:

It is important to avoid sudden movements and strains during the first three weeks. It is not advisable to exercise until after the first month.

You will need to wear the compression girdle for a month.

Contractura Capsular

Capsular contracture or encapsulation of implants is one of the problems of breast surgery with implants that most concerns patients and surgeons.

The periprosthetic capsule:

When an implant is inserted into the pocket of the gland, a natural defensive reaction occurs (because the body considers it a pathogen) consisting of a scar around the prosthesis. This reaction is called a foreign body reaction and occurs whenever an object is introduced into the body. The scar is mainly composed of connective tissue (scarring)

The capsule itself is a good phenomenon and indicates good healing. The main role of the periprosthetic capsule is a curative, scarring mission, allowing the adhesion of the implant to the tissues, preventing open cavities which prevents seromas and prevents infections. So the fact that the capsule is not formed is bad but so is the fact that there is an excess of capsule.

What does it consist of?

The normal periprosthetic capsule is composed at the microscopic level of fibroblasts and collagen fibers as well as blood vessels. At first glance the capsule is a thin fabric that surrounds the implant, whitish, shiny and the same size as the implant it contains inside.

Sometimes the capsule has abnormal characteristics : is thick, very firm, irregular, has non-whitish areas and irregularities, sometimes calcifications, is matte, can even be yellowish, and has a tendency to shrink compressing more and more to the implant.

Therefore we speak of encapsulation or capsular contracture in those situations that after the insertion of an implant that is formed is a pathological capsule and not a normal capsule.

What are the signs and symptoms of capsular encapsulation or contracture?

Capsular contracture can occur initially in the first months after surgery or late years after the implant and in this case indicates a deteriorated or ruptured implant.

So we can say that if a capsular contracture appears in a patient who was well we must think about rupture of the implant (if it happens before 7-8 years we can consider that the implant was defective)

The periprosthetic capsule is formed by a natural, physiological process and during the first 3 weeks after the insertion of the implant. The first symptoms of encapsulation or problems with the capsule usually appear between the 5th and 6th postoperative week, usually in the 2nd postoperative month. From 7 – 8 months the capsule is definitive and only has surgical treatment.

The usual evolution of encapsulation is the progressive hardening and traction of the tissues that are around the implant producing a bad placement of the prosthesis that is progressively placed upwards and externally, the nipple will be progressively arranged looking down and the usual rope of the lower pole disappears. In the case of prostheses introduced by areolar route, it will produce an umbilication of the incision scar.

What degree of encapsulation do I have?

To classify the degrees of contracture most surgeons have been using the following classification according to the degrees of encapsulation for many years:

Grade I: the normal capsule that should always form.
Grade I in: normal feel and shape of the implant.
Grade I b: soft touch and slightly visible implant, is considered within normality.
Grade II: firm touch and normal or acceptable shape.
Grade III: firm touch and abnormal shape.
Grade IV: hard touch, abnormal shape, may be annoying or painful.

In a generic way and always assessing each patient separately, the symptomatology, and the shape of the breast we can say that grade I does not require treatment, the II non-surgical treatment if we take it in time and grades III and IV surgical treatment.

Why did my breast encapsulate?

There are many factors that can favor the formation of a pathology capsule :

Surgical factors:

Aggressive surgery without respecting the plans.
Undrained post-surgical hematoma.
Placement of smooth prostheses in a subglandular plane.
Contamination of the prosthesis during introduction.

Post-surgical factors:

Postoperative hematoma.
Seroma as a result of aggressive efforts or massages during the first postoperative weeks.
Lack of patient collaboration in the healing period. Not keeping enough rest for the first 3-4 weeks can cause bleeding or seroma to occur and this will cause greater fibrosis and contracture.

Individual factors:

They are anatomical and medical particularities of each patient in some known cases (such as poorly elastic skin due to radiotherapy, burns, etc.) and in others of unknown cause.

What solution does an encapsulated breast have?

Any non-surgical or preventive treatment of capsular contracture must be performed during the first postoperative months, being able to consider the state of the definitive capsule from the 7th or 8th month, at which time we can only solve it by surgical treatment.

The possibilities of treatment of capsular contracture that have shown efficacy are:

Massages: They can be effective when done well and in the recommended period. We do not consider that it is indicated to start before the capsule is formed because they could affect the adhesion of the same to the prosthesis and favor a rotation of the same or a lack of adhesion producing a seroma and consequently be responsible for the contracture that you want to avoid. It is very important to follow the doctor’s instructions to make them and would be indicated only in the incipient pathological capsules from the 4th week when the capsule is formed and during the first 6 postoperative months, in which the periprosthetic capsule is maturing and is not yet definitive. They are the first therapeutic step.
Capsulectomy: removal of the capsule. It is the surgical treatment of choice of encapsulation, highly effective and can even be repeated. It is important to perform the complete excision of the capsule if we want to avoid recurrence.
Submuscular conversion: If the encapsulated prosthesis is subglandular, it is preferable to perform capsulectomy + the change of plane to subpectoral.
Replacement of implants: A capsulectomy and replacement of the implants is performed. If they are smooth we change to textured and if they are textured we can consider the placement of polyurethane prostheses.
Reconstructive techniques: One of the techniques that is increasingly used is the removal of prostheses and replacement by fatty tissue grafts. Since the fat must be implanted in the live plane in the first time, very little fat can be grafted and will require more than one surgical time to achieve an acceptable result.

Ineffective or dangerous techniques for the treatment of capsular contracture:

Leukotriene inhibitors: these are drugs for the treatment of asthma, which have been proposed as effective in the treatment of mild degrees of encapsulation. The most used is the Acolate and in addition to not having scientifically proven its effectiveness in the treatment of capsular contracture can cause liver toxicity.
Ultrasounds: Not only have they not shown efficacy but they can cause damage to implants and breast tissues.
Closed capsulotomy: it was applied in the past and consisted of external maneuvers (without opening the skin) squeezing and bursting the capsule. This aggression caused ruptures of the implant and hemorrhages that sometimes forced to enter the emergency room in the operating room.
Partial capsulectomy: That is, removing part of the capsule but not all of it. When leaving pathological capsule the recurrence of the problem is the most frequent.

Currently the incidence of capsular contracture has decreased a lot thanks to the greater training of surgeons and the greater collaboration of patients.