Mammoplasty augmentation is a plastic surgery more commonly known as breast augmentation. More often, young and even very young women feel the need to increase their breasts as they feel they are too small compared to the rest of their body or because they are asymmetrical. Mammary hypoplasia or a severe asymmetry often causes embarrassment or discomfort. This may cause a woman to not accept her body and put at risk social relationships, especially with men. The shape and dimensions of the breast are influenced by many factors – genetic, hormonal, pregnancy, breast-feeding and body weight – and may change over the years. Adult women more often undergo this surgery after pregnancies and prolonged breast-feeding that have led to an involutional atrophy of the mammary gland. In these cases, after breastfeeding is over, the skin is relaxed and not tense and the breasts seem empty, saggy and not turgid.
Why undergo this surgery?
The materials used for breast implants have changed a lot over the years. Nowadays, top quality implants are in silicone with a more resistant external textured cover containing a more or less cohesive gel. For patients with a previous capsular contraction, we sometimes use implants covered in polyurethane. The bigger or smaller size and projection depends on each case and is generally established before the surgery in order to give the breast a more natural look, as suitable as possible to the patient’s physical structure.
What needs to be done before surgery?
Speaking to the plastic surgeon before surgery helps eliminate doubts and perplexities and understand exactly how the surgery will be done and all options suitable for one’s case. In order to achieve the best result, all possible variables to the surgery procedure will be taken into account depending on the patient’s physical characteristics and needs. The consultation is non-binding and gives one the possibility to have all the information regarding the surgical and post-surgery programme, the medicine to take, analyses and check-ups to do and costs.
How is the surgery performed?
The positioning of the implants depends on the characteristics of the breast and the desired target. There are three possible alternatives: - Breast augmentation and implant positioning behind the gland, suitable for patients with good skin and gland coverage; - Breast augmentation and implant positioning behind the muscle, suitable for patients without good skin and/or gland coverage; - Breast augmentation with dual plane positioning, suitable for patients with a light or moderate skin relaxation. The surgery is done under general anaesthesia and lasts about 90 minutes. The implant - depending on the type, size and position site established before the surgery - is inserted through an incision of 2.5 to 6 cm made along the sub-mammary groove or along the lower peri-areolar margin to make the scar as small and less visible as possible. After the incision, a subcutaneous or submuscular pocket is created to insert the implant. Once the implant is inserted, the skin is sutured using a technique to make the scar not too evident. Finally, a compressive dressing is placed, which will then be replaced by a sport bra. Hospitalization lasts one day. The surgery does not involve the mammary gland, thus it preserves its function and allows normal breast-feeding.
What happens after the operation?
The compressive dressing is removed after about 5 days from the surgery and replaced with a sports bra that must be worn for about 30 days. The stitches are removed after about two weeks. During the first days after surgery, absolute rest and limited movements are advised, especially for the upper limbs. Swelling, stiffness and light breast pain are normal in the initial period after the surgery. Return to work occurs after 7-10 days, whilst return to sport is after about 30 days.
Patients normally suffer pain, swelling, reddening and bruises in the treated area during the first days following the surgery. Post-surgery issues can be kept under control using normal painkillers or anti-inflammatory drugs.
Scars are about 4-7 cm long and not very visible. They are located in the mammary groove and at periareolar level.
A good outcome of the surgery depends on many factors: the patient’s initial clinical conditions, her healing capacity and compliance with the doctor’s post-surgical indication, namely avoid inappropriate movements or sun exposure until complete healing of the scars. The final profile will be achieved after about one year, but the outcome and benefits will be immediate.
What are the possible risks?
Rare although possible risks are hematomas, bleeding, infection, late healing of the surgery wound, hypertrophic healing, change in skin sensitivity. The complications linked to the implant are capsule contraction and implant rupture. The cause of these issues is still not really clear and many studies are being made on the matter. Capsular contracture – i.e. the formation of an excessively rigid periprosthetic capsule that dislocates the implant and causes breast asymmetry - is quite common and predictable. There are different levels of contracture; their treatment is established depending on the level of severity. In the most serious cases, a new surgery and a possible capsulectomy and implant replacement may be required. The use of appropriate new generation devices and high quality implants greatly reduces the incidence of this complication. Implant rupture is rare; it causes pain and breast asymmetry and requires new surgery with the cleaning of the site and implant replacement.