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Dr. Júlio Stédile, M.D.

Facial Plastic Surgery

Facial Plastic Surgery
&
Otorhinolaringology

Breast Augmentation

BREAST PROSTHESIS

Breast augmentation surgery is performed when one wants to increase the size of the breast. During the surgery, we can carry out a mastopexy, which is a procedure to lift the breast, correcting ptosis by removing the excess skin. The silicone prosthesis can be implanted through three different accesses: periareolar, submammary groove and axilla, being placed right behind the mammary gland or behind the pectoral muscle. Currently, its replacement is not obligatory. The choice of the prosthesis size and model must be associated to the biotype and desire of every patient.

  • Anesthesia: General, peridural or local with sedation.
  • Surgery time: 1-2 hours (breast augmentation).
  • Surgery time: up to 4.5 hours (breast augmentation + mastopexy)
  • Hospitalization: from 12 to 24 hours.

FREQUENTLY ASKED QUESTIONS:

1) Does Breast Augmentation leave scars? Where?
Every surgery leaves scars. In breast augmentation surgery it is typically small and its location is hidden, making it discreet. The scar size for the placement of the breast prosthesis is as small as possible, usually measuring 4 cm (depending on the prosthesis size and material). The scar depends on the access chosen for placing the prosthesis. It can be submammary, periareolar or through the axilla. When the breast augmentation surgery is associated with mastopexy, the scar can be periareolar, vertical and located in the mammary groove. Some patients tend to the formation of keloid or hypertrophic scarring due to genetic tendencies. Light-skinned people are less likely to present this type of scarring complication, whereas darker-skinned or Asian people, however, are more predisposed to the formation of keloid or hypertrophic scar. In case of keloid or hypetrophic scar appearance, there are clinical and surgical resources that can improve or disguise unaesthetic scars.

2) What is the ideal shape and size for the breast prosthesis?

3) How long will it take for me to see the final result?
The ultimate shape of the breast will be attained 6 months after the surgery.

4) In case of pregnancy, what happens?
The mammary gland increases, causing skin distention, which may not return to normal after lactation. In this case, ptosis may occur (drooping breasts), which may require surgical correction. The prosthesis, however, does not undergo alterations with pregnancy or breastfeeding. The breast prosthesis does not interfere with breastfeeding or with breast growth, because both submuscular and submammary placed prostheses are located under the gland and do not interfere in any way.

5) Does the patient feel pain after the surgery?
Some painful manifestation may occur, which can be resolved with the use of prescribed painkillers. Remember that it is important to follow the doctor’s instructions, especially as regards moving the arms during the first few days. Usually, breast prostheses placed under the muscle are more painful than ones placed above it.

6) Does any alternation in breast sensitivity occur?
Some sort of alteration is common after the introduction of the prostheses. It may take several months for sensitivity to return to normal.

7)What is the shrinkage of the prosthesis capsule?
In lay language, it refers to rejection of the breast prosthesis. But in reality it is the exaggerated retraction of the fibrous capsule the organism forms around the prosthesis, making the region hard when touched. It is estimated that 5% of cases may be subject to shrinkage. If this shrinkage is very pronounced, it will be necessary to remove the prosthesis; the procedure to be followed must be the one that best adapts to each individual case. This shrinkage of the capsule arises from an anomalous behavior of the patient’s organism.

8) Is it possible to associate other procedures to the breast prosthesis surgery?
It depends on the procedure, although it is very common to associate this procedure to other cosmetic surgeries, such as rhinoplasty, tummy tuck, liposuction, etc. The combination of concomitant surgeries must be evaluated by the surgeon in view of the patient’s general conditions and the increased surgery time.

9) Can the breast prosthesis interfere with exams such as mammography, magnetic resonance and ultrasound?
It is important to mention the prosthesis’ presence when scheduling and performing exams, so that the operator can take proper technical measures in order to carry it out safely and show occasional alterations, if any.

PREOPERATIVE RECOMMENDATIONS:

  1. Inform the medical staff 2 days prior to the surgery, at most, about the occurrence of flu, discomfort or fever.
  2. Discontinue any medication for weight loss that might be being taken for at least 14 days prior to the surgery, including diuretics.
  3. Preoperative behavior is also crucial for a successful surgery. For at least 15 days prior to surgery, excessive use of medications or alcohol must be avoided; specifically for tobacco, abstention must last at least one month before the procedure. Diabetics and hypertensive individuals must have their conditions managed.
  4. The doctor will request several essential exams, such as electrocardiography, total blood count, coagulogram, fasting glycemia, electrolytes, HIV, urine and mammography. Patients with chronic diseases need specific tests and clinical evaluation before the procedure.
  5. The surgeon must be informed of the use of any medication, since some drugs may contribute to the risk of hemorrhage: acetylsalicylic acid (aspirin), nonsteroidal anti-inflammatory drugs, anticoagulant agents, vitamin E, vitamin C, ginkgo biloba, ginseng, garlic, alcoholic beverage, and some homeopathic medicines used on a continuous basis.
  6. The patient must plan her professional and social activities so as not to become indispensable for other people for at least 21 days.

SURGICAL TECHNIQUE

he breast prosthesis can be placed through 3 different incisions (periareolar = around the areole; submammary = in the mammary groove; or axillary = through the axilla). The prosthesis can also be located at two different sites: under the gland or under the muscle.Each method has advantages and disadvantages, the doctor and the patient must agree on the choice following a discussion about the pros and cons of each technique.

  1. The incision can be submammary, periareolar or axillary.
  2. The plane on which the prosthesis will be deployed is detached forming an empty space (under the muscle or the mammary gland).
  3. The mammary prosthesis is inserted.
  4. The anatomic planes are sutured
  5. A drain is placed and then removed after a few days, so that the formed secretions do not remain alongside the prosthesis.
  6. The surgical procedure takes approximately 30-90 minutes.

POSTOPERATIVE MEASURES:

  1. The drain is usually removed on the 1st or 2nd day after the operation.
  2. Avoid wetting the dressing until the doctor allows you to do so.
  3. Normal diet, except for special cases.
  4. Most of the stitches are internal. External stitches are removed between the 10th and 15th day.
  5. Any strenuous activity must be avoided, especially sudden movements of the arms and lifting heavy objects for 4-6 weeks.
  6. Due to the postoperative inflammatory process, changes in the color and texture of the breast skin may occur along with some hardening; this should be resolved in around 20 days. To provide relief from these alterations, the surgeon may recommend massage.
  7. Don’t take any kind of medicine that has not been prescribed by your doctor
  8. Don’t expose the operated area to sunlight for two months.
  9. Even if the patient is feeling physically well, she must not forget to refrain from making efforts for 60 days.
  10. Wear a special bra for at least 30 days.

COMPLICATIONS:
Hematoma, seroma, infection, prosthesis extrusion, shrinkage of the capsule formed around the prosthesis and anesthetics-related problems may occur.

FINAL RESULT:
The result related to the shape is already quite evident in the immediate postoperative period. During the 1st month there is a reduction in the edema (swelling) as the scarring process evolves. As in every cosmetic surgery, the result of breast augmentation surgery is usually observed after the 6th month.

BE WISE WHEN YOU CHOOSE A SURGEON. Just like in all other professions (lawyers, teachers, politicians, masons, cabinetmakers, baby-sitters, plumbers, etc.), there’s also a significant difference in the quality of the medical work provided.

Remember that different surgeons have different medical BACKGROUNDS, follow different procedures, have different esthetic views and obtain significantly different surgical results.

Address

Dr. Júlio Stédile M.D.
Av. Dr. Nilo Peçanha, 2825/1403 ZIP CODE 91330-001
Bairro Três Figueiras - Porto Alegre/Rio Grande do Sul - Brasil
Phone: +55 (51) 2111-1017 / +55 (51) 2111-1018

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