Dr. De Fazio Plastic Surgeon :: Procedures :: Breast :: Breast Augmentation with implants

Breast Augmentation

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Breast Augmentation is a procedure aiming to enhance the volume of the breast. This is achieved by using breast implants. The ideal patients to this procedure are women whose breast is either very small or has lost consistency or has become saggy after breastfeeding several times or is asymmetric or has a shape and volume the patient does not like. In those cases where the breast is very sagging, it might be necessary to combine this procedure with a mastopexy.

ANESTHESIA:
local + sedation or general 
TREATMENT LENGTH:
1.5 to 2 hours
STAY IN HOSPITAL:
1 day / day surgery
RECOVERY TIME (BACK TO SOCIAL LIFE):
2 weeks


The procedure

The procedure is performed in a Clinic, under general anesthesia or local anesthesia with sedation. 
The procedure is not so long. Breast Augmentation normally lasts 1hr 30mins, but, depending to the technique used, the time can be either reduced or increased by abt. 30 minutes.
The breast implant size has to be discussed with the surgeon who will perform the surgery. During the consultation, important factors must be taken into consideration, such as size of the breast and of the chest, the body composition and, last but not least, the patient's wishe

The technique
The technique used in most of the cases is the "Dual-Plane" Technique. The dual-plane technique consists of placing the implant underneath the pectoralis major muscle (chest muscle), which will be split from the mammary gland. The incision is normally around the nipple (periareolar), but this is not possible when the areola is too small to be able to introduce the implant. In the latter cases, the incision will be done in the inframammary fold.
This procedure leaves visible scars; yet, the surgeon's objective is to make the incisions in a way that the scars will as less visible as possible. The best position for a scar is periareoral, thus around the lower half of the areola, where the darker skin is joining the lighter skin. This is the best position for the scar because the quality of the scar itself will be better and also because this area is at the center of the treated area with a great advantage for the surgeon. The scars will gradually improve and reach a very good quality already 3-4 months after surgery, but, as any scar, they will stop improving and become permanent as they are after one year.
When the breast has a good parenchyma, together with ptosis (drooping or sagging breast), the implant should be placed in the subglandular position, that is, over the muscle. This allows to raise the breast more. In this case, we normally choose a polyurethane-coated implant in order to avoid the risk of capsular contracture.
The dual-plane technique minimizes both the capsular contracture and the rippling risks; the latter might occur in the upper pole with subglandular implants. 

Breast Implants
The Breast Implants used by Dr. De Fazio are pre-filled with cohesive silicone gel. It is important to underline that the silicone gel is not liquid rather semi-solid, and, therefore, there is no filler leakage (silicone gel bleed) and it keeps its shape. Breast Implants can be divided into two main types: round or anatomical; furthermore, they can have a low, moderate or high profile. We always choose Breast Implants, which are textured (with a rough texture) or polyurethane-coated. We always use the polyurethane-coated implants when we place the implants in subglandular position. In most of the cases, we use textured silicone implants with the dual-plane technique.
The duration of breast implants is unpredictable; on the other hand, it is not necessary, as some people say, that they must be replaced after 10 years. In fact, the major Breast Implant producers provide a long-term guarantee.
Breast Augmentation can be performed using two different kinds of implants. It is essential that the surgeon has the required knowledge about all kinds of implants and that he is therefore able to recommend the most appropriate implant in each case. In other words, there is no breast implant "for all seasons". There is no standard implant suitable for all patients: a surgeon who is using the same kind of implant for all patients has no clear idea of what breast augmentation is about. During the pre-operative consultation, it is important to assess what can be achieved with the procedure and, at the same time, to understand the patient's needs and expectations, in particular the desired size and shape. Based on this, the kind of implant, the volume and the technique will de agreed. Breast Implants can be round or anatomical; furthermore, they can have a low, moderate or high profile; all of them are pre-filled with cohesive silicone gel; finally, they can be textured (with a rough texture) or polyurethane-coated. The latter are the safest to minimize the complication, although rare, of capsular contracture.

Preoperative Preparation

The preoperative preparation implies blood tests, an ECG and, according to surgeon's assessment, an ultrasound of the mammary area.
Two weeks prior to surgery, as well as two weeks after, aspirin should be avoided. Aspirin can reduce blood coagulation and can cause complications.
It is recommended to female patients taking oral contraceptives to stop taking them one month before surgery.

Post-operative care

It is recommended to place drains to remove serous fluid and blood collections inside the breast pocket where the implant is placed. This is why we normally leave the drains for one or two days, no matter if the patient is hospitalized or not. In any case, the patient will take antibiotics also back home and the first check-up will be to remove the drains. The patient will be hospitalized only when there are complications like fever or hematoma.

Follow-up
The time of the first check-up depends on when the drains need to be removed. Normally, they are removed when the fluid and blood collections are below 50 cc in 24 hours.
7 days after surgery the first check-up will take place, in order to check the surgical wounds. No stitches will be removed since only resorbable sutures are used.
The following check-up will be 30 days after and, then, 90 days after. Six months after surgery the surgeon will check the patient at his consulting room.

During the first week after surgery the patient should avoid lifting heavy object and pushing with the arms, to avoid straining the pectoral muscle. The patient should wear a bra night and day and avoid soaking the area where the wounds are. The patient should not sleep with her chest down (prone position) for about 10 days. The patient should not have a shower until the dressings are removed (one week after surgery).
The post-operative pain is kept under control by painkillers (analgesics) and normally the patients feel just discomfort, not real pain, when making movements with the upper limbs.

After the procedure

For a while, the breast will look slightly higher than normal. This occurs especially when the implant has been placed with under the pectoralis major muscle (submuscular technique). The implant will take a more natural position within 2-3 months.

Possible complications

Bleeding. It is very rare, but it can occur only within 24 hours; if so, the patient will be taken back to the surgery room to remove the implant, stop the bleeding, place the implant again and close the wound again. Anyhow, the bleeding, if treated in the correct way, will not cause any other inconveniences or complications.

Infections. They are very rare, but when occurring, it might be necessary to remove the implant and wait for a few weeks or months before repeating the procedure.
Loss of sensitivity in the nipple.T his is a rare complication, but it might be caused by the procedure. Only in extremely rare cases it can be permanent.

Excessive Breast Firmness. The body reacts to the breast implant in the same way as to any other foreign body, creating a fibrous capsule that with time might constrain the implant and increase its consistency. This is the most common long-term complication of breast augmentation even though this occurrence has decreased significantly thanks to the use of textured (with a rough texture) or polyurethane-coated implants.. The occurrence of capsular contraction can also be reduced by placing the implant under the pectoral muscle. Nevertheless, even in this case, the complication might still occur months or years after surgery.
In very rare cases, this complication requires a new surgery, but, anyhow, at the first signals of a change in consistency the patient should contact the surgeon in order to act immediately with some external maneuvers, which could be enough to give the breast its natural softness again. When the implant is placed in submuscular position, during the first few days after surgery the patient might feel some discomfort on the front surface of the chest. This condition will disappear quickly and within the end of the first week after surgery the patient will not feel the presence of the implant anymore.

Recovery time (back to social life)

Work and social life should be reduced for at least 1 weeks after surgery. If the patient's job implies physical activity such as lifting heavy objects, pushing, etc... the recovery time has to be longer. Driving can be resumed one week after surgery. Sports can be resumed 4 to 6 weeks after surgery, depending on how intense the effort required is.

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