Breast Augmentation: Types Of Incisions
In the preoperative consultation of this intervention, a rigorous aesthetic analysis of the breast must be carried out, in order to determine realistic objectives. Apart from agreeing on the volume, the position of the incisions and the design and placement of the new submammary fold will be decided, always altered in this type of intervention. It will be important to analyze each part of the breast together with all the reference measurements that we saw in the Aesthetic Analysis of the Breast section. The symmetry of both breasts and their relationship with the chest will also be observed.
Types Of Incisions:
Axillary: It was very fashionable years ago and is suitable for placing saline prostheses. Avoid any scars on the breast, although they will be visible when raising the arms. This technique is not suitable for placing silicone prostheses and makes it difficult to design the new submammary fold. In addition, unless an endoscope is used, it is difficult to adequately coagulate possible bleeding points, which can cause bruising in the postoperative period. Another negative aspect is that it makes it difficult to properly design the submammary fold.
This incision does not interfere with future axillary surgeries such as sentinel node biopsies for breast cancer staging and treatment.
Submammary Groove: It is currently the most used because it is hidden with the natural fall of the breast if it was properly designed. It presents less risk of capsular contracture than the previous ones and allows an adequate dissection of the pocket that will house the implant. In addition, it allows the adequate design of the new submammary fold.
Periareolar: It is a widely used incision when it is necessary to associate the augmentation mammoplasty with other procedures such as a mastopexy or the correction of a tuberous breast. In addition, it is usually quite hidden by the transition between the areola and the skin of the chest and has not been related to alterations in the sensitivity of the areola-nipple complex. As a negative aspect, the technical difficulty of inserting the prosthesis in areolas with a diameter of less than 3.5 cm stands out. On the other hand, an increase in capsular contracture has been related when using this incision, due to bacterial contamination from the milk ducts.
Navel: It is performed through an endoscope and is not widely used at present, since it does not allow adequate control of dissection, hemostasis and the new inframammary fold. In addition, it is only possible to introduce empty saline implants, which once placed will be filled. Any immediate or late complication that requires secondary surgery requires incisions to be made in the breast.
Types Of Implants:
Implant size: The appropriate size must be agreed prior to surgery, reaching a consensus with your surgeon, who will indicate which is the most appropriate and proportionate for you. The selection of a small size may not meet the expectations of the patient, appearing a feeling of discomfort similar to or worse than the one presented before the intervention. This will cause the frustration of having gone through a postoperative period to obtain an undesirable result, and the thought of wanting a new surgery once recovered.
On the other hand, an excessive size can cause a distortion of the harmony of the female silhouette with an unnatural result. In addition, it is usually related to a thinning of the skin that will mark the superficial veins and can trigger complications such as double bubble deformity or symmastia (For more information, visit the Complications section of the Prosthesis section). The excessive size of the prostheses can also cause thoracic, cervical and lumbar pain.
The anatomical ones are specially designed to achieve a more natural breast shape, since they achieve greater filling of the lower pole with an adequate transition of the upper pole. They are drop-shaped, just like a breast, although they can be rotated and alter the shape of the breast, especially if they are placed in the subpectoral plane.
The round ones, having the point of maximum projection in the center of the prosthesis, do not matter if they rotate, always maintaining the symmetry between both breasts regardless of how they have been placed.
The smooth ones form a very fine capsule, although with a high risk of developing capsular contracture, especially when the implant is placed in a subglandular plane. On the other hand, the rough ones have a lower rate of capsular contracture and, in addition, the irregular surface hinders the migration and rotation of the implant, since it confers a certain degree of adherence to the tissues.
Composition of the implants:
Silicone implants give a natural look and feel to the breast, as the consistency of current silicone gels is very similar to that of a mammary gland. On the other hand, its breakage can cause the migration of silicone to the axillary nodes, a fact that has been minimized with the latest highly cohesive consistency gels, something that does not occur with saline gels. On the other hand, those with saline give a more artificial appearance to the breast.
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