You can have stunning breasts with breast augmentation surgery.

History

In the 1940’s, some Japanese women started injecting substances like liquid paraffin, sponges and industrial silicone in their breasts to enhance their size.

Later on, in 1960, with the intention to develop something to enlarge breasts, the first silicone implants for medical purposes were developed by two American plastic surgeons: Frank Gerow and Thomas Cronin.

Timmie Jean Lindsey, in an exchange of favours with Frank Gerow, accepted to receive the first breast implants developed in the world as long as he operated on her ears. Thereby, she was the first woman to undergo an augmentation mammoplasty with silicone implants. Despite all the glamour behind her title, she had severe capsular contracture and a lot of pain. All this happened for a simple reason: the first silicone breast implants were made with a smooth silicone coating, filled with a silicone sponge.

Since then, various modifications were made to the silicone implants, including its coating, also known as envelop. It got thinner and the sponge was replaced by silicone gel, which gives it a more natural appearance, much closer to a natural breast.

Currently, implants are made with silicone gel of high cohesiveness, whose envelop is extremely reduced in terms of thickness, with a polyurethane foam coating, which significantly reduces the incidence of capsular contracture, and other complications. The silicone breast implants, made by Silimed and used by Dr. Walter Zamarian Jr., are of high quality, being considered by the European Commission's Scientific Committee on Health and Environmental Risks as one of the best in the world. This, undoubtedly, provides safety to the patients who choose Zamarian Clinic for a breast augmentation surgery.

Classification

Breast implants were developed with the purpose of increasing the volume, correcting or reconstructing of the breasts. They are classified by: contents, surface (coating), shape, profile, cohesiveness, position, and surgical approach:

Contents

• Saline implants: very common in the US, they are filled with sterile salt water. They are inserted empty and then filled with saline solution. They are not easily found in Brazil;
• Silicone implants: they are pre-filled with high viscosity silicone gel and many women find that these implants look and feel more natural. These are the implants used by Dr. Walter Zamarian Jr. in Londrina, Paraná, Brazil.

Coating

• Polyurethane: they are technically more difficult to be implanted and to adhere to adjacent tissues, reducing the risk of breast ptosis (drooping). There is less incidence of capsular contracture, therefore, they are considered the safest;
• Smooth: they are used by Dr. Zamarian Jr. in buttock augmentation and in calf implants surgery, since they need to be placed beneath or close to the muscle, in order to prevent capsular contraction;
• Textured: they are technically easier to be placed, but, as a result, the breasts become more movable, increasing the chance of ptosis, and the risk of capsular contracture is said to be ten times greater than by polyurethane.

Shape

• Round: it is the most used shape worldwide. It improves the aspect of the breasts in all directions, including the superior pole, creating a nice cleavage. However, very skinny patients may benefit from conical implants, on order to achieve a more natural result;
• Conical: launched by Silimed four years ago. It is the newest model. It is excellent for patients who want to fix sagging breasts or want a natural result. Patients who want a nice cleavage might prefer the round model, instead;
• Natural or anatomic: also known as tear drop, developed with the purpose of providing a natural result. As they have less volume in the superior pole, Dr. Zamarian Jr. would rather use one of the following alternatives: a conical implant or a round one, placing them one centimeter lower. There is the risk of this implant to turn upside down.

Profile

• Low (LO): generally used in breast reconstruction surgeries, with an average volume between 500 and 800 ml, since, during this surgery, it is necessary to restore the total volume of one breast;
• Moderate (MD): is the most common used profile by Dr. Zamarian. It is recommended for most patients, since it presents an excellent proportion between the width and height of the implant. It corresponds to the previous high profile from the former classification adopted, when the implants were classified only as low and high;
• High (HI): recommended for patients who want more projected breasts, a more visible result, looking either more pronounced or more natural, depending on the shape of the implants. It can also be recommended for patients with very thick dermis, such as asian patients;
• Extra-high (XH): hardly ever used, since it is mainly recommended in cases of severe asymmetry, or in patients whose anatomy requires maximum projection.

Cohesion

One of the characteristic of the silicone gel molecules is their capacity to remain united, preventing the gel to leak in case of rupture. Implants used by Dr. Zamarian are highly cohesive, providing full security to his patients.

Position

One of the points about silicone breast implants to be clarified during a medical consultation in Londrina is, undoubtedly, the position of the breast implant in relation to the pectoralis major muscle. There are two possibilities:

• in front of the muscle (retroglandular): it is Dr. Zamarian’s first choice, since it results in more projection and less pain and complications in the postoperative period;
• behind the muscle (retromuscular): in selected cases, this can be the best option, mainly for very skinny patients with little breast tissue to cover the implants.

Surgical approach

• Inframammary fold: the advantage of this type of incision is that it avoids scars around the areolas and it doesn’t jeopardise breastfeeding nor the sensitivity of the areolas. Besides, scars are hidden underneath the breasts. This is the most commonly used these days by Dr. Zamarian;
• Inferior periareolar (Webster): the incision is made at the lower edge of the areola, following its shape, resultung in a half-circle scar. As it cuts half of the milk ducts, it can affect either breastfeeding or the sensitivity of the areolas;
• Vertical: it extends from the lower edge of the areola to the inframammary fold, without affecting breastfeeding or the sensitivity. It is often used in cases of mastopexia with silicone breast implants;
• Transareolopapilar (Pitanguy): horizontal incision that divides the areola and the nipple (papilla) in half. It does not cause injury to the milk ducts and it does not affect breastfeeding nor sensitivity. It may result in a noticeable scar across the areolas, though;
• Transaxillary: this incision is made in the armpit, followed by a detachment of the pectoralis major muscle. It is not used by Dr. Zamarian Jr. as it increases surgery time, difficults the visibility in case of bleeding, and may leave an unaesthetic scar under the armpits;
• Transumbilical (TUBA): the TUBA incision or belly-button incision is made on the edge of the belly-button. It is commonly used in the US, as it is recommended for saline implants but not for silicone implants.

The choice for the best approach for your breast augmentation with silicone implants will be discussed with Dr. Zamarian Jr., to bring out the best results for your case.

Preoperative evaluation

Consultation

During the consultation, the patient is asked to explain in detail how she would like her breasts to look like. It is advisable to be clear about the expected result and whether she wants bigger and more noticeable breasts or smaller, more natural-looking ones.

Then, Dr. Walter Zamarian Jr. will evaluate the anatomy of the patient, the width of the chest, her height and weight, the width of the breast base, the size of the areolas, the amount of skin and the thickness of the dermis, plus the thickness of breast gland that will cover the silicone implants.

Choosing the volume

The size of the breast implants is chosen by the patient, after being counselled by Dr. Zamarian. He will help the patient try on moulds of different volumes before she makes her coice. Dr. Zamarian gives some suggestions, based on his experience and the patient's expectations, but the final decision is always the patient's. The result of this is an increasing level of satisfaction.

In the Zamarian Clinic, various volumes are used. They vary from 190 to 505 ml, but the most commons are:

• Round: 240, 255, 280, 335 and 390;
• Conical: 245, 275, 300, 325 and 375.

Required tests

Before a silicone implant plastic surgery, some tests are required, for safety reasons:

• Complete blood count + platelets;
• Coagulation tests (PT-INR + APTT);
• Urea;
• Creatinine;
• Fasting blood glucose;
• Total serum protein;
• Urinalysis (UA);
• Electrocardiogram and
• Cardiac evaluation.
• Breast ultrasound for women under 35 and mammography for women over 35.

Anaesthesia

Dr. Zamarian performs augmentation mammoplasty in the operating room, providing the patient with great safety. The anaesthesiology team that assists Dr. Zamarian in the surgeries is extremely careful and uses top notch and safe general anaesthesia, allowing the patient to wake up three minutes after the procedure ends.

Postoperative care

The augmentation mammaplasty is quite simple and is usually performed in the morning. The patient is admitted to hospital two hours before surgery, and stays for 24 hours. Next morning, Dr. Walter Zamarian Jr. removes the suction drain and changes the dressings. Nurses help her to put on the postoperative bra. The patient is the discharged from hospital and can go home. The patient should take the following postoperative precautions:

• Breast skin hydration: it can be done with wild rose oil, starting before or soon after the surgery. Dr. Zamarian Jr. Recommends not applying the oil very close to the cyanoacrylate adhesive, so as to avoid the glue to be removed too soon;
• Dressings: they should not be wetted until the first return consultation with the doctor, which usually happens around the third day after the surgery;
• Bras: postoperative bras should be seamless, usually manufactured with laser cut technology, to protect the scar. They should be very comfortable, loose, since its function is simply to support the breasts. Dr Zamarian recommends wearing this type of bra for two months;
• Smoking: the patient should not smoke fifteen days before and fifteen days after the surgery;
• Nutrition: totally free, there are no restrictions, which means that the patient can eat everything, including eggs, fish, pork and chocolate;
• Sun: who has undergone silicone prosthesis implant should avoid the sun for six months, and after the third month she can be exposed to the sun in the early morning (from 8 a.m. to 10 a.m.) and at the end of the day (from 4 p.m. on) spreading sunscreen factor 30 or 40 on the scars;
• Resting: in the first 30 days, the patient should sleep on her back. After this period, the patient can sleep on her side, and only after the second month, she can sleep on her stomach;
• Physical activities: until the first month it is not recommended to carry more than five kilogrammes of weight or make physical efforts. After 30 days, the patient can perform light physical activities and carry weight up to 15 kg, bearing in mind that heavy physical activities are allowed only after the second month;
• Environment: Always give preference to fresh places with air conditioning, if possible, always remembering that heat increases the swelling of the breasts;
• Movement of the arms: after the breast implant plastic surgery, the patient can perform all the movements keeping the elbows below shoulder level. She can even comb their hair and brush her teeth, with the elbows down;
• Driving: the patients can start driving again after three weeks;
• Sexual intercourse: not allowed during the first month after the surgery.

In a nutshell: after a month, the patient can sleep on her side, go for a short walk, go biking, drive (after three weeks), lift her arms, lift light weight (up to 15 kg) and have sex. In two months, she can carry out any physical activity, including working out with weight.

Is it painful after the surgery?

This surgery is usually virtually painless, except for cases of sub-muscular implants, which can be uncomfortable. Anyway, if Dr. Zamarian, during the patient’s hospital stay, notices that she needs a greater dose of painkillers, he prescribes stronger drugs to be taken at home in order to soothe pain and make the postoperative period as comfortable as possible.

What if I don’t have enough skin?

Normally the inframammary fold is repositioned about 2-4 cm below the original one. Most patients do not have, in this area, enough skin to give the silicone implant its necessary final contour. The implant will exert a pressure on this area’s skin, from the inside out, which will expand it and, from 2-6 months, there will be enough skin to give a round and attractive contour to the inferior pole of the breast.

Smoking

Any patient undergoing any plastic surgery, including breast augmentation with silicone, must stop smoking, since it affects the healing process. A recurring question is: “Not even one cigarette, doctor?” Not even one. One or twenty cigarettes a day will, the same way, affect healing. So, smoking should be avoided.

Breastfeeding

In general, silicone breast implants do not affect breastfeeding, particularly if the inframammary fold incision technique is used, as no milk ducts are cut. However, a breast augmentation surgery is only recommended about six months after the end of the breastfeeding period.

Replacement

Dr. Zamarian Jr. recommends an annual MRI exam after the tenth year with breast implants and the replacement should be performed when the exam shows alterations or upon the patient’s request. On average, breast implants are replaced between 10 and 15 years after the surgery.

Stretch marks

What are they?

Stretch marks are linear atrophies which appear after the rupture of elastic fibres that support the middle layer of skin, as well as when the skin collagen is affected. Both cases are either the result of mechanical stress, like the excessive stretching of the skin or physiological stress, which is stimulated by hormones. Once the fibres are broken, they are soon filled with blood and that is why the recent stretch marks are reddish. Some lesions, then, occur, and they appear on the surface of the skin like mini scars. As time goes by, they become whitish.

Stretch marks x breast implants

The breasts, whose skin's fragility increases with the placement of silicone implants, can develop stretch marks. This is due to the stretching of the skin caused by the volume of the implants, especially while the breasts are very swollen. Hormonal changes can also facilitate this occurrence.

At the Zamarian Clinic, stretch marks after breast augmentation with silicone implants are very rare, but when they occur, they are easily treated with retinoic acid at five per cent.

Prevention

Dr. Zamarian Jr. always recommends immediate postoperative hydration with wild rose oil, since in its formulation, there are emollient properties that increase skin lubrication, helping its natural moisturizing process. Why? It contains Vitamin E. It is important to say that the wild rose oil helps prevent stretch marks by causing a deep hydration of the skin.

The oil should be applied at night before going to bed, on very clean skin. Put a few drops of oil on the area to be hydrated, spread it with circular movements and massage the skin gently until the oil is absorbed. In cases of very dry and fragile skins, it is recommended to apply it twice a day. Preferably, the patient should not be exposed to the sun when applying the product on the skin.

The drain used by Dr. Zamarian Jr. reduces the amount of breast liquid and volume during the postoperative period, also helping to prevent stretch marks.

Treatment

As mentioned above, the best alternative for treating recent stretch marks which appear after the breast enlargement surgery, is the retinoic acid at five per cent. Dr. Zamarian Jr. applies the acid weekly, which makes stretch marks fade away in about two to six weeks.

Special cases

Tuberous breast

Also known as tubular breast, it is a severe deformity that may occur in one or both breasts. The breasts develop with an abnormal shape, like a tuber (tuber = root) due to the presence of a fibrous ring that is located in the mammary base, which restricts breast's width. It does not allow the breast to develop neither horizontally nor vertically, forcing it to develop only towards the areola. That is, the breast's shape is cylindrically elongated, and its inframammary fold is higher than the nipple. Although it is very common amongst indigenous women, it can affect all races.

The treatment of tuberous breast with silicone implants consists of:

• Removing the skin around the areola to flattened the breast;
• Making relaxing incisions inside the breast to widen its base;
• Displacing the inframammary fold to a lower position and
• Use a round silicone implant with wide base and moderate profile.

Poland syndrome

The associations of the signs listed below characterize the Poland syndrome:

• Unilateral absence of pectoralis major muscle (if it's the only sign, it's considered a monotypic form of the syndrome);
• Syndactyly (two or more fingers joined together) on the same hand;
• Brachydactyly (fingers that are shorter than normal or shorter than the fingers of the other hand).

Other signs that can also be present:

• Hypoplasia or agenesis (atelia) of the nipple;
• Hypoplasia (hypomastia) or agenesis (amastia) of the breast;
• Fat hypoplasia (subcutaneous fat);
• Absence of costal cartilages (II, III and IV or III, IV and V);
• Hypoplasia of the proximal portion of the ribs.

The physical examination to find out if there is an absence of the pectoralis major muscle, to investigate the suspicion of the Poland's syndrome, is done by asking patients to put their hands on the hips and force the waist inwards while the doctor tries to palpate the chest muscle contracted at armpit level. A tomography or an ultrasound exam is used to confirm the absence of the pectoralis major muscle.

The Poland syndrome is described here since its treatment in women includes placing silicone implants in the breasts. This surgery often needs some adjustments, such as surgical correction of asymmetric breasts, or simply the use of silicone implants of different sizes. The brachisyndactyly can be treated with a specific technique that involves local flaps and grafts. Some mild chest deformities and even some moderate ones do not require specific treatment, while some other cases may need some muscle flaps (myocutaneous). When there is lack of skin in the area to adequately cover the silicone implant, a tissue expander can be previously used for better results.