Breast augmentation was the most performed plastic surgery in the USA in 2014, according to the American Society of Plastic Surgeons - ASPS. In that year, 286 thousand augmentation mammoplasties were performed. Nose reshaping came in second, followed by liposuction. The demand for breast implants is significantly high. Nonetheless, it is important to know the details about this surgery so that everything goes accordingly and the desired results are achieved successfully.
Patients unhappy with their breasts, either because of their size, shape or appearance, can quickly solve their problem and raise their self-esteem. There are several breast augmentation techniques; many of them have been improved by Dr. Zamarian Jr. The objective of this surgery is to improve the breasts’ size and shape, remodelling them so that they have an attractive, firm and proportional aspect.
Dr. Walter Zamarian Jr, a board certified plastic surgeon, member of the ASPS and SBCP, has developed a great reputation for performing breast augmentation with silicone implants in Londrina, Paraná, Brazil. This surgery has become less invasive, faster and more effective, giving patients a young and sensual appearancein a safe procedure that takes a bit more than one hour.
Silicone, or polydimethylsiloxane, is a silicon by-product, an element similar to a metal that, when combined with oxygen, forms the siloxane. When it is heated and mixed with carbon at high temperature, plus an additional process, it is converted into a polymer called silicone.
This substance is considered inorganic and, for this reason, it is highly durable. It is odourless, tasteless, colourless and resistant to heat, water and decomposition by other oxidizing agents. It is available in liquid, gel or rubber-like consistency, also known as silicone elastomer. In medicine, silicone is one of the most inert (non-reactive) materials amongst all.
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.
Patients of 16 years old and over can undergo a breast augmentation cosmetic surgery, except for those whose first period have not occurred yet. In these cases, the surgery must be postponed until after the first period, as the breast maturity is accomplished by the menstruation.
Therefore, considering the ideal minimum age, the breast enlargement can be performed on patients who have:
It’s important to highlight that, women with very low areolas or severe breast sagging should undergo breast lift with silicone implants, also called mastopexy with breast implants.
In cases of breasts asymmetry, very often, silicone implants of different volumes are used in order to even out the size of the breasts. In cases of asymmetry and sagging, the patient should undergo a breast lift with implants, removing more tissue from the larger breast.
Many patients who want to reduce and lift the breasts through reduction mammoplasty prefer to also have silicone implants for two main effects: firmer breasts, with a nice cleavage. However, patients who want just to reduce their breasts, no matter the resulting shape and firmness, may opt for not having breast implants.
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:
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.
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:
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.
The silicone breast implants used by Dr. Walter Zamarian Jr. in Brazil are constituted by a thin silicone elastomer membrane, filled with highly cohesive silicone gel and coated with polyurethane foam. The high cohesivity provides great safety, since it prevents the silicone to spread through undesirable parts of the body in case of implant rupture.
In addition, breast implants coated with polyurethane have a ten-year warranty against capsular contracture. This is due to their lowest incidence of contractures compared to other surfaces, such as textured and smooth. Moreover, the European Commission's Scientific Committee on Health and Environmental Risks (SCHER) considered the Silimed high cohesivity silicone gel implant, polyurethane coated, one of the world's best silicone implants.
Having perky and natural looking breasts is the dream of many women, and since 2008 this wish has come true by the hands of a plastic surgeon: Noel Lima, M.D., in partnership with the Brazilian industry Silimed, developed a model of silicone implants in conical shape. Silimed is the only one to produce conical implants in the world. Conical implants are exported to more than 70 countries, today. In Londrina, Dr. Walter Zamarian Jr. is amongst the professionals who offer conical implants as a cutting-edge option for the patients.
The greatest advantage of the conical silicone breast implants by Silimed is that they add higher projection to the breasts, in a natural aspect, without increasing their width. This is a great option for women with narrow shoulders and sagging skin, who have lost weight significantly and whose breasts became flaccid.
The natural results achieved with conical implants have attracted the attention of both patients and surgeons around the world. By being focused on the breasts’ projection, large volumes are not necessary to accomplish the desired size. The choice of the ideal shape and size for your body type is made during the 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.
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:
Before a silicone implant plastic surgery, some tests are required, for safety reasons:
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.
The breast enlargement surgery begins with a marking on the skin, depending on the surgical approach chosen. Then, the incision is made through the skin and subcutaneous tissue, creating a space for the breast implant. Next, Dr. Zamarian conducts a careful hemostasis to prevent bleeding. A suction drain is placed and secured. The silicone implant is, then, introduced through the opening in the skin and comfortably adjusted to the surrounding tissues. Dr. Zamarian asks his team to rise the back of the operating table, to put the patient in the seated position, so that he can adjust the height and laterality of the breast implants. This is when the final position of the implant is determined. Then, the patient is put back in the lying position and the suture is made with internal absorbable stitches and cyanoacrylate glue on the surface of the skin, allowing for a better looking scar.
It is a device composed of thin semi-flexible tubes attached to a negative pressure system, which will work even when placed above the patient. It is introduced into the patient to keep the silicone implants dry and reduce the amount of liquid around them, since the body tends to produce about 100 mL of liquid in each breast in the first 24 hours after the surgery. The liquid is drained from the armpit, reducing dramatically the incidence of complications such as stretch marks, infection and capsular contracture.
The cyanoacrylate adhesive was recently introduced in plastic surgery and only a few surgeons use it. In Brazil, it is commercialized by Johnson & Johnson under the name of Dermabond, whose main characteristics are:
The silicone breast implant surgery is quite fast: it takes a bit more than an hour. Thus, the amount of anaesthetic administered to the patient is small and the recovery process is quite smooth.
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:
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.
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.
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.
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.
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.
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.
The insecurity of patients who undergo silicone implant surgery is totally understandable, especially when it comes to breast cancer, the second most frequent cancer in the world, according to INCA data.
The good news is that, a reliable scientific paper published more than five years ago, verified that the presence of breast implants in the breasts makes our body recruit a great number of defence cells against this foreign body. These same defence cells are responsible for exterminating breast cancer in its early stages. That way, if there is any relationship between breast implants and breast cancer, it is a good one. There is a larger number of immune cells in women with silicone implants, which can prevent the development of cancer, which means these women have better chances not to have breast cancer than women who have never undergone this type of plastic surgery.
Mammography is a special type of X-ray, specific for the breasts, known as mammography device. It is a diagnostic imaging which aims at capturing images of the breast tissue to evaluate the breasts. The mammography can not only detect the lesion in its initial stage, but it can also detect breast cancer up to two year before it becomes palpable. This is why, amongst other reasons, routine mammography is the best way to detect early alterations in the breast.
The mammography can usually be done in women with breast implants. In such cases, the Eklund technique is used which basically pulls the breast tissue away while displacing the implant posteriorly. This way, the x-ray will only reach the breast tissue. If, after the manoeuvre, there are still doubts about the diagnosis, an MRI is recommended.
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.
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.
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.
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.
Capsular contracture is the spherical scarring due to the shape of the breast implant with excessive contraction of the capsule (scar tissue).
Baker classified the degrees of capsular contracture as the scale shown below:
Dr. Zamarian Jr. explains that all patients who undergo silicone prosthesis implant surgery fit, at the beginning, in the first or second Baker's classification groups (grades I and II). He also explains that, normally, the patient remains in one of these degrees. The problem only begins to appear when the capsular contracture starts to move up to grades III and IV.
It's not considered a capsular contraction when the capsule is visible in thin patients, without hardened breasts or deformities which may change their anatomic shape. Visible capsule in skinny patients, forming waves, is called rippling, and may be treated with fat graft or changing the implants to a submuscular position.
Baker scale grades I and II are considered normal and no treatment is needed. It's considered a rejection when the contracture is of grade III, a moderate degree, with a deformity that changes the breast and moves it upwards, giving the sensation of tightness and hardness as well as in grade IV, considered the most serious, since the contracture is palpable, visible and the capsule visibly distorted, causing constant pain to patients.
The scientifically proved advantage of the silicone implants coated with polyurethane is that the chances of capsule contracture are minimal.
When the capsular contracture is classified as grades III and IV, the treatments used by Dr. Zamarian are the following:
With the treatment, the capsule goes back to grades I and II.
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:
The associations of the signs listed below characterize the Poland syndrome:
Other signs that can also be present:
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.
Find out how silicone breast implants can make your breasts look more attractive and sexy. Reveal the sensuality and all the confidence in you. After all, you deserve it!
Cosmetic plastic surgeon in Brazil
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Londrina - PR
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