The breasts of a woman represent, essentially, her femininity. Aesthetic preferences have been changing throughout history, however, the breasts of women, their shape and volume, have always been a sign of beauty. The reasons for a breast augmentation mammoplasty are varied, such as asymmetrical breasts, normal breast development, breast reconstruction, etc. However, the main reason why this type of intervention is demanded is purely aesthetic.
The breast augmentation is a surgical intervention that aims to increase the volume of the breasts through an implant or prosthesis, having become the most demanded surgery intervention worldwide, along with liposuction. The main reason for this growing popularity is due to the magnificent results achieved and the high level of satisfaction among the women interviewed. To the above we must add the safety level of this type of operations, due to both the advances of the techniques used and the quality of the prostheses used.
The benefits of a breast augmentation operation not only refer to a substantial improvement in both the shape and size of the breasts, but also to a substantial improvement in the self-esteem of the woman in all the aspects of her life.
The patient may return home on the same day or the day after surgery if she has no medical complications. The first 24 hours of recovery after breast augmentation are quite uncomfortable for the patient not only because of fatigue but also because of pain and discomfort. The plastic surgeon will remove the bandages after a few days and from that moment a surgical bra should be used. This type of bra helps to shape and position the breasts appropriately. The pain relievers will diminish as the recovery progress. It is necessary that a person is found at home to help her during the first few days, drink plenty of fluids and follow the doctor’s recommendations by getting enough rest.
When the patient returns home, it is necessary to take some time to resume work and adjust to the routine for at least a week. In that period, an appropriate care of the fresh wounds it’s necessary to prevent infections.
Recommendations for post-surgery
Next, we will list some recommendations for post-operation period. It should be noted that a large part of the success, as in any other type of surgery, depends on the care during this period. In fact, in these types of interventions, the role of women is highly relevant. Let’s look at some issues that are interesting to know:
- The recommended bra should be used continuously for the prescribed time and should be removed only when bathing.
- Drains will usually be withdrawn within the next 48 hours of the procedure.
- The stitches are usually removed fourteen days after surgery.
- It is very possible that your plastic surgeon recommends you to perform soft massages in all directions on the implant in order to prevent capsular contracture from the fourth day of operation. It is important that the patient is clear that the capsular contracture is a reaction of the organism to the presence of a foreign body, not being conditioned by the greater or lesser skill of the plastic surgeon and, therefore, it is impossible to diagnose its appearance.
- If the surgeon recommends to perform the massage, they should be done in a rotating way, compressing and slightly depressing the intervened area. As the pain or discomfort decreases over the time, the massage should be performed more vigorously. In fact, the more consistent you are, the better results you will get. When severe discomfort, bleeding or allergic reactions occur, the specialist should be immediately notified.
- Absolute rest must be kept for the first two days following the operation.
- Generally, you will be given antibiotics in order to prevent any infection, as well as painkillers for the discomfort during the period.
- The doctor must be notified of any allergies to any medication
- It is advisable that during the first days of the post-operation period, you should have a reliable person to help you.
- It is recommended that during the period prescribed by the surgeon, lie in a semi-seated position. A pair of pillows on the back should be enough to have the proper inclination.
- Aspirins or acetylsalicylic acid or any other similar medication should not be ingested, as they may affect blood clotting and increase bleeding during this period.
- It is absolutely normal for purple areas to appear, precisely as a result of tissue manipulation. They will disappear after the recovery process ends.
- The surgical dressing should not be removed.
- The surgeon should be consulted about the type of exercise you can perform during the post-surgery period and the rate at which the intensity of the exercise can be increased.
- During the first few days after the operation, it is recommended to avoid lifting the arms for as long as possible. During this period, given the limitation that will be required in the movement of the arms, it is recommended not to drive.
- Avoid lifting heavy objects, as well as picking up children or pets during the first few days after surgery. In any case, these issues should be consulted with the plastic surgeon.
- The intervened area should not be wet, unless otherwise prescribed by the doctor, in which case the instructions received should be followed strictly. In addition, contact with external agents should be avoided and having a good hygiene of the wounds will prevent infections.
- Do not shave your armpits during the fourteen days following the procedure.
- You should avoid sleeping on your stomach during the first month after the breast augmentation or during the time indicated by the plastic surgeon.
- Do not sunbathe for two months after the operation.
- It is necessary to go to appointments scheduled by the plastic surgeon to verify that the healing process is going fine.
- You should consult with the plastic surgeon how to perform a self-examination for masses or anomalies in the breasts, not because they could be derived from this type of intervention, but because it is a method of prevention that all women should follow, whether they have gone through a breast augmentation surgery or not.
- The plastic surgeon should be contacted if the bandages are found to be excessively stained, if excessive pressure is felt on the breasts, fever, discomfort or any other abnormalities that don’t correspond to the indications given by the surgeon.
- If an echocardiogram is needed in the future, the sonographer should be informed of the existence of the prosthesis, because they may move the ultrasound terminal away from the cardiac area.
As mentioned, the post-surgery period is of the utmost importance and, as a general rule, it is recommended to massage the area to shape the cavity and the capsule wider than the mammary prostheses. If there is a subsequent retraction, it will be less evident than if it occurs in a very tight capsule. Notwithstanding the above, in some cases it’s not recommended to perform massages in this area. It is something that will depend on the criteria of the plastic surgeon.
A scientific study, published in the prestigious New England Journal of Medicine in March 2000, concluded that “there is no evidence that there’s any relation between breast prostheses in general, nor those filled with silicone gel in particular, with any particular disease of the connective tissue, with all of them combined or with other autoimmune or rheumatic diseases.”
The newly-operated chest is likely to look, at first, taller and larger than it will be in the future. After the operation, the plastic surgeon should give you instructions as to when you can wear bras. It is also advisable to wear a rimless bra to avoid excessive pressure the area that is going through a healing process.
Breast augmentation complications
The most frequent complication is the capsular retraction, already mentioned before, whose incidence rate is between 2% and 15%, depending on the placement of the prosthesis, its type, its filling and the tendency of the woman to generate them.
Recommendations to prevent capsular contractures
Capsular retraction is one of the effects that can be generated during the post-surgery period of the breast augmentation procedure and consists of an increase of the firmness of the breasts to the point where the prosthesis is tangible. When this kind of strong fixation occurs, breasts don’t fall to the sides as normal breasts would, when the woman lies down, and tend to be projected forward. The statistics of capsular contracture assumptions are variable, rotating between 2% and 8%, depending on the placement of the implants and the ability of each patient to generate them. The supra-pectoral or sub-mammary placement has a higher risk for a capsular contracture. Nevertheless, the percentage of subsequent interventions required as a consequence of a capsular contracture is low.
These are some recommendations to reduce the risk:
- The use of good breast prostheses, whether saline or silicone gel. Saline serum prostheses should be of low permeability and multiple layers. This type of prosthesis offers the advantage of being able to correct small asymmetries in the breasts, injecting during the operation, moderate amounts of serum in one of the breasts. The silicone gel prostheses should be of low permeability and of multiple layers as well and they can be smooth or rough. This type of covering has the advantage that it increases the surface of the capsule, thus reducing the percentage of risk of a possible retraction. In Spain, only these type of prostheses that have passed the quality controls of the General Directorate of Pharmacy and Sanitary Products are allowed. These authorized prostheses incorporate a sheet that must be signed by the patient and which will include the type, make, model and even the way of implantation of the same for control purposes.
- Retro-pectoral placement is recommended in order to prevent capsular retraction; however, for those patients who perform a lot of physical exercise, submaximal placement should be assessed, provided there is sufficient cover and good skin tension.
- In order to reduce the accumulation of blood in the cavity where the prostheses are located, very fine aspiration drains are usually applied during the first two or three days after the operation.
- The stitches around the areola will be made from the inside to prevent leaving marks on it.
Some strange breast augmentation complications
There are other complications typical of breast augmentation operations, although they are very rare:
- There’s a chance for the skin to suffer because of the pressure of the implant as well as due to the thin layer of skin that covers it. It is very rare to happen and even stranger in cases of retro-pectoral implementation. In these cases, the breast implant should be removed.
- Possible calcifications in the area or capsule that forms the organism around the implant. A disadvantage in these cases is that calcifications produce bad images in mammograms, which complicates the radiological diagnosis.
- In the case of prostheses filled with saline serum, it is very unlikely, but possible, the appearance of a pore, causing the implant to deflate. If it happens, the woman can see it immediately as a result of loss of breast volume. Today it is very unlikely that this will occur due to the quality of the implants that are used. If it happens, it should proceed to change the prosthesis, although we must say that it has no consequences for the organism.
- In cases of prostheses filled with silicone gel, it is also possible, although extremely rare, a rupture. The rupture leads to a change of implant. The possibility of immediate warning as a consequence of the loss of breast volume will depend on whether the rupture of the implant leads to a rupture of the capsule surrounding the implant.
- In implants filled with silicone gel, depending on the type of prosthesis, there may be a permanent migration of particles from the gel to the body, as it crosses the barrier that surrounds the implant. Today, multilayer cover prostheses minimize this risk, which on the other hand, are the only ones that are authorized for use in Spain. Regarding this possible permanent leakage of gel, there are contradictory scientific investigations as to whether leakage of this gel can produce immune and rheumatic alterations in the patients.
- The prostheses could be displaced from their original position, being able to generate or not, a possible asymmetry. In these cases, the massages have a very important role to prevent this complication. A displacement of the prosthesis may require the need for a new intervention.
- Risk of rippling in the case of patients with a very delicated skin, causing the folds generated by the prosthesis to be perceptible to third parties. It occurs rarely, although the risk is greater if the implant is placed in front of the pectoralis muscle or when serum or rough surface prostheses are used.
- The possibility of the “Mondor syndrome” which are structures in form of a cord that go from the sub-mammal groove to the abdomen, generating inflammation of the veins in the zone. Usually they heal can be healed with no consequences.
- Possible alterations in the pigmentation of areolar skin.
- Although it occurs very rarely, breast stimulation as a result of surgery may stimulate milk production. If this complication arises, it tends to disappear spontaneously.
General complications of surgery
On the other hand, as discussed above, there are risks inherent in any type of surgery. Among others, we can find the following:
- Possibility of bleeding, although it is rare because of the use of drainage.
- Local sensitivity changes.
- Bruising or accumulation of blood.
- Accumulation of blood serum.
- Intolerance to suture materials or infections.
- Risks arising from anesthesia.
Lastly, is important to mention that the vast majority of patients are very satisfied with the results achieved and would repeat the intervention, if necessary. In fact, patients who suffer from a capsular retraction prefer to undergo a new intervention before losing the achieved volume.