Breast augmentation
Breast augmentation is a surgical procedure that consists of improving the shape of the breast and harmonizing it according to the body proportions of the woman herself. We do this by increasing its volume, in the specific areas where it is lacking. Dr. Marc Illa emphasizes the importance of understanding the individual expectations and desires of each patient in order to achieve satisfactory results.
“Each person has a different perception of beauty and taking the step has to be a personal decision and not influenced by the opinion of others”
During the initial consultation, the available options are discussed, including the different types of breast implants, as well as their size and profile. The choice of prosthesis volume is based on the patient’s anatomy, aesthetic goals and lifestyle, allowing for a personalized decision that promotes self-esteem and confidence.
In addition to improving physical appearance, breast augmentation can have a positive impact on a patient’s self-esteem, providing a sense of femininity and body confidence. With expert guidance and careful choice of size and type of prosthesis, patients can achieve natural and satisfying results that improve their emotional well-being and quality of life.
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What does surgery consist of?
Breast augmentation can be achieved with:
Feeling and confidence
The most important thing is to feel comfortable and trust the surgeon who is going to operate on us. That is why it is good, even advisable, to visit different doctors to be able to decide on the one with whom you have had the most “ feeling” and, of course, offer the technique with which we are most satisfied
The medical indications for augmentation mammoplasty are:
- Mammary agenesis: the breasts have not developed.
- Breast asymmetries
- Breast hypoplasia: the breasts have not grown as they should in a normal body
- Glandular atrophy: loss of volume after pregnancy, weight loss…
- Breast deformities: tuberous breast, Poland syndrome, pectus excavatum...
- Breast reconstruction: after breast cancer, breast infections, trauma
It is a complex surgery with many aspects to consider both in the consultation and in the operating room itself. Make sure that all your doubts are resolved in the consultation, with the necessary visits before the procedure. Do not leave any questions unanswered. Make sure that your surgeon has the experience and qualifications that certify the necessary training to be able to perform plastic surgery. It is not uncommon for other untrained doctors to venture into plastic surgery, sadly.
- HYBRID BREAST AUGMENTATION It consists of increasing the volume of the breasts and modifying their shape according to the wishes of each patient, not only with breast prostheses, but also with the patient’s own fat obtained previously by liposuction. The injection of fat into the breast is considered as liposculpture of the breast and allows us to:
- Getting the shape we want
- Achieve a natural result with your own body’s tissues
- Obtain a high level of detail
It allows for large volume increases and the creation of cleavage with the breast prosthesis, and on the other hand, it allows for a more natural appearance and feel, softening imperfections with fat injection, reducing the risk of aesthetic complications such as the dreaded “rippling”.
Are you concerned that the feel of the prosthesis is unnatural?
Are you worried about the dreaded breast rippling?
Want to get that natural, plunging neckline?
What ERRORES should you avoid when choosing a breast prosthesis?
These are common requests that patients make to us in consultation when they request breast surgery, whether it be a breast enlargement or a lift (mastopexy) and we can refute all 3 statements.
the secret?
Communicate your idea clearly to the surgeon. This is the only job the patient has, to convey what he wants to achieve in his breast and I ask you the following questions:
Do I want a more defined or softer neckline? Do I want a more rounded or natural-looking breast? Do I just want to increase breast volume or lift it as well?
It is useful to provide photographs of cases performed so that the patient can see if she would like or could have a more similar result.
Where do we hide a breast scar?
Breast scars are one of the biggest concerns for our patients. Each patient has different characteristics that must be assessed during the examination of the first visits:
- Skin type (elasticity, texture, thickness)
- Shape of the breasts (drooping, empty, wide, etc.)
- Presence of previous skin alterations: irregularities, freckles, scars from trauma or surgery
During the procedure, general anesthesia is used and carefully planned incisions are made around the areola or in the submammary fold or in the armpit area, removing excess skin and reshaping the breast tissue to create a youthful and attractive appearance. We create hidden scars in folds and color transitions, creating very natural results.
There are several ways to perform the surgery depending on what you want to achieve and how you want to achieve it: If the breast is more complex, that is, it is sagging or tuberous, the indication for the scar may be different. In the case of tuberous breasts, the scar may be necessary in the submammary fold or in the areola, or even in both. In the case of sagging breasts, a mastopexy or breast lift will be necessary and the scars will be different.
What is breast asymmetry and what are its causes?
No human being, whether male or female, young or old, athlete or sedentary, is 100% symmetrical. The problem arises when the symmetry between one side of the body and the other is less than 90-95%
One of the most frequent reasons for consultation for breast surgery is to improve the asymmetry between both breasts, which may be due to birth defects such as tuberous breasts or Poland syndrome or external causes such as trauma or previous surgeries.
Surgery is the solution for cases where asymmetry is a factor of discomfort and insecurity for the patient. It allows us to improve this problem and achieve 90-95% natural symmetry.
What is the visita with the surgeon like?
01
First contact
The first thing the surgeon will ask you is what you want to achieve or what you would like to improve. He will then ask you about your allergies, any illnesses you have, any surgeries you have undergone, etc. This information is of vital importance in order to decide on the type of surgery and the postoperative course that we are going to follow. Cosmetic surgery and many of the reconstructive surgeries that we perform as plastic surgeons have to be carried out under the safest conditions, since there is no rush to perform them and they can be planned in detail to obtain the best possible results with maximum safety, minimising the risks to your health as much as possible.
02
Exploration
Next, we move on to the action, we have to perform a physical examination. We will take measurements and the patient's body proportions (height and width of the breasts, distance between both nipples, distance from the nipple to the submammary fold, distance from the sternal jugular notch to the nipple...) and we will explore the area to be treated (quantity and texture of the mammary gland, quality and type of skin, position of the mammary gland, asymmetries between the two breasts, shape of the chest, diameter of the chest...). It is not the same to place 300cc prostheses in a person who measures 85 cm in chest circumference and 1.53 cm in height than to place them in a person who is 100 cm and 1.88 cm respectively.
03
Wants and needs
Once we know the medical context of the patient and where we start from, it is time to have a relaxed conversation with the patient to know your wishes. It is very important to express clearly to the surgeon what we want to achieve or what we are looking to improve (ask useful questions such as: do you like your breasts as they look with the bra? Do you like your breasts better as they look with the push-up bra? Would you like to have a little or much more? Are you looking for a more exuberant result or that you do not notice that you have had surgery, just a discreet breast augmentation? Would you like a well marked cleavage?), it is also useful to bring photos of friends or acquaintances to transmit to the surgeon the idea that you want to achieve, always bearing in mind that each body is different and you will always get a different result than any other person. With this last information the projection of the breast prosthesis is chosen (there is low, moderate, high and extra high projection) and its shape (there are anatomical, ergonomic or round). We will specifically evaluate your case to choose the breast prosthesis that is best to achieve the result you are looking for.
Frequently Asked Questions
What is the right implant size for me?
Choosing the right implant size depends on several factors, including your body anatomy, your aesthetic goals, and your lifestyle. During your consultation, we will help you determine the appropriate size that best suits your needs.
What are the risks associated with breast augmentation surgery?
How long will recovery take after surgery?
Will surgery affect my ability to breastfeed in the future?
Will surgery affect my breast sensitivity?
How long will the results of breast augmentation last?
How is breast augmentation surgery performed?
Types of prostheses
There are different types of breast implants available, each with its own unique features and benefits.
The choice of one or another prosthesis It certainly depends on the individual aesthetic goals of each patient, as well as their anatomy and personal preferences. In consultation we work closely with each patient and We carry out a complete study of the shape and consistency of the breast and the shape and size of the thorax to determine the most suitable type of prosthesis to achieve the desired results and satisfy aesthetic needs.
Before surgery, you will be given specific instructions on how to prepare, which may include stopping smoking, avoiding certain medications, and adjusting your diet. It is important to follow these instructions carefully to ensure a safe surgery and successful recovery.
There are several tricks that can help us achieve an aesthetically pleasing neckline.
- Choosing the prosthesis: This is the most important thing to be able to create a good cleavage. It is necessary that the width is sufficient to cover the entire thorax and thus be able to correctly occupy the entire area. The shape, level of implantation and size of the patient's previous breast must also be taken into account.
- The way in which the pectoral muscle is lifted: this is where the prosthesis is inserted and the muscle itself can help us bring the breasts together.
- Internal Bra: With the help of stitches, we fix and close the edges of the prosthesis pocket well to create an internal bra effect.
Lipoinjection: Fat injection into the breast allows for the creation of a completely natural volume and avoids long-term aesthetic defects such as rippling (irregularities in the surface). It allows us to create a beautiful and natural neckline with the patient's own fat.
The answer is: IT DEPENDS on each case
When to decide “NOT to wait to be a mother”? This is the preferred option for patients who do not feel comfortable or identified with the shape and/or volume of their breasts at the moment. For many patients, for example at 20 years of age, it is not worth spending another 10-15 years (until the age at which they want to be mothers) with a breast that does not feel good. It is true that the breast changes over the years, with sudden weight changes or pregnancies, but retouching a breast that has already been operated on tends to be simpler. These are usually surgeries that mainly affect the skin and fat without having to touch deep areas or previous breast prostheses. Hospital admission is not usually necessary and the postoperative period is usually very bearable. For this reason, many patients decide not to wait and to operate on their breasts at the moment when they do not feel comfortable with them.
When to decide to “Wait to be a mother”? This option is best for women who only want to undergo surgery once. In this case, it is best to wait until you have had all the children you want before undergoing breast surgery. The price to pay will be spending several more years accepting the shape and volume of the breasts that you are not completely comfortable with.
Patients would like to know the exact result of their surgery. While it is true that the results of surgery (and of any medical intervention) have a predictable part (it will depend on the type of intervention planned, the wishes of the patient, and factors that we study in the physical examination such as the quality of the tissues), there is another unpredictable part that can modify the result, such as the underlying genetics of each patient or other factors that we have not been able to identify initially.
Our goal is to minimize these unforeseen factors that may affect the result we leave in the operating room in order to give the patient an idea as close as possible to what they will achieve, but it is impossible to guarantee a 100% result for this reason.
- Minors under 18 years of age with aesthetic objectives
- Pregnancy
- Active or past breast infection within the last 6 months.
- Any uncontrolled disease
Breast mammograms can be performed without problems in women who have breast implants. We recommend that they be performed 12 months after the operation to prevent inflammation from the surgery from interfering with the interpretation of the test. As long as you notify the doctor who is requesting the test in advance so that it can be scheduled to be performed using the Eklund technique, a maneuver that consists of moving the prosthesis towards the back of the breast, leaving it outside the compression paddle, compressing only the breast tissue to perform the mammogram. There is no problem with doing other tests such as MRIs or flying (the prostheses do not explode). Being a breast implant wearer is even beneficial for breast self-palpation, since the breast tissue is more taut and distributed around the implant and allows for greater sensitivity and specificity when palpating all this tissue.
No, the quality of the materials used to manufacture the breast prostheses we work with has allowed us to reduce the risk of complications associated with these to a very low level. This does not mean that it may not be necessary to replace the prosthesis or remove it during life for some reason, but this is rare. The prostheses used years ago did recommend changing them every 10 years, but thanks to scientific advances this is no longer the case.
No type of plastic surgery is related to an increased risk of cancer. The use of breast implants has been linked to some types of autoimmune disease or some types of lymphoma, but there is no scientifically clear or proven relationship with the breast implants we currently use (it has happened with some brands of breast implants used in the past).
General anesthesia is always used to ensure patient comfort and to allow the surgeon to work with maximum precision and safety. Full intubation is not usually necessary; a laryngeal mask with mild anesthesia is usually the route of choice for our anesthesiology team. Breast surgery should not be performed with local anesthesia; it is bad practice. Throughout the entire operation, the patient's general condition and vital signs are monitored and taken care of in the utmost detail by our anesthesiology team.
An overnight stay is usual. It is preferred to be under health surveillance for the first few hours. Although it is not a long or risky surgery, we have gone through an operating room and received medication. In addition, intravenous medication is useful in the first hours to maximize the patient's postoperative comfort.
We work with different brands of breast prostheses: Motiva, Silimed, Politech, Eurosilicon, Nagor… None of them are the same as the other, each brand has its pros and cons that must be assessed. We will specifically study your case to choose the breast prosthesis that is best for achieving the result you are looking for.
The answer to this question must be individualized in each case. Even so, it can be said that in most patients the recommendation is to place the prosthesis under the muscle (also called submuscular or subpectoral, since the muscle used is the pectoralis major). Among the most common ways of placing a prosthesis under the muscle, the most commonly used is the dual plane, where 50-75% of the prosthesis is covered by the muscle and 25-50% by the lower part of the mammary gland.
This placement has several advantages: the anatomical structure of the mammary gland is not touched at all, which means that sensitivity and subsequent ability to breastfeed are better preserved, and it is a cleaner surgery, which reduces the risk of infection or capsular contracture.
Placing the prosthesis above the muscle, although not very common in our normal practice, in certain patients, has certain advantages that must be assessed in each case. Above the muscle, it can be done in two ways: subglandular (directly under the mammary gland) or subfascial (under the first layer that surrounds the pectoralis major muscle).
This is a very common question in consultations, since, as is normal, patients would like to know the exact result of their surgery. While it is true that the results of surgeries (and of any medical intervention) have a predictable part (it will depend on the type of intervention planned, the wishes of the patient, and factors that we study in the physical examination such as the quality of the tissues), there is another unpredictable part that can modify the result, such as the underlying genetics of each patient or other factors that we have not been able to identify initially. Our goal is to minimize these unpredictable factors that may affect the result we leave in the operating room in order to give the patient an idea as close as possible to what they will achieve, but it is impossible to guarantee a 100% result for this reason.
So… in answer to the question: What size bra will fit me? We won’t know the exact size until the swelling has gone down and we have a more or less stable result 3-6 months after surgery.
Did you know that 7 out of 10 women do not know their correct bra size?
30% of consultations about breast pain are due to wearing an inappropriate bra. Wearing the wrong bra size can cause not only discomfort, but also marks and injuries, as well as accelerating the ageing process of the breast.
Where can breast implants be placed?
Under the muscle (also called submuscular or subpectoral implant)): This is the majority of our cases. Among the most common ways of placing a prosthesis under the muscle, the most commonly used is the dual plane, where 50-75% of the prosthesis is covered by the muscle and 25-50% by the lower part of the mammary gland.
Above the muscle or subglandular implant (directly under the mammary gland) or subfascial (under the first layer surrounding the pectoralis major muscle). This technique is less common, but in certain patients it has certain advantages that must be assessed in each case.
Yes, indeed there is a scar.
This is what a scar in the crease of the breast (submammary fold) after breast augmentation with prostheses looks like at 2 years of age.
What incisiones can be used to place a breast prosthesis?
Each technique has its advantages and disadvantages and the important thing is to individualize each case to obtain the best result in a personalized way. There are three main ways:
- Submammary fold
This is the most common way to place them, since the scar behind is very well hidden in the fold under the breast and it is the way that gives us greater precision, speed and safety to place the implant where and how we want it. As it does not require going through the mammary gland, it is a cleaner surgery and the risk of complications is reduced. In addition, as it does not affect the anatomical structure of the mammary gland, it is the way that best preserves sensitivity and the ability to breastfeed.
- Areolar
This approach is indicated when the shape or size of the areolar area needs to be modified. In other cases, in our opinion, there is no reason to use it, since it creates a more visible scar that lacks the advantages of the scar in the submammary fold.
- Axillary
The main advantage of this approach is that it does not leave visible scars on the breast (it is placed in the armpit). The disadvantage is that it can reduce the precision with which the prosthetic pocket is created and the breast prosthesis is placed.
Postoperative
It is normal to experience pain, swelling, and tenderness in the breasts after surgery. Your plastic surgeon may prescribe pain medication to help manage discomfort for the first few days.
You will notice a pain that is usually described as “soreness”, as if you had gone to the gym three or four days in a row. The pain is usually very well tolerated, especially if you follow the medication regimen that we recommend taking the first week after surgery to the letter. Most patients explain that the discomfort is greater during the first 3 or 5 days, and then it is minimal; although each person has a different pain threshold.
In most of our cases, we place the post-operative bra directly in the operating room after the surgery. If it is a complex surgery (such as tuberous breasts or prosthesis replacement), it is likely that a compression bandage will be placed around the breasts to help reduce swelling and keep the bandages in place.
The first postoperative hours are spent in the hospital's recovery area, where all vital signs are closely monitored. When the patient has fully woken up from the anesthesia (no longer groggy), the pain and dizziness are under control, and she is therefore in optimal condition, she is taken to her room with her family and friends. There, recovery begins in preparation for returning home. In her room on the ward, the nursing staff will diligently ensure that the patient is comfortable and with minimal discomfort, using the medication prescribed by our anesthesiology team when necessary. The nursing team will help the patient to tolerate the intake of liquids and solids, and walking, and thus ensure a safe return home. The next day we will come to the hospital to visit you, to check that the patient is in good general condition and that there are no complications of any kind in the areas that were operated on. We will consider the possibility of removing the drains and bandages, and if everything is in good condition, we will proceed to deliver the discharge report where we will detail all the postoperative instructions that the patient must follow and the prescriptions that she will need to give to the pharmacy in order to receive the medication that we recommend. In the first week after surgery, pain and dizziness are rare, but there are specific moments when they can appear and you have to be prepared.
During the first three months (more pronounced during the first month) the breasts will appear higher and larger due to postoperative edema or swelling. It may even be that one breast is more swollen than the other and therefore appears larger (there are patients who have this swelling greater in one breast than in the other and it varies depending on the week and from one breast to the other) giving a sensation of asymmetry or deformity. After three months we have fairly stable results. The result of cosmetic surgery should not be considered definitive until a year has passed since the day of the intervention.
We have to consider them our allies, since they remove the liquid that causes a lot of inflammation if it stays inside and can even increase the risk of complications. They are a nuisance, but there is nothing worse than that. In many of our interventions we leave them, at least until discharge from the hospital. We always leave them longer in abdominal and back surgery than in breast surgery.
You can move your arms to do activities that do not require effort. The important thing is not to lift them or lift heavy weights. Normally we allow you to lift your arms from the second postoperative week, until the surgery is well healed on the inside and movement cannot affect it. And finally, you can lift heavy weights from the fourth postoperative week.
It depends on the type of job. Normally, we allow you to start computer work (secretarial work, IT, telecommunications, etc.) two weeks after surgery. Jobs that involve driving or a lot of movement usually start after three weeks.
We usually allow driving from three weeks postoperatively.
We recommend spending the first five to seven days postoperatively at home, after which we allow going out for a coffee or visiting family or friends. Driving or taking long walks from three weeks postoperatively. Sports such as going to the gym or running from four weeks postoperatively. Intense sports such as climbing, swimming, triathlon… from six weeks postoperatively.
Most stitches are subcutaneous or intradermal, that is, they are under the skin, they go inside. We do not normally leave external stitches (only those at the ends of the intradermal suture). If there is a need to leave an external stitch, we normally remove it after 7-15 days.
Unless there are any conditions that require a longer period of wear, we usually recommend wearing the sports bra for a month, both day and night.
