Breast augmentation surgery is performed by introducing an implant or prosthesis in the patient’s breasts through a small cut or incision leaving an almost imperceptible scar. The skill of the plastic surgeon and the location of the scar guarantee its almost total invisibility, as it remains almost unnoticeable. That is why it is important for the skin to heal properly, which we are going to describe.
Cicatrization depends on the surgical approach where the incision is made or the area where implant placement is performed. However, in most cases, as the incisions are minimal, over time they become imperceptible. When the incision is made on the bottom edge of the areola and the breast skin, a scar is usually of very good quality and imperceptible, so within several months, since the skin of the areola is thin, healing, in most cases, looks excellent. In the other approaches such as the armpit and sub-mammary crease, the scar takes longer to disappear, but it is hidden and discreet in both cases.
The thing is that humans in their evolution, through a process of cicatrization can repair themselves but tissues do not regenerate. The organism leads to epithelial regeneration and replacement of the dermis by fibrous tissue, which basically consists of collagen with characteristics different to normal. The new fibers are shorter and disorganized, less soluble, so the scar will never get to have the strength of healthy skin.
It would be unwise to say that there will not be scars after an implant, because every operation involves a mark. But some scars are less visible than others, but for the plastic surgeon will be almost impossible to predict how the skin will heal, as healing depends greatly on the body of the patient. The body’s response to incision is one of the most complex physiological processes after surgery. Some skin types heal better than others.
Each patient will have a type of completely individual healing that even varies according to age, so a young patient with firm skin is not the same as a 45 or 50 year old patient with less flabby skin, or a patient who smokes and one who doesn’t.
To avoid false expectations, the patient should ask the specialist to explain exactly how the surgery will be performed, the shape of the incisions and what scars will remain. This information should be explained in a way that you understand it perfectly as if you can have this information, you may achieve more realistic expectations.
Although in early days incisions appear very marked, which makes them visible, it is important that the patient understands that the skin needs time to heal, to evolve, so that the appearance of the skin after surgery is as close as possible to that before the intervention. The surgeon will inform you of some methods to minimize the appearance of the marks.
Once the cut or wound is produced, the healing process starts, which is a process of recovery or repair of the damage caused, with certain biological times to achieve the full functional and cosmetic tissue repair. The goal of every plastic surgeon is also to achieve a healing, which is not only functional but also totally acceptable from the aesthetic point of view.
The healing process
The healing of damaged tissue in breast augmentation is performed in several stages:
- A first hemostasis phase, the factors responsible for normal healing begin at the moment of injury. When making a wound, the body loses internal fluids and it causes vasoconstriction, which seeks to reduce blood flow. On the other hand, by altering the epidermis, the dermis and as blood vessels are broken, platelets communicate with injured collagen and start to degranulate and to aggregate. The coagulation cascade that restores hemostasis is activated, temporarily isolates the wound and provides an extracellular matrix for the following processes of the healing.
- Second inflammatory phase usually lasts between one and four days, in which the wound closure occurs. A vascular response with a first phase of vasoconstriction occurs to control bleeding and subsequent vasodilation that stimulates cell migration. Cleaning of the wound starts. At this stage the characteristic symptoms are heat, pain and itching. The duration of this phase determines the final size of the scar. The longer this phase lasts, the bigger the scar and the worse aesthetic result.
- Third phase of fibroblastic that starts from the fifth day until the sixth week (40 days) in which the recovery of connective tissue starts. The blood vessel formation and epithelialization begins.
- Fourth phase of maturation from the forty days in which scar softens and flattens and any itching sensation or heat disappear. More than eighty percent of the tensile strength of the tissue recovers. Note that almost never a hundred percent of the tensile strength recovers.
After the suture and during the previous three phases is based on the action of proteins called polypeptides, whose biochemical messages to certain cells regulate tissue repair, tissue regeneration and healing.
Correct healing factors
There are numerous factors that can affect proper healing and among them the following should be highlighted:
- Surgical technique and skill of the plastic surgeon: there must be special care in the area where the incision is performed, choosing an area with proper tension on the skin. Obviously, it is necessary to use special stiches for each case and they should be especially thin, accompanied by an appropriate surgeon’s ability to damage the least possible tissue and reverse the edges of the wound in the right way.
- Appearance of infections: infections do not usually have an impact in most cases and as cosmetic surgery is a very controlled process, an appearance of a serious infection is rare and easily treated.
- Blood contribution to the wound and its nutrition: both factors depend on each patient and there are numerous drugs that help these basic functions.
- The direction of the wound.
- Surgical approach.
- Degree of tension of the scar.
- Skin type and location of the scar.
As negative factors in the healing process there are the following:
- Age: the body’s ability to carry out proper healing decreases with age.
- Prior existence of certain diseases that can affect the healing process as diabetes mellitus, arterial insufficiency, atherosclerosis, hyper and hypothyroidism, etc.
- Tobacco: affects the process as it alters microcirculation causing unwanted vasoconstriction and hypertension on the arteries.
- Alcohol: that in its phase of alcoholism produces malnutrition and delayed healing.
- Radiation therapy and chemotherapy.
- Unexpected skin reactions.
- Presence of old scars in the area.
Abnormal response to healing
In some patients the healing process has an abnormal response to treatment. This condition is known as hypertrophic scarring. There are various forms of manifestation of hypertrophic scar, however, it is a very broad topic to be exposed here.
To sum up, we should understand that healing is a process in which living tissues repair their wounds and thus the behavior of tissues against injury is unpredictable. The good news is that nowadays, there are specific treatments to treat this type of scars.
Before asking for an appointment due to the poor healing, the patient should allow some time to pass so that the entire healing process is finished.