Augmentation mammoplasty

Increasing mammoplasty (Aesthetics augmentation mammoplasty)
The aesthetics augmentation mammoplasty, also known as augmentation mammoplasty, aims to increase the breast, using implants to add volume to the breasts or to restore breast volume lost after weight loss or pregnancy.

The augmentation mammoplasty does not correct severely sagging breasts. If you want a result that corrects sagging, the breast lift procedure (mastopexy) can be performed at the same time as the augmentation mammoplasty, or it may be necessary a second surgery. In your appointment, we talk about this decision.

Who is it indicated to?
If you are unhappy with the size of your breast, augmentation mammoplasty surgery is an option to be considered. The augmentation mammoplasty can:
• Increase the size and projection of your breasts;
• Improve the balance of your body;
• Improve your self-esteem and self-confidence.

Note: The implants can also be used for breast reconstruction after mastectomy or injury.

Breast increasing can be a good option for you if:
• You are physically healthy;
• You have realistic expectations;
• Your breasts are fully developed;
• You are bothered by the feeling that your breasts are too small;
• You are unhappy with your breasts due to loss of shape and volume after pregnancy, weight loss or aging;
• Your breasts differ in size or shape;
• One or both breasts have not developed normally.

Preoperative
In the preoperative, you must:
- Communicate with us until 2 days before the surgery in case of flu, ailment or other pains and illnesses;
- Hospitalize yourself in the indicated hospital respecting the established time;
- Avoid alcoholic beverages or heavy meals on the surgery eve;
- Avoid any medicine to lose weight that eventually is being taken for a 7 days period before the surgery, including diuretic;
- Schedule your social, domestic, professional or school activities, in a way that you are not indispensable to others for a period of about 2 days.

Anesthesia
General, high epidural or local anesthesia with assisted sedation. The anesthesia depends on the case.

Hospitalization
The hospitalization period is 4 hours (general anesthesia), 10 hours (high epidural) or 8 hours (local anesthesia with assisted sedation).

Based on texts by SBCP.

Operation

On choosing the implants, size and shape of breasts are important. The type and size of implant will be determined not only by the increase on the desired size, but also by the elasticity of the skin, anatomy and physical type.

Silicone implants, for example, are filled with cohesive gel. These implants have a very similar texture as natural breast tissue. In case of implant rupture, the gel may remain within the involucre. The rupture of a silicone implant does not reduce the breast, then you should consult your plastic surgeon regularly to ensure that the implants are under normal conditions.

The method to insert and position the implants depends on the type of implant, the desired volume, the anatomical features and the surgeon's recommendations.

In the procedure, the incisions are made in discrete areas to help minimize the scar is visible. The same vary with the type of implant, the desired volume, the anatomical features and the surgeon's preference.

After the incision, it is determined where the breast prosthesis will be inserted:
• Under the pectoral muscle (submuscular placing);
• Directly behind the breast tissue, on the pectoral muscle (submammary placing/subglandular).

On average, the surgery lasts from 30 minutes to 40 minutes if necessary.

Postoperative

Usually, the postoperative is not painful since the medical instructions are obeyed, especially regarding to the arms movements on the first days. Eventually, it may occur painful manifestations that will easily cease with the prescribed painkillers.

- Avoid efforts on the first 4 days;
- You can and should move your arms, but beware of excesses. Follow the instructions that will be given at the time of hospital discharge on the movement of the upper limbs or massages;
- Do not expose yourself to sun or cold, until further order;
- Obey the medical prescription;
- Regular diet (save specific cases that received guidance);
- Go back to the clinic for subsequent dressing on the days and times stablished.

Obs: Note: Usually, we do not do stitches on the skin. Therefore, we do the first dressing change on the scar between 12 to 18 days.

Caution
Many patients have questions about breast increasing and recovery period. Although many factors are involved, the post-surgical recovery period is usually from 24 to 48 hours, followed by a relative rest period of a few days. You will probably feel pain and swelling for a few weeks. Physical exercise and normal activities will be released following the guidance of the plastic surgeon: generally, from 3-4 days you will be able to perform activities with the lower limbs, such as walking, exercise bike and other, if they do not cause impact. Serial and repetitive exercises with arms, only after a month.

Scar
The results of breast augmentation surgery are immediately visible. Over time, the swelling decreases.

Fortunately, this surgery allows us to place the scars quite disguised, which is very convenient in the first months.

- Immediate period: Until the thirtieth day, it is presented with little visible aspect. Some cases have a discreet reaction to the stitches or dressings.
- Mediate Period: From 30 days to 12 months. In this period, there is the natural spacing of the scar, and starts a color changing, moving to darker (from red to brown), which will clearing. This period, the less favorable cicatricial evolution, is what most worries the patients.
- Late Period: From 12 months to 18 months. During this period the scar begins to become clear and less consistent, reaching its the final aspect. Any evaluation of the final result of the surgery, regarding the scar, should be done after this period.

Some scars are located in the furrow formed between the breast and thorax. Further, in the area of the areola and even the armpit. Since the early postoperative days, it may be worn a very generous neckline because the scars will be quite disguised. With the time, the scars will be better and getting almost imperceptibility in certain cases.

It is important to know that the results of breast implant surgery are not permanent and they may require replacement throughout life. Over time, your breasts may change due to aging, weight oscillations, hormonal factors and gravity. If, after a few years, you become dissatisfied with the appearance of your breasts, you may choose to have a breast lifting procedure or replacement of the prosthesis.

Important: Do not rely on information from well-meaning friends. Get the necessary information directly from the doctor and you will avoid having doubts and anxiety in the postoperative period.

The augmentation mammoplasty is the consecrated method over time to increase the breasts. The prosthesis has been used for more than 50 years for medical use, and have always been and are still the object of research and studies. It is practically unanimous its benefit to small breasts. I consider that it is the surgery that more brings immediate satisfaction, soon after finished the operation: “Sleep without breast and wake up with breasts.” Therefore, this is a high-resolution surgery, which today has an extremely fast postoperative, and the patient is released to her routine immediately after. I.e., released for normal movement of the arms and body, and can (and should) get involved with work, study and even driving on the day after the surgery.

We follow strictly the teachings of Dr. John Tebbetts (www.thebestbreast.com) which since 2002 has been demystifying the need that to have good results and without complications, the patient should be immobilized for several days, being prevented to perform her daily activities by a long period of time. My conclusion is that with immediate mobility and body relaxation, the postoperative period is much better and almost painless.

Nowadays, all surgeries are performed under general anesthesia; last approximately from 30 to 40 minutes and the patient would have from 2 to 3 hours postoperative recovery to be discharged. We encourage the patient to return to work or her daily routine on the very next day after the surgery, normally mobilizing her body and arms, which promotes a faster postoperative period, less uncomfortable and safely in terms of complications.

Association of Mastopexy (breast lift) with silicone prosthesis

It is an instigating topic and with much discussion.
It is undeniable that there is a desire to reposition the breasts and also increase them, this alternative is the most appropriate. However, it is a challenging surgery and has a good index of surgical reviews and/or retouches, as they are antagonistic approaches, i.e., while adjusting its excess at the same time more stretches this tissue, thus creating greater potential to lack of control on the postoperative result.

Greatest challenge is to associate prosthesis with only sagging breast, but with good tissue volume that even without the prosthesis the result would maintain good volume, i.e., when the need to set the prosthesis could be dismissed. Some patients find that associating the inclusion of prosthesis, the breasts would be “harder” or firm and they would have less chance of falling…I draw attention to the tendency will always be falling, with or without prosthesis. Therefore, each case must be exhaustively analyzed, and discussed with the patient to reach a consensus on the conduct. Each case has its particularity.

Anyway, the surgery has an average time from 1 to 2 hours, and is performed on outpatient basis (the patient is discharged on the same day of the surgery) and has few restrictions of mobility in her postoperative, being released to drive on around 7 days. Special attention will be given regarding the scar over time as well.

Reduction mammoplasty with or without prosthesis, that is the question...

It has been frequent the search for adjustment in the breasts, and request of the inclusion of a silicone prosthesis with the intention that the breasts remain perky and stable in their postoperative period, and that they do not fall immediately or over time, even in breasts with good volume. My pondering is that, anyway, the tendency to a breast with volume is falling, with or without silicone prosthesis. Thus, if it is to increase breast volume, there is no doubt that we have to associate the surgery with a silicone prosthesis.

The most complicated is when the patient has enough volume or wants to reduce and set prosthesis. We have to draw the attention of the entire postoperative evolution and the falling tendency is completely different from another patient who only set prosthesis, because that already had no breasts to fall over time, i.e., in those cases the breasts will remain firm and in place over time. Who has volume breast will always have the falling tendency, even operating the breasts. In this case, the tendency will be in less proportion than before and the benefit of having been involved in the surgery is eternal. Remember that the result will have changes over time according to what the nature and individual tendency provide.
In conclusion, the best indication of conduct will be exhaustively discussed with your surgeon to provide the best and most desired result.