Breast augmentation: What Is It, | Risks, Results, Options and Cost

Introduction

Breast augmentation is the most requested cosmetic surgery carried out in our country. According to the ISAPS, in 2016 more than 42,000 breast augmentation surgeries were performed in Spain.

What is breast augmentation?

Augmentation mammoplasty is cosmetic surgery performed to improve the size and shape of a woman’s breast. The main reasons that lead a patient to have surgery are the following:

• Breasts too small for your silhouette
• Breasts that have been left empty or sagging after pregnancy and breastfeeding
• Breasts that are different sizes
• Reconstructions after breast surgery

When performing this operation, the most important thing is to choose the size of the prosthesis and the type of surgery to be performed. The key to achieving a natural result is choosing a size and shape that is in harmony with the rest of the woman’s figure.

Currently, there are different techniques to perform breast augmentation:

• With silicone breast implants
• With saline breast implants
• By fat transfer

This surgery is within the group of breast surgeries with other related treatments such as:

• Elevation
• Reconstruction
• Reduction

How do I know if I am a candidate?

To perform this surgery, you must be close to your ideal and stable weight. That is, losing weight of more than 5-8 kg can lead to cosmetic changes in the chest after the intervention. In addition, to undergo breast surgery you must be healthy both physically and mentally.

If you have a heart condition, lung condition, or neurological disorder, you should discuss this with your surgeon as you may not be able to operate.

It depends on the technique to be used, nowadays it is possible to do breast augmentation surgery and develop future breastfeeding in a normal way.

Tobacco is not recommended before or after surgery as nicotine impairs wound healing and healing. Therefore, if you are a smoker, you should quit for at least 6 weeks before and after your surgery.

How do I choose my surgeon?

It is very important to choose an experienced plastic surgeon to ensure the success of the cosmetic operation. In Spain, only SECURE-certified plastic surgeons are trained and endorsed to offer breast augmentation. You should check their credentials and their studies. We also recommend having different appointments before choosing your surgeon to compare and solve all the doubts that may arise about the intervention, the pre, and post-surgery.

The recommends reviewing the following aspects before choosing a surgeon :

1. Check your studies and experience, make sure it’s the plastic surgeon specialty official title. To do this, check the page of the Spanish Society of Aesthetic and Reconstructive Plastic Surgery.

2. Check that its facilities are correct, as it is surgery, it must be performed in an operating room and it must have the necessary resources to attend to any possible emergency (ICU).

3. Make sure that it is the medical specialist who attends you from the first consultation, and not a salesperson since you must always be explored by a doctor.

What is the first appointment with the surgeon like?

The first appointment with your surgeon is very important because normally, fundamentals will discuss e l chest you want to have and how will the operation be. For this reason, during this visit, the surgeon will examine the current size of your breasts as well as the shape they have.

Another point that the professional will have to evaluate will be the firmness of the skin, which may vary depending on the age of the patient and her conditions. After this exploration of the breasts, the surgeon will probably order a mammogram to see in more detail the condition of the breasts and rule out any possible complications.

In this appointment, the surgeon will also detail what techniques exist so that you have as much information as possible about each one. Another important point that you should consider with him is the size and shape of your future breasts. Depending on these and other factors, the specialist will recommend one technique or another.

As in any cosmetic operation, you must talk to your surgeon about expectations as they must be realistic. Ask all your questions and ask for photos of their results. For its part, it should warn you of the risks and possible complications of the operation.

Some surgeons prefer that patients stay in the hospital after surgery. In this appointment, take the opportunity to ask if you will have to stay one night at the clinic, what anesthesia you are going to use, and the total price of the surgery.

The plastic surgeon will also ask you if you are a smoker or are taking any medications since they can affect the surgery and the postoperative period.

Types of implants or breast prostheses

Breast augmentation can be done with implants or by fat transfer. Breast implants exist in saline and silicone varieties, as well as many sizes, shapes, and textures.

• The saline implants are made of physiological saline composed of water and salt that is used as a filler in the breast prosthesis. In case the implant leaks, the body will absorb the saline solution and eliminate it naturally.
• Silicone implants contain a stretchy gel that can look more like natural breast tissue. When placing them, the surgeon may need a longer incision. The patient will surely need regular check-ups because, in case of leakage, the silicone is not absorbed naturally.
• Cohesive gel implants are made from silicone gel that is thicker than traditional silicone. They generally hold their shape better but require a longer incision in return.
• B-Lite implants are innovative prostheses considered the lightest in the world. It is a cohesive gel silicone prosthesis but up to 30% lighter than the traditional one.

Techniques

Breast implants can be saline or silicone. In addition, they can have different sizes, shapes, and textures. The implants can be placed above, below, or in a mid-position of the pectoral muscle, depending on the area where the incision is made. Doctor Dr. Martín del Yerro specifies each placement below:

• Subglandular: In this position, the breast prosthesis is placed under the mammary gland, so there is direct contact between the prosthesis and the glandular tissue on its anterior face. Therefore, below the prosthesis is the pectoral muscle.
• Submuscular: In the subpectoral or submuscular position, the implant is placed below the pectoral muscle. A partial detachment of the muscle is performed at the bottom to prevent muscle contraction from displacing the muscle upward.
• Dual Plane: It consists of combining the advantages of the sub-glandular plane and those of the submuscular, leaving the prosthesis covered in its upper part by the muscle (submuscular) and uncovered (sub-glandular position) in its lower part.

Fat transfer consists of collecting fat cells from one area of the body, commonly the abdomen, hips, or thighs, and injecting them into another to achieve more volume in the area. Fat is removed from the body by liposuction, processed and purified with a centrifugation process, and injected, for example, into the breasts. The biggest drawback of this technique is that up to 50% of the injected fat is reabsorbed in the first months.

According to a study of 105 patients, “if the volume of the transplanted fat in the breast is less than 150 ml on each side, the result of the increase is less obvious. Therefore, in our opinion, the transfer of Autologous fat for breast augmentation is not suitable for thin women who do not have enough fat deposits. ”

How to choose the correct size?

Breast implants and fat used for fat transfer are measured in cubic centimeters (CCs). Keep in mind that the same implant size or amount of fat will look different in each person. It is important to discuss your expectations and desired results with your surgeon to help you decide what will be most correct for you and the final breast size that will fit you. Many physicians use digital imaging software as a way to see what the breasts will look like with different levels of CCs. Another option to check the size of the prostheses is to try on a bra with them to get a rough idea of the volume and see different examples.

recommends that if you like two sizes, choose the larger of the two. In addition, he mentions that the breast always falls somewhat and the viewers end up getting used to it. Furthermore, he insists on the enormous benefit of 3D simulations before implant choice. Since each woman is different (previous breast size, height, weight, thoracic contour, etc …), 3D simulation is the only way to check how a specific prosthesis shape and size would look on your own body.

What is the implant profile and projection and why is it so important?

The projection of the implant will determine the sensation of size as well as its naturalness. This will be added to the one you already have before surgery, so that the same projections may be different in different women.

The degree to which your future breast will come out of the thorax will be known as projection. The profiles or projections are measured according to their grade and there are normally 3 or 4 types for each prosthesis. Surgeons usually use the medium (very subtle), high (the most used), or extra-high (for more exuberant results) profile.

You should consider that if you choose a higher profile you will have the feeling of a larger breast. This is because it projects more outwards and therefore, it is more attractive. Typically, surgeons advise barely-breast girls to place high or extra high projections.

What type of prosthesis to choose: round or anatomical?

This question is one of the most frequent among women who want to do a breast augmentation. The  explains the differences:

• Round prostheses: These are implants that have the same shape above and below. They have the advantage that they fill the neckline more in the upper part in patients looking for a “push-up” type result and the disadvantage that, since no natural breast is completely round, it can seem somewhat more “operated”, although it depends a lot on the type of patient and the size being used. In many patients, round dentures look excellent and very natural.
• Anatomical prostheses: They mimic a normal chest “drop shape”. The main advantage is that the shape is more natural. In many cases, the result is indistinguishable from an unoperated breast. The biggest drawback is that, although it is not the general norm, some patients may undergo implant rotation and have to undergo surgery again.

It is important that above all, the result is natural and by the physical characteristics of the patient. For this reason, the surgeon will be the one who will best tell you what type of prosthesis is best for you and for the results you want to obtain.

According to a summary published in January 2020, “The choice between anatomical and round implants is an important decision in breast augmentation surgery. When both types are an option, anatomical ones can offer greater flexibility and are associated with positive long-term results and high levels of patient satisfaction. ”

Breast implant textures

If we classify breast implants according to their surface, they can be smooth, nano-textured, micro-textured, or micro-textured. When it comes to a smooth implant, its surface is completely smooth. On the other hand, in the case of textured implants, the surface is more or less rough.

• Smooth implants: These implants move more since being smooth, they adhere less to the surrounding tissues. They are usually softer than textured ones and generally cheaper. It should be noted that these implants have a greater risk of capsular contracture if they are placed above the muscle. Encapsulation occurs when scar tissue around the implant grows and therefore presses on the implant. This causes the chest to become hard and a prosthesis change is needed. The second disadvantage and perhaps the most important one of smooth prostheses are that they tend to move a lot in the first months after surgery, which is why it is much more common to find implants that are badly placed (too low, too high, or that move towards the sides) than for textured implants.
• Textured implants: As they have a rougher surface, they adhere better to the surrounding tissue and there is less risk of capsular contracture, although the latter is debated among plastic surgeons. Perhaps the greatest advantage of an implant having some texturing is that it tends to move less and adverse events from misplaced prostheses are rarer. These implants are usually more expensive than smooth ones.

It is important to speak with the surgeon to explain the advantages and disadvantages of each implant and agree on the most appropriate.

Most used implant brands in Spain

The brands of breast prostheses that comply with the European CE quality directive, that is, that are considered the highest quality on the market are

• Polytech – Germania (CE)
• Mentor (J&J) – USA (CE-FDA)
• Allergan – USA (CE-FDA)
• Eurosilicone (GCA) – France (CE)
• Nagor (GCA) – Ireland
• Sebbin – France (CE)
• B-Lite (Polytech) – Germany (CE)
• Motiva – Costa Rica (CE)

For a prosthesis to be selected among the best on the market, it must meet several of these requirements:

• Have extensive experience in the market
• Have proven quality over the years
• Not present serious complications throughout its use
• Pass studies and quality tests by neutral and approved laboratories
• Comply with the quality and safety directive of your place of origin or your place of manufacture and sale
• Provide a warranty and after-sales service
• Offer information about the product and its range on the internet or in informative catalogs

Types of incisions

The surgeon can make different incisions when placing the breast prosthesis. The patient must know which incision she will use in her case and the advantages and disadvantages of each one. Generally, the surgeon will recommend the best one for each case.

• Submammary incision: It is performed in most operations and leaves a hidden scar as it remains between the fold that joins the breast with the thorax. It has the advantage that the nipple and gland are not touched for placement, so there is less risk of future problems with nipple sensitivity or breastfeeding.
• Areolar incision: In this case, the scars are hidden around the areola, in the color change. For its placement, we will have to cut part of the gland. It has the advantage that in some cases of complex breasts, entering through the areola allows it to change shape (reduce its size or eliminate tuberosity).
• Axillary incision: Surgeons make an incision in the armpit of about 4 centimeters to be able to place the breast implants. Normally, it is practiced when they have to work with round prostheses. The great advantage of this technique is that it does not leave any scars on the breasts but the armpit. Sometimes this placement can cause an asymmetry between the breasts and some studies to indicate an increased risk of infection.
• Transumbilical: This is the least used surgery since it consists of making an incision through the navel to place the implants.

How is the day before and the day of the surgery?

During the different appointments, the surgeon will give you all the information regarding the preparations for the surgery. In the hours before the operation, it will tell you what foods and liquids you can eat and when. Remember that if you are a smoker, you must quit 6 weeks before. If you take any medication, the surgeon will tell you if it can affect the operation or the postoperative period and therefore, you should stop it.

We recommend that on the day of surgery you are accompanied by a family member or friend. In addition, it will be good for you to have someone help you, especially during the first days after the intervention.

Breast augmentation surgery generally lasts between one and three hours. After you arrive at the hospital or operating room, the anesthetist will administer the anesthesia. General anesthesia is the most common.

After the procedure is complete, you will be taken to a recovery area for a short period of observation. Admission during the night is recommended with a view to greater security in the immediate postoperative period and better recovery the days after.

How long is the recovery?

In the hours and days following the intervention, it is normal to notice discomfort in the breasts, that they are swollen and that bruises appear in the treated area. Also, the area can be very sensitive. After 48 hours, body temperature may increase and small bleeding may occur.

In the first week, it is best not to raise your arms and keep them practically close to your body. During the first month, the patient should sleep on her back, and afterward, she can begin to sleep on her side. Sleeping on your stomach is not recommended for three months.

Remember that you must follow all the recommendations that the surgeon indicates for the postoperative period. To promote proper healing after breast augmentation, IML recommends:

• Take all the medication that the plastic surgeon has prescribed
• During the 15 days after the operation do not take anticoagulants
• Do not make a physical effort and try not to move your arms a lot
• Wear the bandages and post-surgical bra for as long as the surgeon indicates
• Do not smoke or drink alcohol
• Do not touch or remove the dressings
• Sleeping in a position that is on your back
• Caring for scars with products that help heal, such as rosehip oil or silicone patches.

One month after the operation, you can start doing sports, and gentle exercises that do not involve using your arms. In addition, special care must be taken with the sun since the breasts should not be exposed to the sun in the six weeks following the operation.

In about three months the recovery is complete and the patient can already carry out all the activities she did before the surgery.

How long do results last?

In most cases, breast augmentation results last for a long time. However, it is important to check the condition of the implants regularly. Those with saline implants can check their status simply by looking in the mirror. The leak will be obvious as a ruptured implant will deflate and the saline solution will be absorbed into the body. In the case of silicone prostheses, the recommendation is to perform periodic ultrasound and/or magnetic resonance imaging to assess their condition, especially after 10 years.

If you choose to have the fat transfer, you may lose some volume over time. Your breasts can also change due to pregnancy, weight fluctuations, hormonal factors, or aging.

What are the possible side effects?

When performed by an experienced plastic surgeon, breast augmentation has a high success rate. However, like any surgery, it is not risk-free. Possible side effects include infection, bleeding, bruising, scarring, capsular contracture, implant rupture, adverse reaction to anesthesia, and unsatisfactory results that may require additional surgery.

The most common complications after breast augmentation are:

• Capsular contracture: It is the most common complication. It seems that it is more associated with some factors: smooth implants in the glandular position, use of drains, approach through dirtier routes, etc … In these cases, the breast becomes hard, and sometimes, it will be necessary to change the prosthesis to avoid future complications.
• Hematoma: It occurs when there is accumulated blood. In some cases, a second operation may be necessary to be able to remove it completely.
• Infection: In rare cases, during the first weeks an infection occurs just around the breast prosthesis.
• Sensitivity changes in the nipples: Some women comment that they notice their nipples are more or less sensitive. In some cases, sensation may even be lost. It should be noted that these changes are not usually permanent and after a while, the sensitivity will return to the same as before in most of them.
• Prosthesis breakage: It is possible that, over time, the prostheses break and the liquid inside them comes out. Sometimes this can occur asymptomatically, so it is important to do routine checks. In these cases of rupture, it is important to go to the surgeon to be able to remove the affected prosthesis and place a new one.

Currently, there is no proven scientific evidence on the relationship between breast implants and breast cancer. It should also be taken into account that breast prostheses do not prevent mammograms or control ultrasound.

Results

Patients are usually very happy with the results obtained. In addition, thanks to the regular reviews that will be carried out with the plastic surgeon, it will be possible to see the evolution and observe if there are any complications. If it corresponds to the age of the patient, mammograms will also be performed to detect any possible abnormalities in time.

Sometimes, some women request another operation because they are not satisfied with the result. After all, the breasts are too small or large. To ensure that the size of your breasts is what you imagined, it is important not to have doubts about the type of implants that the surgeon is going to place and the CCs (375cc, 400cc, 500cc, etc). These points are the ones that most often concern patients before the operation.

Is there a risk of lymphoma?

To date, a firm causal relationship between breast implants and the very rare occurrence of a lymphoproliferative disorder called BIA-ALCL (anaplastic large cell lymphoma) cannot be established, but there appears to be a statistical relationship between implant carriers (especially macro textured) and lymphoma. Fortunately, it is a very rare complication and one that in most patients has a favorable prognosis.

The SEC monitors the BIA-ALCL and compiles and analyzes the studies that are published.

Frequent questions

• Does the prosthesis have a lifetime guarantee? “Currently the most reliable commercial houses offer a lifetime anti-breakage guarantee but it is misleading to tell our patients that their prostheses will surely last a lifetime.” mentions
• Should I wait to have a breast augmentation until after I have children? The states that ” It is obvious that pregnancy and lactation are likely to affect the breast, whether it is already carrying prosthesis as if it is not due to hormonal changes, increased size and weight”
• How will my scarring be? IML that “the aesthetic quality of the scars depends on the approach used for the implantation of the breast prosthesis. In any case, in a year, the incisions for breast implantation, with few exceptions, are very little perceptible. “
• When can I expose myself to the sun? According to the recommendations of the AECEP (Spanish Association of Aesthetic Plastic Surgery), the sun is the natural enemy of recent scars, since it can be the cause of them becoming pigmented and therefore more visible. It is important to keep scars out of the sun for the first year and not to expose them later without adequate sun protection.
• When can I have sex after breast augmentation? states that “after a breast augmentation intervention, it is advisable to wait at least 48 hours before having sexual intercourse. What is important is that they do not touch or press their breasts, so hastily. In the first weeks, you may have tender nipples, but that will disappear with time. After about 6 or 7 weeks, you will be able to resume your sexual routine touching the breasts as you wish, as long as you do not feel pain. “
• What type of bra should be used after the operation? La emphasizes that “for the immediate postoperative place a special bra in our clinic we provide to all our patients. This bra is recommended to take 2 to 4 weeks, depending on the evolution of each patient’s normal.”
• Does it make it difficult for breast exams or the detection and treatment of a breast tumor in the future? “ Breast prostheses are perfectly safe for all women and it is not considered that they make the diagnosis or treatment of any breast process difficult.”
• Is it necessary to use drains? La  says that “the techniques have evolved enough for that day we now able to perform virtually all breast surgeries without drains.”