Augmentation mammoplasty is indicated in women in the adult life who have not developed an adequate volume of their breast, mammary ptosis (dropping of the breast), and reconstructive surgery (e.g. breast cancer). Mammary ptosis can be seen after pregnancy and lactation, losing volume and normal appearance of the breast, without significant variation in position of the areola/nipple complex.
The selection of patients undergoing the procedure includes an evaluation of the mammary gland, skin elasticity, type and volume of the implants according to the patient’s desire. The main objective is to obtain proportional, harmonic and esthetic breasts.
The surgery consists in placing silicone gel or saline solution filled implants in the space between glandular tissue and pectoralis muscle (sub-glandular space) or in the space between pectoralis muscle and rib cage (sub-pectoral space).
Silicone, as the raw material of mammary implants, is an inert substance widely investigated, that has no evidence of increased risk for cancer or collagen related diseases. In addition to this, implants do not affect the normal development of pregnancy or lactation.
The clinical interview is important because it evaluates the expectations of each individual, as well as the limitations in shape and projections of the mammary gland, making this procedure the best or least indicated for what the patient is looking for.
Surgical Technique
Throughout history there has been different surgical approaches described, including axillary, periareolar, mammary sulcus and umbilical. This latter approach uses laparoscopic or endoscopic surgery techniques.
The axillary approach has been one of the most antique ways of introducing the mammary implants. At present, its use is infrequent due to limitation in technique and esthetics, but it is still an option. The periareolar and mammary sulcus approach have been the most widely used interventions.
The umbilical approach described in recent years, requires endoscopic and laparoscopic equipment. The procedure starts with an incision in the periumbilical region, where surgical dissections are made up to the mammary gland, where the implant is placed. The implant has to be saline solution filled, due to the distance between the site of incision and placement. Which makes it necessary to be introduced and placed empty, in order to fill it through a valve.
Each one of the previously described techniques offers advantages, disadvantages, indications and contraindications that would be evaluated in the medical office. This, added to the pretensions of the patient and, off course, the preferences of the surgeon, will make any of these options the most elegible.
The election of the anatomical placement of the implant, whether it is subglandular or subpectoral, has to be evaluated, discussed and concerted with the surgeon; based on indications and recommendations that exist in medical literature.
Surgical time is expected to be 1 to 2 hours long.
Women with loss of mammary volume in addition to mammary ptosis that request augmentation need different surgical techniques that would be evaluated and explained in the medical interview.
These cases have an approximate time of surgery of 2 to 3 hours.
Usually does not require hospitalization time.
Surgical Work up
Essential laboratory work up includes: coagulation tests (PT, PTT, Platelets), renal function tests (Uranalysis and Creatinine) and complete blood count.
Mamography or radiological exams of the breasts are recommended in every woman older than 35 years of age.
In special cases, additional work up is needed for example: Electrocardiogram (EKG), chest X rays, thyroid function tests, glucose, etc.
Post-operative recommendations and incapacity
The patient has to wear a support bra for 3-5 weeks.
The recuperation time for social and working activities are within 3-5 days, and for sport activities are within 2 to 4 weeks.
Complications
Even though complications are infrequent, it is important to mention the most common ones:
- Inadequate wound healing
- Infections
- Hematomas
- Sensibility abnormalities
- It is important to highlight that the sensibility abnormality risk is influenced by the anatomical placement and surgical approach.
- Capsular contracture
- Statistical frequency and incidence are going to be discussed in the medical visit.
- It is important to take into account that any patient with mammary implants will always have the risk to develop a capsular contracture independent of the surgical technique. Other risk factors are surgical time, trauma, diseases and physiological changes.
- Venous thrombosis and Pulmonary embolism
Note: Please avoid using medication or substances that can increase the risk for complications. Cigarette consumption must be suspended