BREAST AUGMENTATION

One of the most important factors of femininity is breast aesthetics.  Their shape and size condition women to a great extent and thus affecting their self-esteem and confidence.
There is no such thing as the perfect breast.  But when it is too small or lacks volume due to breast-feeding of important weight loss, it can be corrected easily with a breast implant.
Breast implants come in different forms, shapes and sizes; although they are all enveloped in silicon filled with saline (water) or silicon gel. The silicon gel implants are the most reliable and render excellent and very natural aesthetic results.

Breast implants have gone through an important evolution process and the earlier silicon gel implants have been substituted by cohesive gels. Cohesive gel has many advantages over the previous type of gel used. Basically, it feels more “compact”, although not necessarily harder. The advantage of cohesive gel is its greater security:

1. If the implant breaks, the gel does not leak out of the wrapping.
2. The gel has a “memory”, so the shape does not change and the problem of rippling (creasing) that can occur with earlier implants and very slim patients is reduced.
3. The problem of micro-perspiration through the envelope has apparently disappeared; this means that the chronic inflammation that earlier models of implants caused has been reduced. Other problems, such as rejection, hardening and capsular contraction are also intensely reduced.

The comparison between earlier models and the newer ones can be related to that of a current car and one that is 15 years old.

Implanting Technique

Anatomical Implants:

These implants simulate the shape of the mammary gland in the vertical position. They were originally designed as implants for mammary reconstruction.  The main advantage being that they best simulate the breast shape in extremely thin patients. Their features are:
1. They are firmer to the touch
2. They bulge excessively on the top parte of the breast
4. Mobility is limited
4. They require a sub-mammary scar (not very aesthetic) for a correct placement.

Round Implants: The features of round implants are:
1. There is a wide variety of models and they render a much more natural result.
2. The gel is softer and takes the shape needed according to the position of each patient. In a drop form if they are vertical and rounded in a horizontal position.
3. They change with the patient's movements much like a normal breast.
4. They are softer to the touch and can be inserted using any method.
5. The ample variety of models makes them perfectly adaptable to any patient.

Procedure:
1. General anaesthetic is recommended and much safer. The anaesthetic used is gentle and fast (1 hour).
2. The patient awakes without bandages and wearing a sports-type bra. Two fine drainage tubes should be inserted to avoid bruising.
3. In order to increase safety, the patient should remain in the clinic for 24 hours; the drainage tubes are removed the following morning and she can then be discharged.
4. The initial appearance of the breast is somewhat peculiar and unnatural. This is due to the inflammation and swelling.

Post-operative care:
1. There is some discomfort for the first two days. This is caused by itching, skin dryness and to the weight of the implants, but no pain is experienced by the patient.
2. The first check up is held 48 hours after the procedure and at this time the patient can shower and use moisturising lotions. This eliminates almost all of the discomforts and the patient can resume her normal daily life. The sole exceptions are that she should wear the bra for 24 hours a day and avoid exerting her arms in excess for a fortnight.
3. The stitches do not need to be removed as absorbable sutures are used.
4. Exposure to the sun must be avoided during the first month. From then on, and especially in the case of areola scars, they should be exposed to UVA light to disguise them.
5. One month after the procedure the breast is soft and looks good but still has some slight swelling.  The permanent state is reached after 4 to 6 months.

Results:
The results of an augmentation mammoplasty are completely natural and aesthetically perfect if the size and final volume follow those appropriate to the patient’s thorax and physical features.

Complications:
1. The standard complications of any surgery: Infection, hematoma, seroma, etc. Every effort is made to avoid these and they are infrequent, but zero risk does not exist in any type of surgery.
2. Capsular contraction. This is a normal occurrence and only in the event of extreme cases can it be considered a complication that requires treatment. Its incidence rate is less than 1% for cohesive gel implants.

Frequently Asked Questions:
1. Can a mammography be performed after a breast augmentation?
Yes. The physician should be informed that the patient has breast implants. Nevertheless, mammary ultrasounds are more advisable in these cases.

2. Is there a risk of cancer or breast disease?
Absolutely not. Every study ever carried out has shown no risk at all.

3. Can I breast-feed? 
Yes. The implant does not affect the normal functioning of the mammary gland in any way whatsoever. In the event of pregnancy and breast-feeding, the aesthetic changes are those typical to any woman and have no relation with the prosthesis.

4. Is there a loss of sensibility?
No. There may be alterations in sensibility in the first few months, but these can increase or decrease but these are completely transitory since they are due to post-operative inflammation.

5. Will it be noticeable?
Yes. Those closest to you will notice the change, but the important point is that strangers will not notice that those beautiful breasts are the result of an operation. It must be natural and integrate perfectly with each patient's physical structure with the ability to move.

6. Do implants explode?
Absolutely not. It is advisable during the first month to avoid flights of over 6 hours since the cabin pressure can increase inflammation. Implants have been tested at NASA laboratories and they do not explode.

7. Should they be periodically replaced?
No. Mammary implants should be checked once a year but they do not need replacing unless a problem is detected. Manufacturers issue guarantees that cover a certain number of years, but this does not mean that they require replacing.

Prosthesis of cohesive gel (1)
Mamaplasty or breast augmentation continues to be one of the most popular cosmetic surgery procedures in today’s society. This is one of the reasons why the medical industry continues to conduct research studies that aim at developing safer prostheses and longer-lasting results
 
Cohesive gel prostheses are prostheses made of silicone gel (similar to those in use up until recently), with the difference that the gel has physical properties that impede the filtration of the gel into other parts of the body even if the external capsule is torn. Another advantage is that it facilitates the replacement of the prosthesis in the future.
 
There are two types of cohesive gel:
 

Anatomical prostheses
They are called “anatomical” because they resemble the anatomy of the breast. These prostheses were initially developed for breast reconstruction after a mastectomy.
 
One of their main advantages, apart from providing greater safety, is that they provide a more natural look. Mild cases of ptosis (saggy breasts) are resolved with the use of this type of prostheses without having to resort to surgery, which would entail more scars and trauma. There are several models with different dimensions that adapt to the needs of each individual patient.
 
The main disadvantages are: a somewhat harder texture than conventional silicone gel prostheses, their price (40% higher), and the need in many instances of having to insert the prosthesis through an incision in the submammary furrow, instead of the most common route which is through the areola.
 

Round prosthesis of cohesive gel
At present, there are few companies that manufacture this sort of prosthesis. The main advantage they present is that they have the previously mentioned physical characteristics of their gel that prevent the migration of silicone in case of rupture. Unlike anatomical prostheses, this type of prostheses can be implanted through the areola and have a similar price to conventional gel prostheses. The main drawback is a their harder texture.
 

Cohesive gel prostheses (2)
The gel inside newly developed breast prostheses has been treated to ensure maximal safety in case of rupture. The use of cohesive gel opens up a new door to breast augmentation procedures.
 
Breast augmentation continues to be one of the most popular cosmetic procedures by Spanish women. Nonetheless, it is also one of the most debated interventions due to the future consequences derived from the insertion of the prostheses. People still acutely remember the social alarm caused by the release of some information warning about the risks of silicone implants just over a decade ago.
 
The medical industry has not forgotten these facts and this is why its research activities are now more constant than ever before. Scientists continue to study new filling materials that result in safer and more durable prostheses. As a result of this on-going research, a new typology of prosthesis has been launched into the marked, a prosthesis filled with cohesive gel that ensures maximum patient safety in case of rupture with unrivalled results.
 

The same, but different
In practice, cohesive gel prostheses do not differ that much from those currently available in the market and which are characterised by being made of silicone. Unlike silicone prostheses, the gel contained in this type of prosthesis has been treated to present new physical qualities, mainly featured by a consistency that prevents passage of the gel into other body areas in the unlikely event of rupture of the internal capsule). Moreover, the way of presentation of these implants facilitate their replacement in the future without added complications, something which was unthinkable a few years back.
 
Depending on their presentation and the final objective pursued, you can choose between anatomical and round-shaped prostheses. Both offer excellent results and the choice for one or the other will ultimately depend on the surgeon’s assessment and patient preference.
 

Anatomical prostheses
They are called anatomical because they adapt to the normal anatomy of the breast. In fact, these prostheses were originally made for breast reconstruction in mastectomised women. Their main advantage is the very natural appearance they provide. Thus, these prostheses are indicated in mild cases of ptosis (saggy or droppy breasts) without having to resort to more aggressive techniques that might cause scarring.
 
The Spanish market offers a wide variety of anatomical cohesive gel prostheses. At present this type of implant is manufactured in every imaginable shape, so they can be adapted into any anatomical shape or in patients without a breast.
 
One of the disadvantages of this type of implants is their texture to touch, slightly harder than conventional silicone gel prostheses. Some manufacturers are now offering “Soft Touch” lines that minimise these differences. Also, anatomical prostheses cost 40% more than silicone prostheses. In certain types of surgery, implantation of the prosthesis is carried out through an incision performed in the submammary furrow. In these instances, the surgeon must abort the most frequent access route through the areola.
 

Round-shaped prostheses
At present, nearly all prostheses manufacturers offer cohesive gel round prostheses as part of their catalogue. These prostheses combine a series of advantages that are worth mentioning, such as the gel qualities that prevent migration of the silicone in case the prosthesis ruptures. Unlike anatomical prostheses, round cohesive gel prostheses can be implanted through the areola and their cost is 25% higher than conventional gel prostheses.
 

Breast augmentation

Breast augmentation is the second most requested cosmetic procedure in Spain after liposuction.
Breast augmentation (augmentation mamaplasty) has become one of the most popular cosmetic surgery procedures in recent years especially among younger women. It is estimated that last year alone 20,000 pairs of prostheses . were implanted. The ideal woman of the 90´s had feminine and womanly curves and having small breasts was a defect that needed to be corrected. Fortunately, the procedure is becoming less and less complex and prostheses are safer and more durable. Surgery lasts less than an hour and the patient only needs to stop normal activity for three or four days. Breast enhancement is now easier than ever, for as long as the procedure is carried out by skilled surgeons and in fully accredited clinics.
 
"Instituto Médico Láser has been performing augmentation mamaplasties for quite some time. Lately, though, there has been a dramatic increase in the demand of this procedure, and by younger and younger women ", explained Ignacio Sanz, plastic and cosmetic surgeon at Instituto Médico Láser. "The medical industry is constantly studying new safer and more durable prostheses".
 
This simple operation is systematically performed by skilled surgeons . The prosthesis is usually placed behind the retropectoral muscle. Because it hides behind the muscle, both touch and texture are very natural. The prosthesis is inserted through an incision in the lower margin of the areola. The incision is practically invisible after two months. Sensitivity and ability to breastfeed are fully preserved.
 
At present, the prostheses used are made of cohesive gel which is silicone gel, like the ones made some time ago, but with the difference that the gel has been treated to provide specific physical qualities. These qualities prevent the passage of the substance into other parts of the body should a rupture of the capsule occur. Future replacement of the prosthesis is also facilitated.
 
There are two types of cohesive gel prostheses: anatomical and round-shapedprostheses.
 
Anatomical prostheses look more like a normal breast and provide a more natural look to the breasts. There is a wide range of models and shapes to fit the needs of each individual patient. One of the main disadvantages is that they feel harder to touch than conventional silicone gel prostheses and are more costly ( about 40% more expensive )Another drawback is that they need to be inserted through an incision made in the submammary furrow instead of using the most common access route which is through the areola.
 
Round cohesive gel prostheses also present the same physical characteristics as anatomical prostheses, that is, they prevent migration of the substance in case of rupture, but unlike anatomical prostheses, round prostheses can be implanted through the areola and their price is similar to that of conventional prostheses. The only drawback is that they feel harder to touch.