BREAST IMPLANTS (BREAST AUGMENTATION)

Indicated for women who, after reaching adulthood, have not developed an adequate and harmonious breast volume, and for patients who, after pregnancy and breastfeeding, have lost volume and/or shape without significant changes in the position of the areola/nipple complex (breast ptosis).

We must consider the use of breast implants not only in patients with little volume and adequate glandular position, but also in cases of drooping (ptosis) and breast atrophy (loss of volume and alteration of shape and position due to pregnancy and breastfeeding), and in breast reconstruction for cancer or disease.

In the selection and evaluation process, we must define the physical conditions of the gland, skin types and elasticity, and the patient's expectations regarding volume.

The ultimate goal is to achieve a harmonious, proportionate, and aesthetic breast.

This surgery consists of placing an implant filled with silicone gel or saline solution in a space between the glandular tissue and the pectoral muscle (subglandular) or between the pectoral muscle and the rib cage (subpectoral).

Silicone as the raw material for implants is an inert substance, extensively researched, with no evidence of increased risk of cancer or collagen diseases. It also does not affect the normal course of pregnancy or breastfeeding.

The consultation is important to carefully analyze the indication for this procedure and evaluate the patient's expectations.

Surgical Technique

Throughout history, different options for surgical approaches have been described: the axillary approach, periareolar approach, mammary fold approach, and umbilical approach — the latter using endoscopic or laparoscopic surgical techniques.

The axillary approach has been one of the oldest options and, although not discarded today, its use is infrequent since it has important technical and aesthetic limitations.

The periareolar and mammary fold approaches are the two most common surgical approaches. Each offers advantages and disadvantages, indications, and contraindications. During the medical evaluation, all of these considerations, combined with the patient's expectations and the surgeon's preferences, will determine which option is chosen.

The umbilical approach, described in recent years, requires the use of endoscopic or laparoscopic surgical equipment. Through periumbilical incisions, a dissection process begins to reach the mammary gland area, where an implant — which must be saline — will be placed.

This is because the approach far from the thorax and the instruments used require the implant to be inserted and adjusted completely empty, to be subsequently filled through a valve.

The choice of anatomical plane for implant placement (subglandular or subpectoral) must be evaluated, discussed, and agreed upon with the surgeon. There are indications and recommendations for choosing either of these two techniques.

Surgical time: 1 to 2 hours.

Women with loss of breast volume and breast drooping who request breast augmentation with implants usually require different surgical techniques, which we will carefully evaluate during your consultation in my office.

For these cases, surgical time may be longer.

Hospitalization is generally not required.

Pre-Surgical Examinations

Coagulation tests (PT-PTT-Platelets), kidney function tests (creatinine and urinalysis), and a complete blood count are essential.

Mammography and ultrasound are recommended for every woman over 35 years of age planning a surgical procedure on the mammary gland.

Electrocardiogram, chest X-ray, thyroid function tests, blood glucose, and others may be requested in some cases.

Post-Operative Care and Recovery

A supportive bra must be worn for 3 to 5 weeks. Recovery time is 3 to 5 days for social and work activities and 2 to 4 weeks for sports activities.

Complications

Although uncommon, they should not go unmentioned:

1. Altered scarring process.
2. Infections.
3. Hematomas.
4. Altered sensitivity.

It is worth highlighting the risk of altered sensitivity, which is influenced by anatomical variations and surgical approach.

1. Capsular contracture. Some statistical incidence and frequency values will be discussed in my office. We must remember that any patient with breast implants will always have the risk of developing capsular contracture regardless of technical considerations, but there are other factors of time, trauma, diseases, and physiological changes that must be taken into account.

Let us avoid the use of medications or substances that may increase the risk of complications.

Smoking may in some cases contraindicate this procedure.