This is one of the most common cosmetic surgery procedures now according to statistics. The only safe device to increase the size of the breast is the breast implant. They can be from Saline solution and silicone (both FDA approved). They have to be replaced every 10 years. Breast augmentation, or augmentation mammoplasty, is one of the most common plastic surgery procedures performed today. Over time, factors such as age, genetics, pregnancy, weight changes, sun exposure, and gravity can cause the size and shape of the breast to change. Women who are dissatisfied with the size of their breasts, or have experienced changes in breast appearance can achieve a fuller, shapelier breast with breast implants. During breast augmentation, a breast implant is placed inside a pocket over or under the pectoral muscle. This can help to increase or balance the size of the breast, and will provide breast volume and restore the shape of the breast after partial or total loss. It is important to realize that breast augmentation will not correct sagging or excess skin in the breasts. If this is the case, a breast lift will be necessary, which may be performed in conjunction with this procedure. The most important factor to be happy with your surgery is that “You have to know very well what you want”. The clearer you are in what you want, the easier to make it happen. I normally send patients to measure different sizes and shapes of bras, and also look for before and after pictures of naked breasts that they like and bring those pictures on the day of the operation.
Patients must have blood work before the surgery and a preoperative evaluation with a cardiologist if they have any medical conditions. They must stop taking the following medications and supplements (Aspirin, Motrin Ibuprofen, Multivitamins, Vitamin E, Ginkgo Biloba, Ginseng, and Green Tea) as all of these medications are blood thinners and patients will bleed more in the operation.
They have to take a shower the morning of the operation, and quit drinking alcohol a couple of days prior to surgery. They must disclaim all medical conditions, and medications and drugs prescribed by their doctors.
There are basically 2 type of implants: saline solution and silicone implants.
Saline solution implants: The saline solution implant is a deflated bag made of silicone. This bag has a small valve where the surgeon will plug a connector and fill the bag with saline solution up to the manufacturer’s suggested volume. Once the implant installs and the size is ideal, you disconnect and close the valve. The most common problem with saline solution implants is the water like or gradual deflation of the implant from the valve. This deflation usually will bring rippling that you can perceive when you touch or see the breast. The water jiggling especially with some bubbles is also possible. This can happen in up to 30% of the patient in the next 5 years.
Silicone Implants: You have 2 types, the silicone gel, and the cohesive gel or gummy bear.
Regular silicone gel: this implant is ideal as it has a natural filling and consistency. When you touch the breast it is very similar to the natural breast tissue. This new type of implant is very unlikely to leak which is the most common concern for patients. This implant eventually has to be replaced between 10 and no more than 15 years.
Cohesive silicone gel: this implant has a firmer consistency like a gummy bear. This implant has the disadvantage of being firmer and harder. This is a downfall for many patients.
Silicone implant leakage:
The new type of silicone implants are tested so the implant will last up to 10 to 15 years before the implant leaks.
The leakage of silicone implants is a major concern for many patients, but they have to remember our body is so wise. As soon as the implant gets into your body, it will create a natural capsule or scarring tissue to isolate the implant from the rest of your body. All patients with implants have the natural capsule around the implant. In up to 10% of the patients, their bodies will react more exaggerated, and build a thicker capsule (up to 10 times thicker than normal). If an implant leaks, the silicone is contained in the normal capsule created so it will not migrate to other areas or organs. It will stay inside the capsule. When a breast implant leaks or ruptures, your body will produce a thicker capsule and patients describe having one breast harder than the other.
Most of the patients I evaluate with breast implants more than 15 years that are hard, have a rupture implant in 90% of the cases. At the time of the implant exchange, I try to remove the capsule intact with the implant inside. This makes the operation cleaner, and we are able to place a new implant.
When is the best time to have a breast augmentation? The recommended age to have a breast augmentation is after 18 years of age. This is the average time when the breast tissue has completed development and patients are a good age to make a firm decision to change their body. If you just had a baby, it is important to wait until you finish breast feeding and there is no milk production. As far as what is the oldest you can get a breast augmentation? I don’t think it is age but the general health condition. It is more important to have a healthy patient. Do breast implants cause cancer? No, in many studies they have proven that breast implants do not increase the risk of breast cancer.
The implant can be located over or under the pectoral muscle.
The guideline is the amount of tissue on the chest. If on the pinch test the patient doesn’t have more than 2 inches of tissue in the upper part of the chest, we must go under the muscle. If the patient has more than 2 inches of tissue, the implant can go over the muscle.
Advantages and disadvantages: When the implant is placed under the muscle, the patient must expect to have a bigger gap in the center. The muscle has the tendency to push the implant apart so there is more separation. This will be a big drawback for many patients. Over the muscle allows for more of a chance of cleavage, but is cleavage is the most important thing? One of the disadvantages is there is a higher chance to have capsular contraction, and see rippling and irregularities of the implant especially in saline solution.
The most common incision is:
Around the areola and the infra mammary crease. The operation itself is very simple. Normally we use twilight sedation or regional anesthesia with sedation, the operation is done in 1 hour. The majority of patients go home the same day. You will wear a compression bra with a strap on the top for 3 to 4 weeks that will push the implant down.
Recovery time usually is 5 to 7 days before driving and office work. Patients must have a daily shower, and minimal arm movement recommended. You can go back to the gym in 3 to 4 weeks.
The most common complication of breast implants is the capsular contraction. We don’t know who it will happen to or when it can happen. Under or over the muscle, saline or silicone, Mexico, or USA, Latinos, Caucasian, Asian, 1 month or 10 years after the operation, nothing is predictable.
You will be discharged from the clinic with: antibiotic, pain relief meds, and a special bra.
Things we do to minimize capsular contraction:
At the time of the operation: I remove very well the powder of my surgical gloves, nobody touches the implant but me. I dip the implant in Iodine solution, apply antibiotic in the pocket I created, and introduce the implant. If the surgery has more bleeding than normal, I like to place a surgical drain there. The massage will consist of applying pressure in a circular motion to the implant. The idea is to make sure the implant will occupy the entire pocket I have created. The larger the pocket, the less chance there is of the implant to become encapsulated.
The patient will take antibiotic for 7 days, empty the drainage 2 times a day, and will begin massaging the breast implant after 2 weeks when the breast is not tender anymore.
Minimal arm movement, no lifting anything heavier than 5 pounds, daily shower, and blow dry the tape for 5 to 10 min. Empty your drainage 3 times a day. You can apply ice to reduce swelling, take your antibiotic and pain relief medication as prescribed. The drainage tube must be removed after 7 days or when the fluid turns yellow for more than 24 hrs.
You must begin massage with your breasts after 10 to 14 days. The massage consists in displacing the implant in a circular motion so it can occupy the entire pocket. You must massage 5 min in the morning and 5 min in the evening for at least 6 months. No driving for 4 to 6 days. You must wear your compression bra for 4 weeks day and night.
A breast lift can be combined with augmentation at the same time.
A woman’s breasts help define her femininity, and with the vast differences in shape, size, and appearance, breasts further help to define her individualism. Therefore, changes to the breasts can be dissatisfying and make women feel as if they are losing some of their femininity and youthful vitality. Like other areas of the body, the breasts undergo changes in response to factors such as genetics, the aging process, pregnancy and breast-feeding, weight gain or loss, and hormonal fluctuations. Breasts that were once firm and shapely often begin to sag and droop giving them a loose or heavy appearance. A breast lift, or mastopexy, can help restore a firmer, shapelier breast, which will improve body contours and give the breasts a perky, youthful appearance.
A breast lift can be combining with augmentation at the same time.
Although there are many factors that can contribute to sagging of the breasts, the aging process and the effects of gravity play a primary role in these changes. Just like facial skin, the skin around the breast loses its elasticity in response to a gradual breakdown of the skin’s support network. This causes it to become lax. In addition, the suspensory ligaments that attach the breast to the chest wall weaken and stretch in response to gravity. The breasts enlarge during pregnancy and breast-feeding, which further causes the skin to stretch. As the breasts reduce in size following pregnancy, the skin that was once stretched, is now loose and sags. Lastly, fluctuations in your weight and even hormonal changes can cause your breasts to change in appearance. Combined, these factors can cause the breast to droop and sag, or in some cases rotate in a downward direction.
What size of breasts do you want: same, more or less? This will help me understand what type of procedure will be ideal. If my patient’s answer is the same, I mention that a traditional lift or mastopexy can give the appearance of ½ a cup smaller. If you don’t what to go smaller, I like to suggest a small breast implant.
The second question I like to ask in the consultation is: How long do you want your breasts to be lifted?
The patient replies what? Yes, how long do you want your breasts to be lifted? You have to remember, the skin is an elastic organ so when we do a breast lift, we are basically removing a lot of excess skin. The next day you will see your breast lifted, perky, and firm. At the time the swelling and inflammation is reduced, the breast will have a “NATURAL DROP” in 3 to 6 months. If you are not going to like a natural drop, I like to suggest a breast implant for enhancement and shape in the long run. An implant doesn’t mean you have to go necessarily to a large size. We can use a small implant to leave you in the same size. I always insist my patients bring photos of breasts they like, this gives me a better idea of what they want.
There are different types of breast lifts, and it will depend on the amount of breast tissue, the degree of sagginess, and the size you would like to be after. All of these factors will determine what procedure you need. The most important factor for a breast lift is the position of the nipple. The nipple has to be located in the middle distance of the arm, and if the nipple has migrated down, we must lift it up.
In a patient with an A or B cup that wants a small augmentation, we normally suggest a per areola lift (only an incision around the areola). At this time, if the patient wants, we can also reduce the size of the areola to a standard size of 3.5 to 4 cm.
If the patient has more than a C or D cup, we will most likely have to do the inverted T, or the keyhole. This means the incision is located around the areola.
It is very common for us to suggest a breast implant with our breast lifts. This will give more projection and firmness, especially in the long run.
The postoperative instructions are similar to the augmentation.
Breast Reduction in Mexico
There are several reasons why a patient looks for a breast reduction, cosmetic or reconstructive.
Either because of excessive weight on the shoulders, heavy creases by the bra, upper back pain, bad posture, moisture and humidity in the infirmary crease that turns in to mycosis, or simply for cosmetic appearance. A breast reduction is a very gratifying procedure. The size of the scar has to justify the discomfort of large breasts. In the end, the only difference is the size of the reduction, but the scar is the same. The typical scar is the key hole for inverted T.
Most of our surgeries we leave drainages, and they are removed in one week. Sutures are removed in two weeks. Young patients that have not had children have to be suited to a technique that preserves the center of the breast tissue and the milk duct connected to the nipple. This is very important to allow breast feeding in the future. The reduction can be performed medially, laterally to preserve the center of the breast. If the actual consistency of the breast tissue is fatter and doesn’t have a firm consistency, there is an alternative to remove excessive tissue and replace it with a breast implant. This will provide a long term internal support to the breast and will have a better shape in the long run.
If the patient has firmer breast tissue, there is no need to add a breast implant.
Most of the large breast reduction patients can expect to lose sensitivity at the nipple areola complex, but patients can gradually recover during the first year.
The postoperative instructions are similar to augmentation and lift.