Augmentation mammoplasty is a surgical procedure to enlarge the breasts. Breasts are also lifted and become firmer through this procedure. A similar procedure can be used to reconstruct a breast after a mastectomy. Breast augmentation can also be performed to correct symmetry in case of difference in size between breasts, or to restore breasts to original size if shrinkage occurred after a pregnancy.
There are many techniques for breast augmentation, and in all of them there is an insertion of a silicone-gel-filled implant behind the mammary gland or beneath the pectoral muscle.
The implant is introduced through a minor incision at the infra-mammary fold, along the areolar border or in the armpit. Scarring is of great final quality, but may require several months to reach acceptability.
The surgery usually takes 2 to 3 hours and it can be performed as an outpatient procedure or inpatient procedure, requiring hospital admittance for a day. Most frequently used anesthetics are epidural or general anesthesia.
The patient must wear a bandage for 3 days post-op, and then wear an appropriate brassiere. Postoperative pain is well tolerated with the use of common painkillers. There might be some edema of the breasts for 2 to 3 weeks post-op, and final results can take several months to be seen.
Patients may return to their normal activities after 1 to 3 weeks, and should abstain from more strenuous activities for a longer period of time.
Capsular contraction may occur (2 to 3% incidence), and can cause the breasts to feel hardened or tight, cause a shift of the implant and also cause an increase or decrease of sensation of the skin.
Mammogram and/or Breast MRI are requested pre-op. This surgery does not impair patients of retaking these exams in later time.
There is no scientific evidence of implants influencing the development of breast cancer or any other disease, or of it interfering with breast-feeding.
Frequently asked questions:
1. HOW DO I KNOW WHAT IMPLANT SIZE IS RIGHT FOR ME?
Patients talk about cup sizes and surgeons talk about cubic centimeters. In order to figure out your right implant size, we use a mold that will give you an idea of volume. This mold is removable and in different sizes and it is placed inside the patient’s brassiere, at a consult, enabling the patient to choose the one with the volume that is most pleasing.
2. SHOULD I OPT FOR SILICONE GEL IMPLANTS OR FOR SALINE IMPLANTS?
Silicone gel implants provide for more natural results visually and to the touch. Saline implants will present more undulations over time, which can be avoided if the implants are properly filled.
3. SHOULD IMPLANTS BE PLACED BENEATH THE MUSCLE OR BENEATH THE MAMMARY GLAND?
It has been recommended that implants be placed beneath the muscle. Aesthetically, submuscular placed implants are less noticeable, allowing for a more natural result. Clinically, this type of pocket placement is more favorable towards radiological routine exams. Saline implants placed beneath the gland are more noticeable on the upper part of the breast and may result in an artificial looking breast. However, if the patient has an adequate amount of fat beneath the skin (more than 2 cm), subglandular implants may be considered.
4. DO YOU RECOMMEND ANATOMIC OR ROUND IMPLANTS?
Anatomic implants are used when the patient wishes to structure the breasts, elongating them. Round implants are more frequently used.
5. HOW LONG DO IMPLANTS LAST?
There is no specific expiration date set for implants. Some manufacturers give a 10-year substitution warranty, while others give warranty for undetermined time. The recommendation is for the patient to undergo routine control exams and in the event of an alteration, discuss with the surgeon if there is the need for implant replacement.
6. WHAT IS CAPSULAR CONTRACTURE?
Capsular contracture is when an implant hardens, tightening and squeezing the breasts. It can vary in levels, from a mild contracture to a severe contraction. It happens as a reaction of the body to the implant. Gradually, the body places scar tissue around the implant, mostly composed of collagen fibers, as an immune response to a foreign body. This may cause implants to alter shape and feel tighter. Mild contractures should not be a reason for concern, as long as the patient is satisfied with the overall look and feel of the implants.
7. IS THERE ANY RESTRICTION OR LIMITATION POST-OP?
Yes. After breast augmentation, patients should abstain from high impact aerobic exercises or contact sports for a period of 4 to 8 weeks.
8. WHEN CAN I GO BACK TO WORK?
This is determined by the kind of work you do. A patient may safely go back to office work after a week, but should only drive a car after 3 to 4 weeks.
9. HOW OFTEN SHOULD FOLLOW UP APPOINTMENTS BE?
Every week after surgery, for 3 or 4 weeks, again after quarantine, and also 5 days to 3 months after that. In long terms, patients should have annual appointments for a quick examination of the breasts.
10. MAMMARY IMPLANTS INTERFERE WITH MAMMOGRAMS?
Special exam techniques will be required, and there may be the need for breast MRI or ultrasound exams. Implants placed beneath the pectoral muscle are more easily examined.
Before and After - The Federal Board of Medicine forbids the display of pictures of patients who underwent plastic surgery. On ASAPS’ web site, several pictures are available for viewing and under public domain:
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ATENÇÃO : Seguindo as normas do Conselho Regional de Medicina, este
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