Breast and Thorax
What is it for?
- Improves the shape, volume and projection of the breast
What does it mean?
- Breast augmentation is a surgical procedure that makes use of silicone implants to change the shape of the breast, improving its aesthetics. The determination of the ideal shape of the breast and the choices made during the surgery follow some rules and depend on the patient's characteristics, including her height, shape of the chest, thickness and quality of skin and subcutaneous tissue, and especially the previously existing breast. Some of the variables to consider are:
- Shape and volume of the implant - The anatomical (or "teardrop") shape generally gives more natural results than a round implant, allowing a better adaptation to the shape of pre-existing breast, to create a more balanced final result. However, some patients already have enough breast volume such that a round implant may permit an equally attractive breast. The volume must be adapted to the patient, although there is some leeway; however, it must be borne in mind that the larger the implant, the greater the risk of complications and loss of natural aspect in the medium/long term.
- Relative position of the implant - The discussion of the placement of the implant position, in front of or behind the pectoral muscle, is also relevant. The plane that we use in our technique to place the implant in front of the muscle is called the subfascial plane, which is an evolution of the subglandular technique, because it uses the muscle fascia as an additional layer of protection, while also reducing bleeding risk. Nowadays, the concept of placing the implant behind the muscle (submuscular plane), corresponds to the "dual-plane" technique, in which the prosthesis at its upper pole is behind the muscle and its lowest portion is (at a variable length) in a subglandular/subfascial position. The "dual-plane" technique is of particular advantage in patients who have a small breast, since it allows a better covering of the implant, reducing the visible stigmata of a prosthesis, such as "rippling" (skin creases), and at the same time allowing better expansion of the lower pole, providing the normal “teardrop” shape the breast usually has. However, placing the implant in front of the muscle may be a good option in patients who already have some breast tissue, allowing to better disguise the prosthesis, or in patients undergoing very intensive sporting activity, because it better avoids implant "bouncing" with the contraction of the pectoral muscles.
- Incision/approach/scar - the most common approaches are inframammary (along the lower breast fold), periareolar (along the lower half of the areola) and axillary (as the name implies, through the armpit). They all have advantages and disadvantages and all can be performed as long as the anatomy and procedure safety allow it (for example, you cannot place a large volume implant using a periareolar approach in patients with very small diameter areolas; the risk of bleeding from the axilla is theoretically superior to the others due to reduced direct visualization). Scars typically have about 4 to 5.5 cm in length depending on the chosen approach and size of the implant
Other procedures that can be associated
- Breast asymmetry correction, liposuction, fat grafting ("lipofilling"), tummy tuck (abdominoplasty), thigh lift, facelift, blepharoplasty
Type of anaesthesia
- General anaesthesia or deep sedation (always with a certified Anaesthetist)
- Scars typically have about 4 to 5.5 cm in length depending on the chosen approach (inframammary, periareolar, axillary) and size of the implant
- It can be performed on an outpatient basis or with 1 day in hospital
- You can return to work in three days provided that it does not require exertion. We recommend that the complete elevation of the arms start only during the second week. Sports can be resumed after 6 weeks. You should also use a compressive bra (recommended by our team) for 6 weeks. After a few months, the scars usually acquire a tone similar to the surrounding skin, becoming less conspicuous
Most frequent problems and risks and problems
- Initially there may be an easily tolerable discomfort (manageable with painkillers), mild swelling, a change in sensitivity of the nipple (increased or decreased). The breasts may be sensitive to stimulation for a few weeks. Over time, loss of elasticity of the tissues, physical trauma/injury, pregnancy or weight changes can alter the shape of the breast and may require revision surgery in the future. Either one or both breast implants may also need to be removed and/or replaced to treat problems such as bleeding, infection, rupture of the implant or the formation of scar tissue around the implant - capsular contracture, which can cause the sensation of tightness or stiffness in the breast. The concept that a young patient may, throughout her life, require at least one breast augmentation revision surgery is quite consensual nowadays, because we are dealing with many decades of life with an implant. Other risks are increased or decreased sensitivity of nipples or breast skin, which may occasionally be permanent
- Except for the indicated situations, the results remain throughout life, with the overall effect of an increase in breast size, as well as improvement in shape and appearance