1.Does breast augmentation leave scars?
Every surgery leaves scars on our body, but some are smaller and more hidden. This is the case of breast prosthesis surgery, in which the scars are well hidden and small and of good quality. The size of this scar is smaller and smaller in breast surgery, measuring between 3 and 4 cm.
2. Where are the scars of surgery located?
There are three possible sites for the scar in augmentation mammoplasty. It can be located in the groove formed between the breast and chest, at the outer and lower limit of the areola or even in the armpit. Each scar has advantages and disadvantages that must be fully explained by the surgeon at the consultation.
3. How to know if I will develop very visible scars, forming keloids?
The tendency to develop hypertrophic or keloid scars is greatly influenced by genetic factors. In general, fair-skinned people are less prone to this healing complication, whereas dark-skinned or oriental people are more prone to keloid or hypertrophic scarring. This trend, however, is not an absolute rule, as background analysis facilitates prognosis, but does not define it. The genetic tendency will influence the scar regardless of location, either in the breast or underarm.
4. Is there correction for unsightly breast scars?
Today, plastic surgery has several features that not only improve such scars, but also prevent their appearance. Corticoid-based ointments and injections at the scar site and small compressive silicone plaques are the main treatment that will be instituted by the surgeon at the appropriate time. It is worth remembering that keloids or hypertrophic scars should not be confused with the normal course of a scar, which maintains a reddish appearance for the first 2 months and gradually improves over time and that doubts about its scar should be clarified by the surgeon and not by third parties.
5. I’ve heard that there are numerous size of prostheses. Can I choose the size and shape I want?
Patients differ greatly in breast size, shape, consistency and symmetry. So it's not because a friend or a well-known actress has put on a prosthesis of a certain shape and size that you can necessarily put on the same prosthesis. A 275 ml breast implant may be ideal for a 1.65m patient, but may be large for another 1.50 patient with a thin, narrow chest biotype. After a thorough physical examination, performed with various measurements of the breast and chest, the surgeon will indicate the most appropriate shape and size of prosthesis to be used on you, allowing a pleasing result proportional to your body.
6. Can you choose the size of my prosthesis based only on my weight and height?
Certainly not, as there are many variables used to calculate the ideal prosthesis in each patient. In addition to the patient's weight and height, we take into account the size of the chest, the elasticity of the breast skin, the distance between the breasts, the current breast size, and the patient's expectation of enlargement. All these measurements are calculated on a thorough physical examination performed during the medical appointment. So if your friend is 1.65m tall, 55kg tall and is very pleased with a 275ml breast implant, this size may not be right for you. This demonstrates that nothing replaces a detailed physical examination and a well-made medical consultation for the final decision on prosthesis size.
7. Talking about size and consistency, how will my breasts look after after surgery?
The breasts will certainly have increased volume after breast implant surgery. Another goal of surgery is to improve their shape and consistency. Today we have more than ten different types of breast implant formats and a wide range of sizes. Another variation is regarding the type of material on the surface of the prosthesis (smooth or textured) and the inner coating of the prosthesis (polyurethane foam or highly cohesive silicone). There are indications for each of these types, which will be explained by the surgeon during the consultation. What must be preserved, however, is the harmony between the size of the chest, the height of the patient and the optimal volume of the breasts. As for consistency, the breast prosthesis is larger than that of normal breast tissue, so patients with a small mammary gland (called hypomastia) will have an increased consistency of their breasts after breast implant surgery.
8. Can my breast prosthesis burst?
Breast prostheses have been around for over 30 years and have evolved a lot in recent years, making today's prostheses much more resilient and distensible than early models. Thus, a chest trauma to burst them would have to be strong enough to break ribs and cause lung damage. If this happens, most of the time, the manufacturer provides another prosthesis to the patient at no cost and the implant replacement surgery can be performed by the same previous scar.
9. If I get pregnant, will the result remain or may be impaired?
Maintaining the outcome depends on a number of factors. Certainly one of the main aspects is weight gain obtained during pregnancy. Exaggerated weight gain during pregnancy (over 15 kg) will cause distension of the breast skin and after weight loss this skin may or may not return to its previous appearance. Lactation (breastfeeding) also assists in this breast distension. If the breast skin does not return to its original appearance, ptosis (fall) of the breasts may occur to a greater or lesser extent, depending on the distension to which the skin has been subjected. The surgeon's guidance in a future pregnancy comes with the proper nutritional follow-up that allows you to gain just enough weight during pregnancy (an average of 7 to 10kg) and to follow routine care of your breast skin using specific moisturizers and creams. Prevent stretch marks and maintain normal skin consistency. As for the breast prosthesis, there is no change in shape and consistency with pregnancy or breastfeeding.
10. May breast prosthesis interfere with breastfeeding?
Usually not. The breast implant can be placed below the muscle or just below the mammary gland and in both situations there is no interference with breast growth during pregnancy and breastfeeding. What may occur is a slight decrease in lactation efficiency in areola scar surgeries, since in this situation some breast ducts are injured to allow the placement of the prosthesis. However, even with this scar there is hardly a significant decrease that prevents lactation in a future pregnancy.
11. When will I reach the definitive result after surgery? Does the swelling takes too long to regress?
The immediate result of augmentation mammoplasty is very good, however only in the late period (after about 6 months) the breasts reach their definitive form with the regression of all operative swelling. Most of the edema (about 90%) subsides about 2 months after breast implant surgery. Regression of edema leaves the breasts looking more natural and beautiful, and the result of the surgery progressively improves until the sixth postoperative month.
12. Is the postoperative breast surgery painful?
Not in general. Following medical advice, especially with regard to restriction of arm movement in the first two weeks, the postoperative pain of breast implant surgery is very mild and easily subsides with common painkillers. However, it is important to emphasize that there are variations between patients and surgeries, for example, the breast implant placed below the muscle is a little more painful than the one above.
13. Does breast sensitivity change after breast augmentation surgery?
There may be slight decrease in breast sensitivity after surgery, but it is temporary and tends to regress to normal within a period of up to 6 months. However, there are individual variations between patients and this decrease may not happen or may be a bit more pronounced in some cases.
14. What type of anesthesia is used?
In the great majority of cases epidural anesthesia, in some cases general anesthesia. The indications of anesthesia, their advantages and disadvantages will be specified by the anesthetist in the appointments before surgery.
15. How long does the surgery take?
The average duration of surgery is 90 minutes. Variations in this time may occur depending on each case, however the duration of surgery hardly exceeds the period of 120 minutes.
16. How long will I be hospitalized?
Usually for 24 hours regardless of the type of anesthesia used. In some situations, less than 24 hours, such as morning and afternoon patients, may be discharged.
17. Are drains used in breast prosthesis surgery?
It is common to use a small drain that stays inside the breasts for an average period of 24 hours, usually removed before hospital discharge. The drain is important to prevent accumulation of blood and secretions inside the breast, reducing the incidence of complications in surgery and helping in the regression of postoperative edema.
18. When will I be able to work out?
Lighter walks can be performed after 3 weeks of surgery. Running and cycling, just one month after surgery and weight training, 2 months later. These periods are average and so it is important to ask your surgeon if you are qualified to perform any kind of physical activity before doing so.
19. When will I be able to drive?
If the car has power steering, 3 weeks after the surgery you are already able to drive it. In cars with normal steering, excessive effort to turn the steering wheel can force the scar and cause detachment of the prosthesis. Therefore, the recommended would be to drive again after 1 month. Driving motorcycles and bikes is allowed 1 month after surgery, provided that with the use of the surgical bra and a certain caution when driving.
20. What is the best location for my prosthesis: in front or behind the muscle?
It depends on each patient. There are indications for placing the prosthesis in front of or behind the muscle and these should be discussed during the consultation. In general, when the prostheses are located in front of the muscle, the result tends to be more natural, with better aesthetic appearance. However, in very thin patients with very thin skin or very small amount of breast tissue, the location behind the muscle is more appropriate as it protects the prosthesis, preventing it from being superficial and palpable in the breasts. The best location will depend on the appearance of your breasts and should be discussed with the plastic surgeon during the consultation.
21.How long will I have to wear the surgical bra (mesh)? And when can I sunbathe again?
It is recommended that the surgical bra is worn for at least 1 month after surgery, as it decreases breast swelling and protects scars, which is not the case with conventional rimmed bras. In the 2nd month it is allowed to alternate periods using the surgical bra and rimless bras, as well as short periods without using the bra, depending on the surgeon's assessment.
As for the sun, the ideal is to protect the patient for at least 3 months. During this period, the mammary scar still preserves a local redness, which is fully expected and regresses spontaneously as it matures. If the patient exposes himself to the sun without adequate sun protection, the scar may appear darker (hyperchromy) and will not have a pleasant aesthetic result. Even after the 3rd month, the ideal is that the patient applies sunscreen factor 50 to the scar site whenever sunbathing, because even hidden by the bathing suit there is the action of sun rays on the breast scar.
22. What is the retraction of the breast prosthesis (contracture) capsule that occurs in some patients?
It is an exaggerated retraction of the fibrous capsule (internal scar) that forms around the prosthesis, determining different degrees of hardening to the region when touched, better known as “prosthesis rejection”. Some cases may be retracted with varying degrees of breast pain and if this occurs the prostheses may be removed and replaced. Subsequently, surgeon and patient may consider whether or not to reintroduce other prostheses with a different introduction plan or other approach that best suits the case. The retraction of the capsule does not reflect a surgical problem, but rather an exacerbated reaction behavior of the body due to the presence of silicone prostheses. However, currently the quality of new silicone prostheses greatly decreases the incidence of these retractions in patients. Its occurrence is around 3% of cases. Lay people often call the capsule contracture "rejection," but augmentation mammoplasty does not produce true rejection, after all silicone is inert and does not lead to antibody production.
23. Will I need to change my prostheses after some years?
This is certainly one of the main questions of patients in breast surgery. In the past, breast implants had a much lower quality material, being the surface of the prosthesis coarser and subjecting the body to greater risks of unsatisfactory results, such as capsular retraction. Invariably, after 7-8 years, the prostheses lost their original shape and size, needing to be replaced. Nowadays, with the advancement of Medicine and Plastic Surgery, we have higher quality breast implants, with lower risks of complications. Some manufacturers report that after 12-15 years the prostheses may have change in their shape, however daily practice shows that the last generations of prostheses remain, in most cases, more than 15 years without major changes. In short, after 12-15 years, prostheses are more likely to change shape, which may or may not happen depending on each patient. What happens is that after about 15 years the breast naturally undergoes changes with the aging of the patient and shows a decrease in its volume, sagging skin. Thus, even with the breast prosthesis without change in its shape or size, the patient often chooses to change it in an attempt to reverse the changes caused by time.
24. When will the stitches be removed?
In the vast majority of cases, the patient has no external point, only internal points followed by the application of a surgical glue (Dermabond) to the skin. This glue, besides improving the aesthetic aspect of the scar, allows a waterproofing of the scar, reducing bleeding and the risk of infection after surgery. If surgery is performed by the areola, some points may be given externally and removed after the 5th day of surgery.
25. Breast augmentation corrects breast sagging?
The breast prosthesis increases the volume of the breast and, consequently, promotes some distension in the breast. In cases of small excess skin, the breast prosthesis allows the correction of this slight sagging. However, in cases of great sagging and sagging breast (ptosis) it is necessary to remove skin and reposition the breast in its anterior location (mastopexy), and may or may not be associated with the placement of a breast implant to increase breast volume, allowing greater consistency to the breasts.
26. Can I associate another plastic with the breast prosthesis?
Yes. It is extremely common to associate other surgeries with breast surgery, especially liposuction. Other very frequent associations are with rhinoplasty and abdominoplasty. Any association should be questioned with the surgeon, and the possibility of associating more than two surgeries is not usually recommended, because excessive duration can bring more harm than benefit to patients.
27. Is there rejection for breast prosthesis?
There is no rejection to the breast prosthesis. Medical rejection occurs when antibodies are formed against cells transplanted from a different living being (for example, in a liver transplant). Silicone, being inert, does not cause antibody formation and is not rejected. What is commonly called breast prosthesis rejection actually corresponds to the contracture of the breast capsule formed around the prosthesis.
28. Are there risks on the augmentation mammoplasty?
Serious complications rarely occur in breast augmentation. This is due to the adequate preparation of the patients, as well as the analysis of whether or not this surgery should be associated with others. The risks of breast implant surgery are those inherent in any other surgical procedure (bleeding, infection, unsightly scarring) and some specific risks, such as breast capsule contracture. However, choosing a good professional, Member of the Brazilian Society of Plastic Surgery, and choosing an appropriate and well-equipped hospital or clinic for the surgical procedure helps minimize such risks.