Breast augmentation surgery is one of the most demanded by the female sector. Several factors must be taken into account before undergoing a breast augmentation, on the one hand the most appropriate technique for each person and on the other hand if the augmentation is going to be carried out using silicone breast prostheses or with the patient’s own fat. Before performing the surgery, we take into account the patient’s preferences regarding breast augmentation and, after assessing her needs, the type of technique to be performed is determined.
Breast augmentation with autologous fat
In the event that the patient presents an excess of fat in some part of the body that is bothersome aesthetically and wants a not very large breast augmentation, that is, to increase one size in a single session, she will be an excellent candidate to perform a liposuction of the area where the excess fat is located to re-inject it into the breast area.
In order for most of the fat that is injected into the breast to remain fixed, the plastic surgeon must be very careful in the treatment and processing of that fat. Liposuction must be performed with ultrasound to better separate the cells and, in this way, when reinjecting the fat in the chest, the nutrient reaches this receptor area better, making the vast majority of these cells live. In addition, the way in which the fat is placed in the breast is also very important, trying to inject small lines of fat from the deep plane of the pectoralis muscle to the subcutaneous plane of the breast. In this way, the breast augmentation is effective since the reabsorption of fat is substantially reduced, being around only 20%. The result is an obvious and very natural change, achieving a one-size-fits-all breast augmentation that will never cause any type of complication.
Breast augmentation with breast prostheses
A breast augmentation with a prosthesis will have to be resorted to in cases of women who want an exuberant result and in very thin people, with very little chest and who do not have any type of fat in their body. To place mammary prostheses, the axillary approach generally gives more problems, so the safest routes are the areolar and the sub-mammary.
To place breast prostheses, the safest approaches are the areolar and sub-mammary, while the axillary route generally causes more problems since, although it is faster to perform, it is difficult to visualize how the prosthesis is placed. The placement of the breast prosthesis via the axillary causes problems of asymmetry, displacement of the prosthesis… In cases of very muscular people, it is difficult for the muscle to yield, so there is a risk that the prosthesis will be placed on top and, on the contrary, in cases where there is muscle laxity, the prosthesis slides down over time. In addition, the axillary approach has a higher percentage of complications and, although it seems to be less traumatic because the breasts do not have any scars, internally it is much more traumatic and recovery is slower.
The areolar route and the sub-mammary route are the best approach routes to place the breast prosthesis since the plastic surgeon has direct visibility of the space, being able to make an exact “pocket” of the place where to place the prosthesis. Depending on the person’s anatomy, the best of these two approaches is chosen and, in cases of very small areolas, the sub-mammary approach will be the only option.
As for their shape, breast prostheses can be round or anatomical with a teardrop shape and, within each type, there are different variants such as their projection. The breast prostheses that give the best results are the micro-textured cohesive silicone gel ones, since they are the safest because they have the least risk of contracture and, therefore, the lowest rate of breakage. It should be borne in mind that if the person has a small areola it is impossible to use anatomical breast prostheses.
Regarding the position of the breast prosthesis, the technique that provides the best results is the so-called dual plane, which means that the prosthesis is placed under the pectoralis major muscle, which occupies only two thirds of the prosthesis. A dissection is performed on the lower margin of the muscle so that the lower third of the prosthesis is not located below it and, in this way, the muscle is prevented from pulling or deforming the breast prosthesis when the person exercises. Also, since the muscle covers the upper part of the prosthesis, the result is much more natural.
Post-operative breast augmentation program to prevent prosthesis contracture
To prevent a possible capsular contracture of the breast prosthesis, the post-operative program has a key factor. Any protocol that favors post-operative inflammation to decrease more quickly greatly reduces the risk of contracture. It is proven that if the patient has complications of excessive bleeding, inflammation, infection… the risk of contracture greatly increases. A very small rate of patients develop a contracture due to genetic causes as their body reacts to silicone this way.
The majority of patients suffering from breast prosthesis contracture is caused by complications after the operation. Our specific post-operative program after breast augmentation surgery is aimed at preventing prosthesis contracture since this capsule begins to be created from minute one and during the first two weeks it will be fully formed. For this reason, it is vital that during these two weeks the patient be treated to reduce inflammation through lymphatic massage, external ultrasound and Vacuum therapy.
In addition, this post-operative improves healing and favors a rapid recovery so that the patient returns to her daily life as soon as possible.
After following this specific post-operative protocol for breast augmentation, it is difficult for a prosthesis contracture to occur but, if it does, during the post-surgery check-ups, the condition of the prosthesis is monitored and how it is doing is observed. evolving the capsule produced. In those cases in which it is detected that the breasts harden, the ultrasound sessions and Vacuum therapy are reinforced until the evolution of the contracture is paralyzed.
What usually happens in mild or incipient cases of prosthesis retraction is that the capsule retracts a little, creating an asymmetry with respect to the other breast since the prosthesis rises a little upwards and is somewhat higher. With the reinforcement of the post-operative sessions, we managed to stop the contracture of the breast prosthesis and the asymmetry is corrected by means of a simple revision with local anesthesia in which, from the lower groove of the breast, the space that has retracted is enlarged and solved.
What happens if I cannot tolerate a silicone prosthesis for breast augmentation?
If the contracture continues to progress and becomes severe, it will be necessary to change the prosthesis, completely removing the capsule and placing a new prosthesis with a polyurethane membrane, which is especially useful in patients who do not tolerate silicone. These types of polyurethane breast prostheses look great and are an excellent second option for these people, but they are less natural than silicone ones as they are less mobile.
Another excellent alternative for those people who no longer want to continue using prostheses because they cause problems, is to replace them by filling in fat (provided there is excess fat in another part of their body). At first, when the breast prosthesis is removed, a discreet breast augmentation can be performed to avoid leaving a deformed breast and, once the tissues surrounding the prosthesis are adhered again, if the patient wishes, a breast augmentation can be performed. second intervention to perform another filling of autologous fat and achieve a breast with more volume.
Mastopexy with prosthesis
In order to correct and raise sagging breasts through a mastopexy and for the result to be optimal, the most important thing is that the plastic surgeon calculates very well the amount of skin that has yielded that must be removed, in addition to the accumulated fat that may be in the lower pole of the breast. Once the amount of skin to be removed has been determined, the most suitable prosthesis size is chosen to fill the breast. Internally, mastopexy uses the same technique as for breast augmentation, placing the prosthesis under the pectoral muscle.
In a mastopexy, the assessment of the surgeon is essential. He calculates and draws the breast with the patient standing, his intuition and experience being essential to achieve an excellent result. To determine the amount of excess skin to remove, the different measurements are taken into account, the position of the nipple, the fold of the breast… Although it is important to take into account the opinion of the patient, the surgeon can never make the mistake of performing something that will not give a good result, for example, if the plastic surgeon considers that an inverted T is necessary, his opinion should prevail before that of the patient, otherwise the result will not be good.
If the patient has large breasts, the placement of a prosthesis will not be necessary. Mastopexy in this case will consist of removing skin and elevating these breasts and, in some cases, it will also be very useful to perform a pectoral lipofilling, placing fat extracted from another part of the body in this area to prevent the upper pole of the breast from being hollow , obtaining a result with the effect of a mini-prosthesis.
It should be borne in mind that a breast prosthesis does not achieve a sagging breast lift by itself, it only occurs in people in whom the sagging is very slight and there is no excess skin.
Breast augmentation, round or anatomical prostheses?
As for their shape, there are two main types of breast prostheses: round or anatomical. In most cases, the result of breast augmentation is better with round prostheses because the silicone of an anatomical prosthesis is much more rigid to maintain its shape, so its touch is harder and less natural.
Another added risk of an anatomical prosthesis is that, even after some time has elapsed since the breast augmentation procedure, it can rotate in the capsule itself, generating a deformity and causing the nipples to become cross-eyed. Although the rotation is slight, the appearance of the breast looks strange, so the only solution in these cases is to intervene again to remove the anatomical prosthesis and replace it with a round prosthesis.
In our case, we use the anatomical prosthesis only in cases of post-mastectomy reconstruction since the patient does not have a breast and it is very suitable for giving it volume and shape. Anatomical prostheses are also used in those patients with breast deformities that have a very marked restriction of the skin in the lower pole of the breast that is necessary to expand more and a very protruding upper part, although these are very specific cases.
Breast reconstruction after a mastectomy
Women who have undergone breast removal for oncological reasons generally go to the plastic surgeon once the mastectomy has been performed and he or she decides on the type of reconstruction to be performed. Sometimes breast reconstruction is performed immediately: at the same time that the oncologist removes the breast from the patient in the operating room, a first part is performed in which the plastic surgeon places an empty expander that is like a prosthesis mammary gland incorporating a valve. Starting three weeks after the intervention, when the tissues have already healed, the patient goes to the plastic surgeon’s office every two weeks to inject serum into the expander and expand the tissues.
Lipofilling with fat is a very good option to fill out the breast after a mastectomy, giving it a natural look. Several sessions of lipofilling are usually carried out, filling the area where the breast would be with fat and then putting on a prosthesis that will be covered with fat on the outside so that it looks much more natural both to the eye and to the touch. A breast reconstruction requires several interventions and, when the breast is already recovered, the last step is micro-pigmentation. In our case, we began to reconstruct the nipple through local anesthesia surgery to achieve the bulge of the nipple with the same skin in the area and, once it heals, we perform micro-pigmentation of the nipple and areola.