mevclinic.net clinica medicina estetica e cirurgia vascular

BREAST AUGMENTATION

INTRODUCTION

Breast augmentation is the most popular cosmetic surgical treatment in the eatworld. The good results obtain make women feel comfortable and happy in the use of this type of treatment. Breasts that are hypodeveloped, small or atrophied due to genetic factors or pregnancy, are the cause that impels women to seek proportion and harmony for their body and the comfort of being able to wear their preferred clothing through a dramatic improvement surgery.

GENERAL

In order to apply for this type of surgery, the woman must, as a rule, be more than eighteen years old, have no breast disease, have a good general physical and psychological condition. She should not have had a pregnancy and childbirth for less than six months.  Surgery if the women intends to become pregnant within 1 to 2 years (changes introduced into the body by pregnancy may interfere with the esthetic results obtained by the surgery). There is no perfect technique, no perfect implant, no perfect surgeon, no perfect patient ... The good results are obtained with a set of factors that complete and contribute to the best results and the final satisfaction of the patient.

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There are many technical aspects to consider when planning to avance to a breast augmentation, namely:

1. Incision site - Axillary, periareolar, inframammary or transumbilical

2. Implant position - Sub-glandular or sub-muscular

3. Implant type - Saline or silicone gel

4. Implant surface texture - Smooth or textured

5. Shape of the implant - Round or anatomical (in the form of a drop)

6. Implant design - Low, medium or high

7. Implant volume

Any route has its advantages and disadvantages and any surgeon prefers or feels more comfortable with this or that approach.In the medical literature there may be multiple references to the advantages and disadvantages of the various approaches, implant placement, type and volume of the implant, etc. The final solution is to find a technique where the surgeon feels comfortable and has experience, a perfect identification of the patient's expectations so that results in a success operation, make the patient happy and not have complications

PERIAREOLAR INCISION

This technique uses an incision around the nipple (periareolar) that generates a very thin, usually imperceptible scar (at the transition between the areolar tissue and the skin). The recovery is identical to that of the other approach methods, with the same post-operative and high one to two hours after surgery, with no drains and only the need for a compression bra.

INCISION IN THE INFRAMAMMARY FOLD

The fold at the base of the breast (or inframammary fold) is an excellent approach for a large number of patients. With an incision of about 5 cm, excellence way to entry for the prosthesis is achieved, especially when using larger prostheses. In cases of marked hypoplasia of the mammary gland and when using small prostheses, it is not a very recommendable way. The recovery is identical to the other approach approaches with discharge one to two hours after surgery, without drains and only with the need to use compression bras.

PRONS AND CONS OF THE VARIOUS APPROACHES

 

AXILAR INCISION:

 

Pros

 

1. Absence of scar on the breast

2. Axillary scar well tolerated and with full concealability

3. Non-interference with future breastfeeding

4. More accurate surgical control of prosthesis placement and hemorrhage control (in the case of endoscopic surgery)

Cons

1. A less successful scar may be visible, especially in small armpits

2. Technique advised against tuberous breasts

3. Technique advised against prosthesis revision or capsulectomy

4. Risk of scar band formation in the axilla

INFRAMAMMARY INCISION:

Pros

1. Direct visualization of pocket creation and implant placement.

2. In cases of larger dentures the scar becomes more hidden.

3. Good approach to revisions or capsulectomies.

4. Good approach for tuberous breasts.

 

Cons

 

1. Potentially visible scar

2. Visible scar in cases of small implants

3. Scar visible in the lying position

PERIAREOLAR INCISION:

Pros

1. Excellent visibility in the creation of the pouch and placement of the implant.

2. Scar usually masked by the areola / skin transition zone.

3. Good approach to prosthetic revision and capsulectomy.

4. Good approach for tuberous breast

Cons

1. Possibility of causing sensory changes of the nipple.

2. Possibility of causing changes in future breastfeeding

SUBGLANDULAR VERSUS SUBMUSCULAR POSITION 

Once the approach is decided, it is important to decide whether the prothesis is to be placed underneath or over the pectoralis muscle. Although most cases are performed sub-muscularly, this does not mean that the subglandular pathway is incorrect. 

 

The use of round or anatomical (drop-shaped) implants may be of particular importance in this discussion. The use of implants in the submuscular position may be preferable because of the advantage that it can benefit in terms of visualization of the mammary tissue in future mammograms. Additionally, some statistical data suggest that submuscular placement implies a lower incidence of capsular retraction. With implants in the submuscular position, breast movements can occur when the pectoral muscle is contracted (this may be of particular importance in patients who perform body building) Submuscular implant placement usually results in more painful postoperative Only a few days and that is controlled with adequate analgesic medication.

 

 

PREOPERATIVE CONSULTATION

The preoperative consultation, with evaluation of the patient's expectations, open discussion of all the possibilities and potentialities of the methods to be used, rigorous anatomical measurements, use of the external molds that mimic the size of the prostheses to be used and strict observance of contraindications and Limitations of all possible approaches, is the most effective tool for obtaining surgical success and patient satisfaction.

MAMMARY AUGMENTATION WITH AUTOLOGOUS FAT AND GROWTH FACTORS (WITHOUT PROSTHESIS)

 

Breast augmentation produced with fat taken from another part of the body, enriched with growth factors of the body itself is now a reality and an alternative for the use of silicone implants or other artificial materials. This procedure is indicated for women who have always wanted a larger breast and for those who, for the most varied reasons (breastfeeding, weight loss) have seen breast volume reduce noticeably. This method achieves a considerable increase in volume, in a single intervention with or without previous distension of the skin of the breast.

 

The breast augmentation is carried out in a properly equipped operative block and under local anesthesia. The procedure takes about three hours. The fat is collected by liposuction, without suctioning machines in order to preserve the integrity of the fat cells (adipocytes) and then enriched with growth factors that contribute to a greater longevity than In the case of the use of isolated fat.

 

The postoperative period is well tolerated with return to normal activity after one or two days and the need for a sports compression compression bra for about 4 weeks.

 

The results are excellent in that the breast assumes a natural look in any position, whether at rest or in motion. On the other hand, the rejuvenating effects of growth factors give the breast a better looking, younger looking appearance. firm.

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