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Breast Augmentation

Information in spanish

How to increase breasts?

Breasts are the symbol of femininity and sexual attraction. Most women experience a harmonious development of breasts. However, in some women breasts never mature or develop properly, in comparison to the rest of the body. As the normal process which creates a fully formed breast in a grown woman never occurs, patient´s breast result in a flat appearance. Although in these cases woman´s development continues, breasts do not mature appropriately causing a body disproportion. For many women, breasts are not a concern. For instance, for most of European women breast size is not really important. Unlike Latin women, for who curvaceous hips and breasts represent an important part of their femininity. However, for some patients whose breast tissue never matures into a developed adult breast, this condition may become an emotional problem stressed by the social pressure.


In other cases, when breast asymmetry occurs one breast can be larger than the other. As some patients consider this asymmetry a physical defect, this difference in size of one breast may lead a person to certain psychological problems. Tissues develop following the complete genetic code of every human. Breast size is influenced by heredity. It is easy to find certain physical characteristics among the members of the same family, such as certain facial features, size and shape of nose, or eyes color. It is uncommon within one family to see mothers and daughters with very different breast types. However, underdeveloped breasts can be the result of a variety of diseases or growth disorders. Whether your breasts are small or if your breasts are asymmetrical (breast hypoplasia), or they just look flat, any condition can be managed through plastic surgery procedures.

Breast Augmentation
Among plastic surgery procedures, breast surgery is one of the procedures that has experienced more remarkable advancements. Popularity of plastic surgery, particularly breast augmentation has developed an expanding research field in techniques and surgical approach. Breast implants appeared as a social need for implants. There are a variety of breast implants available today and they are considered safe.

Candidate for breast augmentation

The ideal candidate for breast augmentation is a healthy woman with positive attitude, who had an inadequate development of their breasts, and therefore one or both breasts never mature properly.

The adult woman, who seeks an improvement in her appearance but not perfection, is a good candidate for breast augmentation. Also women with little to no volume in their breasts as a consequence of pregnancy, breastfeeding, and weight loss are ideal candidates for breast augmentation.

The surgeon may observe the nipple´s position. If the nipple is located 1 cm or more from the Inframammary fold, the physician may suggest a mastopexy or breast lift. In case of ptosis, breast augmentation is not recommended so augmentation may increase ptosis grade. For a mild ptosis case, physician may recommend a mastopexy or breast lift with implants.

Breast surgery recommendations and risks

Breast asymmetry or difference in size of one of the breasts may be a matter of concern among women, in particular when the difference is noticeable.

Only the plastic surgeon can ascertain every individual patient´s necessity after a through physical examination. In some cases, the physician may suggest to increase the smaller breast with a small implant, reduce the larger breast to correct the difference in size and obtain acceptable symmetry.


The breast implant



Silicone gel breast implant

There are a variety of breast implants with plenty of advantages and disadvantages. The choice of breast implants should be made on the basis of the patient´s desires and surgeon´s experience. Since this can be a confusing experience for women, surgeons experience must predominate. Some surgeons prefer saline implants as they may be filled with saline and can be adjusted at the time of breast augmentation surgery. However, some surgeons prefer silicone implants because saline implants have a tendency to rupture and leak with more frequent implant failure. Silicone breast implants are the most popular implants in Colombia. Breast implants are available in a variety of textures, profiles, and shapes, and implant shells come in either a smooth or textured surface.

A silicone gel breast implant has an exterior sac or implant shell made of silicone elastomer. The implant is filled with silicone gel. Silicones are polymers that may have a solid, liquid or gel form and are chemically stable polymers, rust proof, thermally stable and biocompatible. Silicone is a material non-reactive to human tissue.

The silicone gel implants have a soft shell and mobile content, and shells come in either a smooth or textured surface. Some gel implants are coated with polyurethane coverage. These implants have several barrier layers. Manufacturers develop new models of silicone breast implants every year.

Silicone breast implants have a soft and clear external covering with no edges. This shell may be either smooth or textured. The implant´s soft shell usually is clear and transparent. While on the contrary, the textured surface implants exhibit some kind of roughness, and the implant is not transparent but translucent. Implants are encapsulated medical devices filled with liquid or semi-liquid type of silicone and may vary in shape, size and projection/profile.

Today´s silicone breast implant filler can be:

  • Fixed volume silicone gel-filled breast implant.
  • Double lumen 75%saline/25% silicone gel reconstruction breast implant with valve.
  • Double lumen 50%saline/50% silicone gel reconstruction breast implant with valve.


In Colombia women prefer the fixed volume silicone gel-filled breast implants than the saline breast implants.

Cohesive silicone gel implants


Cohesive gel breast implants are made of silicone, but these are more cohesive than implants made in the past. The silicone in the cohesive implant is a gummy jelly solid, creating a smoother and pleasing appearance. The shell is extremely strong and resistant to damage. Manufacturers offer different cohesion degrees in implant models according to patient´s needs.

Saline implants


Saline implants are those implants with an outer shell made of silicone. The shell is empty during surgery when implanted in the patient´s chest and is filled with saline solution. All saline implants have valves.

Implants can be filled in three different ways:

  • Pre-filled by the manufacturer
  • Fix volume implant, which is filled intraoperatively.
  • Adjustable volume implant, which is filled intraoperatively with the possibility of subtle volume corrections to be performed after placement.


Although saline implants are also used, Colombian women prefer the silicone breast implants.

Sterilisation of the breast implant

Breast implants come in a sealed packaging and reliable sterilization conditions. The implant is removed from its sealed packaging only by the surgeon just in the moment to be implanted.

Dr. Nieto usually refers her patients to the breast implant manufacturer office in the city, so they can verify implant originality. Also, Dr. Nieto will give you an ID card for you to fill out with information about your implants. ID card provides important information about date of implantation, manufacturer, type, size, serial number and placement of implant used.

Breast implant placement

Breast implants can be placed either over the pectoral muscle or under it. When the implant is placed over the pectoral muscle is called subglandular because the implant is located behind the mammary gland and over the muscle. And when the implant is placed under the pectoral muscle is called subpectoral. Subpectoral implant placement is recommended when saline implants are used, because this placement gives a more natural appearance and because subpectoral implant placement may help to mask possible postoperative noises resulting from movement of saline.

Breast implants and cancer

For many years controversy has existed over whether breast implants increase the risk of breast cancer. There is no scientific evidence of an association between breast implants and breast cancer. However, the presence of breast implants may interfere with the sensitivity of screening mammography, making it more difficult to visualize breast tissue on x-ray.

It seems to be a coincidental factor that women who have had breast augmentation with implants can be later diagnosed with breast cancer. Scientifics have not found any convincing link between breast implants and breast cancer.

Breastfeeding and breast implants

Is breastfeeding possible after breast implant placement?
Women who want to have breast augmentation may be concerned whether they will be able to breastfeed their babies after the procedure or not. Breastfeeding with implants is still possible if the mammary glands persist. The periareolar incision has been suggested to interfere with future lactation, even when the mammary gland persists. Breast implants themselves do not constitute a difficulty for breastfeeding. However, the surgery procedure technique that involves placement of the implant might become an obstacle for breastfeeding.

Breast implants – Contraindications

What are the contraindications patients should consider for breast implants?

Breast implants are contraindicated for women when:

  • Existing pre-malignant or malignant disease without adequate treatment.
  • The patient is breastfeeding.
  • The patient is pregnant.
  • When there is an active infection anywhere in the body.
  • During examination you must speak candidly about your expectations from breast surgery. You should be able to express why you want undergoing breast augmentation and what you would like to accomplish with the procedure. Your medical and gynecological history will be reviewed along with information about number of pregnancies, whether or not breastfeeding was performed, breast pathologies, birth control pills, etc. Your doctor will listen to you carefully and discuss with you your expectations. Remember the type of procedure depends on your current breast anatomy.


Examination of the breast must be performed to assess for the presence of palpable breast masses. Also nipples´ position is evaluated. Preoperative mammographic screening of the breast is utilized for a malignant mass-detection. Depending on your circumstances, your surgeon will determine whether you are a candidate for a submuscular or subglandular breast augmentation. Preoperative photographic documentation is taken for planning surgery and analyzing postoperative changes. All potential risks and side effects will be discussed with you in advance of the procedure. Some potential complications are:

Breast Implants Consultation

In consultation with the surgeon you will be able to talk widely about your expectations regarding breast augmentation.

You should be able to inform your surgeon about the reasons why you want to increase the size of your breasts and what you hope to achieve with the surgery.

Your surgeon will ask about your clinical and gynecological history. Number of pregnancies, whether you have breastfed or not, if you have or have suffered any type of breast disease, if you have taken hormones or contraceptives.

Your doctor will listen carefully and will be clear about the prospects according to your anatomy.

The surgeon will perform a physical examination of your breasts to make sure there is no doubtful mass. It will examine the situation of your nipples. This will also determine if you are a candidate for a subpectoral or subglandular augmentation mammoplasty. If you consider it necessary, you will order a breast ultrasound or a mammogram. Likewise, a photographic study will be carried out that will serve as a record and guide of the changes to be made.


Breast asymmetry - What is the breast asymmetry?

Breast asymmetry or difference in size of one of the breasts may be a matter of concern among women, in particular when the difference is noticeable.

Breast Augmentation

Only the plastic surgeon can ascertain every individual patient´s necessity after a through physical examination. In some cases, the physician may suggest to increase the smaller breast with a small implant, reduce the larger breast to correct the difference in size and obtain acceptable symmetry.


Important data of the procedure

Purposes of surgery:
Increase or decrease the mammary volume of one of the breasts in an aesthetic and harmonic way.

It can be done with breast prostheses and / or the same breast tissue of the patient to correct imbalances.

Many patients undergo this procedure with breast pexy (lifting or breast enhancement) to feel more comfortable and generate a greater aesthetic impact.

Many patients have problems with the aesthetic shape of their nipples (size or shape) and correction can be made.

Approximate duration of surgery:
2 to 3 hours approximately depending on the surgical specifications of each patient.

Inability:
7 to 10 days approximately.

Recovery time:
approximately between 3 to 4 months. (It depends a lot on the organism and characteristics of each patient).

Type of anesthesia:
General.

Surgeon:
Dr. Claudia Patricia Nieto González, corporal and reconstructive plastic surgeon. More than 20 years of experience.


Breast surgery risks and potential complications

Bruising (Haematoma)
Your doctor will take the preventative measures during and after surgery to minimize potential complications. However, in some cases drainage are used to minimize bruising.

Infection

Despite all preventing measurements, as with any surgery, risk of infection may occur. The use of perioperative prophylactic antibiotics may prevent surgical site infections. You must contact your physician immediately if you develop symptoms or signs such as fever, sensitivity in the surgical site, if the area around the wound becomes red or if it feels swollen. Patients´ ability to care their surgical wounds is the key to optimal healing. Patients must avoid applying substances on surgical site, and avoid baths until the incision is completely healed.

Scarring Scarring may be a side effect of surgery. Some scars are less visible than others, but it is impossible for a surgeon to know how the skin is going to heal. Some types of skins have a better healing process than others. The new skin usually has a different texture, but the patient must understand that injuries need time to heal. Skin appearance after surgery is temporary and may improve over time. Scars are more visible during first months, but after this time gradually wounds improve as they mature. Surgeons perform plastic surgery techniques to make scars less visible. Also surgeons may recommend some methods to minimize appearance of scars.

Wounds final appearance depends on many factors such as:

  • Unexpected reactions of skin.
  • Skin type.
  • Location of the incision.
  • Presence of old scars around the new wound area.
  • Wound and tissue tension.
  • Caring of wounds.
  • Surgical technique.


Every patient develops a different wound healing process, even in the same procedure. Even with the best planning and the most meticulous surgical techniques, development of scars is unpredictable. You can be sure your doctor makes every effort to hide, camouflage and have a less noticeable incision. However, some marks may be obvious. In these cases, remember that a scar is a consequence of an enhancement in your appearance, and it may improve in time following some medical treatments. Enough time must have elapsed to allow healing of tissues before judging results. As every person has a different wound healing response, the time this process may take is unpredictable. Body response to injury is a very complex process. Be sure to ask your surgeon specific questions about your procedure, the incisions and expected scars.

A well informed patient may have also realistic expectations.

In the wound healing process you may expect:

  • Inflammatory phase
  • Proliferative phase
  • Remodeling phase


In each patient every stage develops in a different way. However, in most healthy patients´ wounds heal in a satisfactory way and with minimal intervention.

Abnormal scar formation
Some patients have an abnormal wound healing process. This is known as hypertrophic scarring. This is a complex matter, but what you have to understand is that scarring occurs as a natural part of the healing process, and therefore the way how tissues repair is uncertain. There are special treatments for skin scars. Before proceeding with any scar treatment, surgeon must identify the wound´s stage. Remember, you need to give the injury enough time to heal. Please ask your doctor about abnormal scars.

Loss of sensitivity
Alteration of nipple and areola sensitivity may be a result of nerve injury during surgical procedure. This condition may be temporary or permanent. Even the best surgeon cannot ensure complete nipple-areola sensitivity. For many patients nipple sensitivity is an important part of their sexual life. Therefore, you must consider this risk before undergoing breast surgery.

Capsular contracture
Silicone breast implants can be placed under the muscle (submuscular) or under the mammary gland (subglandular). In both cases, body develops an organic tissue which grows around the implant. This tissue is called capsule.

This is completely normal and expected event. Usually, this capsule is soft, no palpable, elastic, and undetectable. However, sometimes a capsular contraction occurs and the capsule becomes hard.

The capsular contraction is a body´s natural response to protect us from foreign objects. But this contraction may cause an aesthetically unpleasant appearance, pressure and pain. There are many degrees of contracture. In the worst case of capsular contracture, breasts look unnatural, and a new surgery is necessary to remove the capsular tissue. Many surgeons believe that submuscular placement along with textured-surface breast implants can help decrease the risk of capsular contracture. However, this thesis is not accepted for all surgeons.

Breast massage is often recommended by the plastic surgeon as an effective method of preventing capsular contracture. Your doctor may advise you, from the fourth day following surgery, a gentle massage in all directions. This prevents scar tissue from tightening around the implant. However, capsular contracture must be understood as body´s response condition, and it has nothing to do with the surgeon´s skills.

Breast implant rupture
Implant rupture and implant deflation risk persists, despite the technologic advances of implants. When saline implants break the contents usually leak and the body absorbs it.

When a silicone gel breast implant breaks, the contents usually remain intact, though the implant is broken. In very rare occasions silicone passes through the implant, but silicone may migrate. A breast implant rupture occurs by a loss of implant shell integrity. Two types of rupture may occur:

  • Intracapsular rupture occurs when silicone escapes the membrane shell but is contained in the fibrous capsule.
  • Extracapsular rupture involves the escape of free silicone gel through the fibrous capsule with escape of fluid into the breast tissue.


A woman with breast implants should be on the same schedule of routine mammography as other women.

Other potential complication:

  • Breast implants displacement or movement.
  • Asymmetry.
  • Calcifications.
  • Extrusion: (when breast implant comes through the skin) very rare
  • Granuloma: Reaction of soft tissues to capsular rupture.
  • Nipple and areola necrosis: It is produced by poor circulation.
  • Galactorrhea.


Breast augmentation – information & indications

  • Nipple and areola size can change after breast surgery.
  • Many women experience changes in the breasts size after pregnancy, even when they have implants.
  • Most often surgeons may obtain symmetry in size between the breasts than symmetry in shape.
  • Breasts are not perfectly symmetrical.
  • There is no evidence that breast implants can cause breast cancer.
  • Surgeon cannot ensure complete nipple-areola sensitivity. Each woman should consider possible loss of nipple or breast sensitivity, especially if it is an important factor in sexual life.
  • A woman with breast implants should be on the same schedule of routine mammography as other women.
  • Breast implants are not permanent and may require replacement during your lifetime.
  • A serious surgeon prefers not to perform breast augmentation in young women that have not yet completed their growth. Usually, girls have reached full physical development by age 16.
  • Young girls need their parents´ permission to have breast augmentation surgery.
  • The surgeon may refuse to operate on patients who suffer from a particular pathology, on individuals with emotional disorders or patients who appear to have unrealistic expectations.



Women, Breast Augmentation Surgery
Thanks to my breast augmentation to achieve correct an asymmetry hook it me for a long time, now I feel more comfortable with my body.

Women, Breast Augmentation Surgery and Liposculpture Surgery
The Dr. Claudia performed an excellent job on me, liposuction and breast augmentation that I underwent covered my expectations, I am very happy with my current shape (size 8-10) before (14-16).


Women, Breast Augmentation Surgery
Not only is it important to feel fully satisfied with the result but also the warmth human surgery and feel that you are in good hands.

Women, Breast Augmentation Surgery and Liposculpture Surgery
I am completely satisfied and happy with the result of breast augmentation enlargement surgery and liposuction of the abdomen, back, legs and arms as a result of my 2nd pregnancy my body looked like before not had 77 inch waist, now I have 65. My breasts were empty and flaccid today look toned and ideal size thank Dr. Claudia Nieto for giving me back my self-esteem by being comfortable with my figure my husband also very grateful.

Women, Breast Augmentation Surgery and Liposculpture Surgery
I want to share with you my experience with postpartum plastic surgery. After pregnancy and lactation in this sagging breasts and fatty accumulations in the abdomen and legs, changes despite a routine of exercise and good nutrition, I could modify. Consult with Dr. Claudia Nieto, who appreciate me propose some management with liposuction and breast implants. I perform these two procedures, no complications, and today I find a good sized breasts and especially suitable tone as well have removed all chubby tummy, legs and back, which with exercise can not be changed. I am very happy with the result. Many thanks to Dr. Claudia Nieto.

Women, Breast Augmentation Surgery
I am very happy with the surgery, the doctor is excellent and the receptionists are very attentive.