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The first report of a breast augmentation procedure dates from 1895. At that time there was used fat accumulation from other parts of the body to be placed in the breast area. Of course, a lot has changed in the surgical history of mammary augmentation. Silicone gel implants began to be used in the 60's and since then there has been a great evolution, as well as improvement of design, materials and reliability of these elements in benefit of those patients who wish to have a breast augmentation surgery.
Approximately 80% of the implants are placed with cosmetic purposes and the other 20% due to reconstructive reasons such as the restoration of the shape of breasts damaged after a cancer treatment.
Pre-surgical Evaluation for Breast Augmentation Surgery
There are various aspects to be considered in those patients who ask for a consultation regarding breast augmentation surgery. These aspects are related basically to patient's height and weight, as well as proportional longitude between body and thorax, breasts symmetry or asymmetry and volume of the mammary tissue present in the patient at the moment of the consultation.
Once all these characteristics are considered, I choose the implant's appropriate volume according to each patient's needs and expectations. A large quantity of methods have been suggested to calculate exactly the size of the prostheses, however, the most commonly used is the implementation of samples underneath the patient's bra. This method reflects in a reliable way the possible outcome to be obtained with the procedure, as well as the approximate definitive size.
Placement of the implant in the Augmentation Mammoplaty
The incisions made to approach the definitive spot where the prostheses will be placed may vary according to the case. One of them is the Inframammary incision which is made in the inframammary fold. Another one is the Periareolar incision, placed around the outline of the areola, which is the limit between the brown area of the nipple and the light skin of the breast. And there are also incisions that can be performed through the armpit or the belly button. In my experience, it is better to choose an incision around the areola, which allows me to place the scar in a cosmetic spot and leave almost no visible scarring.
Types of Implants for Breast Augmentation
The implants currently used in augmentation mammoplasty present certain characteristics that make them safe when placing them in the patients. They are chemically inert and don't provoke allergic or inflammatory reactions. Besides, they do not originate cancer and resist to mechanical force.
There are various types of mammary implants, all fabricated to be used in breast cosmetic surgery. Some are safer than others and with characteristics that will be provide a more enduring outcome. The most commonly used are:
1. Inflatable saline implants with silicone cover
First implemented in 1965. They are used as an alternative to those patients who do not wish to have any other type of prosthesis. They have the disadvantage of losing volume with time, which occurs in a range between 0,5 % and 16% of this kind of implants.
2. Silicone gel implants
Most commonly used in our country. They come in different volumes, shapes and types of cover (textured or smooth) and their content consists of a highly purified polymer of dimethylsiloxy (silicone), which has been proved to be innocuous inside the organism. Through its use for several years, silicone has reassured to surgeons its reliability and durability when using it in breast augmentation procedures.
Placement of the implant in augmentation mammoplasty
There exist basically two places where prostheses can be implemented in breast augmentation surgery. One of them is within the prepectoral space, which is above the thoracic muscle and below the mammary tissue. The other location is within the subpectoral space, which is under the pectoral major muscle. The main advantages of a subpectoral implementation of the prostheses are that there is a low incidence of capsular contracture and a better breast outline, since all ends of the prosthesis are covered by the muscle. There is also less risk of bleeding during the procedure and the preservation of full sensation in the nipple.
A great quantity of the plastic surgeons that perform breast augmentation surgeries choose to implement silicone gel implants. These are to be placed under the muscle and can be either textured, round or anatomical. The volume will depend on the patient's characteristics that were noticed during the consultation and also on a well guided consultancy carried out by the treating surgeon. After the surgery, there are several instructions that have to be followed by the patient during the recovery time, which lasts 5 days. After this period, the patient will have to wear a special bra for 4 weeks, which will help to define the shape of the breast. During the scarring process of an augmentation mammoplasty, the patient is asked to have a series of massages over the mammary gland to accomplish the best aesthetic outcome according to the patient's expectations.
