Body Procedures: Breast Augmentation
(Breast Implants or Augmentation Mammoplasty)

The external layer of all breast implants is made of the same material, that is, flexible silicone. This is the material that will be in permanent contact with your body, no matter what kind of implant is chosen. What differs is the kind of filling they have, which could be saline solution or cohesive silicone gel. Each filling has distinctive characteristics. To help you choose better, we offer you a short summary of their respective advantages.

Advantages of saline-filled implants

• If they rupture, the filling is assimilated by the body and eliminated naturally by it. In a matter of hours, it becomes evident that some volume is lost and it is a sign that the implant needs to be replaced.
• If the implant’s filling should happen to leak through the outer layer, it will not lead to capsular contraction because it will be metabolized and eliminated naturally by the body. Today, these microleakages have been reduced to a minimum thanks to the new shells made of several layers.

Advantages of cohesive silicone gel implants

• Cohesive is that which tends to remain whole. This means that, even if the outer layer of an implant were to rupture, the filling will not spill out. It would remain whole as a solid unit, without any division.
• They do not lose their volume as time goes by.
• They do not make sounds as of water moving when you do physical activities.
• They feel natural to the touch.
• In the past, the filling would leak through the micropores of the outer layer and caused capsular contracture. Today, these leakages have been reduced to a minimum thanks to the cohesive properties of the filling and to the new shells made of several layers.
• The use of this kind of implants is allowed in most European, Asian, and American countries, but in the United States it is only allowed for reconstructive purposes or in investigation programs.

Even though the outer layer of all breast implants is made of flexible silicone, we may classify them as smooth or textured, according to its characteristics.

Smooth implants:

• Their surface does not present any kind of roughness.
• Their shell is thinner and, at the same time, very resistant, since it has no unevenness that may give rise to fissures.
• They are looser inside each pocket and are not “stuck” in the body's tissues. This gives them a more natural consistency and allows them to yield to the changes in posture that daily activities require. Since they do not become part of the surrounding tissues, they are not complicated to remove if a removal happens to be necessary.
• Since they are more “slippery”, they are less palpable.
• Since they slide better, they are easier to introduce through the small incisions that the surgeon makes during the surgery.

Textured implants
Their surface is rough and irregular.

They were devised thinking that they would reduce the incidence of capsular contraction. Some surgeons consider that there is not enough scientific evidence to prove that they do reduce it.

Anesthesia
Local anesthesia and sedation, or general anesthesia.

How long will it take?
According to the complexity of each case, it may last between 30 and 120 minutes.

How is breast augmentation surgery performed?
Among the possible places and kinds of incisions, two are the most frequent. They are both about 1.5 inches (4 cm.) long:

a) Periareolar: a semicircular incision that follows the lower outline of the areola (dark area around the nipples).
b) Submammary: on the lower fold of the breasts, where they join the chest.

According to the characteristics of your own body and to the kind of implant chosen, the surgeon determines which of the three incisions is the most adequate for you. Using special instruments, he works through the incisions to make a pocket inside each breast where the implants will be placed. Then he places the implants inside each pocket, using the nipples as reference to place them correctly. He places the drainage tubes and closes the incisions with stitches.

It is important to highlight that the implants will ALWAYS BE PLACED BEHIND the mammary gland, but there are two possible locations:

a) Behind the pectoral muscle: this procedure is more complicated and the recovery period is a bit more painful, but it has the advantage that the muscles prevent the implant’s outline to be noticed through the skin, giving the breasts a more natural look. Placed behind the muscles, the implants interfere less in mammograms.
b) Over the pectoral muscle: this is the most advisable location for women who do intense physical exercise using their arms

How long will I have to stay hospitalized?
When the surgery is done with local anesthesia, no hospitalization is needed. When general anesthesia is used, you will have to stay hospitalized half a day.

What kind of bandages will I need, when will they be removed?
To heal properly, you will have to wear a compression bandage on the treated area for about 24 hours. It is a bit uncomfortable but, unfortunately, it is necessary. A couple of flexible and thin drainage tubes will be placed that will drain off excess fluids from the wounds to an airtight plastic bottle. These drainage tubes will help reduce the incidence of bruises and are removed together with the bandages. During the following week, you will have to wear a sports bra day and night and, for another month, you will have to wear it only during the night.

Will I feel a lot of pain?
Implants placed over the pectoral muscle: mild to moderate.

Implants placed behind the pectoral muscle: moderate to intense.

In both cases, you will be greatly relieved if you take analgesics every 6 or 8 hours.

When will the stitches be removed?
A week after the surgery.

What about swelling and bruises?
No matter the kind or location of the implants, one breast may heal faster than the other and you may notice a temporary asymmetry. The inflammation is at its worst during the first three days, then it lessens progressively during the next three or four weeks. It tends to be greater and to last longer when the implants are placed behind the muscle.

What will the scars look like?
According to the procedure, there could be two different kinds of scars, both of 1.5 inches (4 cm.) long.

a) Periareolar: a curved line following the lower outline of the areola. This scar heals very well. It remains concealed by the outline of the areola and, as time goes by, it becomes very difficult to notice.

b) Submammary: right on the lower fold of the breasts, where they join the chest.

You will have to rest at the hotel for 48 hours. You may probably feel a burning sensation during the first days and discomfort when raising your arms, just as if you had done a lot of push-ups in the gym. From the fourth day onwards, you may go back to your job and to your social life, but be careful not to lift heavy weights. Your surgeon will tell you what kind of bra you may use. You will be able to do physical exercise 30 days after the surgery.

During the recovery period, some people may feel quite depressed. It is quite normal to feel this way after any kind of surgery, no matter how simple it may be. You may even come to think that you made a big mistake. But do not worry. Most of the people who are happy today and who are satisfied with the results obtained, have also felt somewhat depressed.

Every surgery, no matter how simple it may be, has certain risks, and we should not rule them out. However, it is very unlikely for breast augmentation surgery to present any complications when performed by a qualified surgeon.

• Adverse reactions to anesthesia.
• Asymmetry. Even though the surgeon marks the areas he will operate on very carefully, in 1% of the cases there may be asymmetries.
• Infections may develop but, if you take the right antibiotics, they will be less likely to develop. If there is an infection, the implant will have to be removed and will not be replaced unless the infection is completely healed and the scars are fully formed (about 4 months).
• Capsular contracture due to excessive tissue proliferation around the implants. There are three levels of severity and is the most common cause of pain, of changes in shape, of hardening and even changes in sensibility. Many times a second intervention is necessary for treating it.
• In about 3% of the cases, keloids or hypertrophic scars may develop, according to the genetic traits of the patient.
• Temporary alteration of the nipple’s sensibility. The nipples may become more sensible, less sensible or may feel differently. These changes are never permanent.
• The implants may puncture or rupture if a violent pressure is applied or if they are hit strongly; if this happens, the implant must be replaced. When this happens to saline implants, they lose their volume very quickly and it is very easy to notice. Those with cohesive silicone gel, however, do not lose their volume, since the gel does not leak outside the pocket in which the implant is placed. This is why it is very important to check the implants often with magnetic resonances. The FDA of the United States recommends a first control 5 years after the surgery, and then every one or two years.
  The implants used by T-Change have replacement warranty from their manufacturers: http://www.mentorcorp.com/index-aesthetics.htm

The results of this procedure are permanent. Your new breasts will remain with you for many years without losing their attractive shape and firmness. You will quickly learn to choose new styles of clothing that will allow you to dress them the way you like best.
Even though it is the procedure with the highest satisfaction rate of all plastic surgery procedures, it is good to know that it can be reversible. If you do not get the results you expected, the implants can be removed or replaced by others of a different size.