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Breast augmentation or Breast Augmentation, Breast Implants, Breast Prosthesis.

It is the placement of breast implants or prostheses to increase breast volume. There are patients who, genetically, have small breasts and even alteration of the shape given by a high inframammary fold and very wide areola called tuberous breasts. In other patients, the volume decreases after breastfeeding or by massive weight loss. Finally, this surgery is useful in patients who require breast reconstruction either due to congenital defects such as Polland Syndrome, mastectomies or sex changes. Breast implants are bags or containers made of silicone on its wall or wrap and with a silicone or saline (physiological serum) filler. In Colombia, silicone gel is used more frequently since it gives a texture closer to the natural one.

Your plastic surgeon will review your medical history of importance and assess your breasts to explain the options available and allow your choice in terms of surgical approach, size and desired shape. If you smoke, use drugs such as aspirin, anti-inflammatories, vitamin E, corticosteroids or have spontaneous or prolonged bleeding, tell your plastic surgeon, it is important to avoid complications in surgery. You should also comment if you have had urological problems such as urinary infections as these can affect the prostheses.

There are several approaches to prosthesis placement. These can be placed by periareolar approach, that is, by the lower edge of the areola; by inframammary incision in which the incision is located in the lower fold of the breast and, finally, axillary, the prosthesis is inserted through the fold of the armpit. The periumbilical approach is described but requires inflatable prostheses in saline solution. As for the plane in which the pocket is made where the prosthesis will be located, it can be retroglandular, that is, exactly behind the breast; retropectoral or submuscular that is behind the pectoral muscle and finally retrofascial that places the prosthesis behind the gland but below the muscle envelope called fascia.

The next day you will feel tired and in pain, which is controlled with the medication prescribed by your plastic surgeon. You must use a flannel bra, sporty, to give the best modeling to your breasts 24 hours a day for 1 month; In addition this will limit the pain. The points will be withdrawn by 10-14 days. The use of swimming pool should be avoided the first 2 weeks as it favors infection. The sport and other physical activities can be done by 3, 4 weeks later. You may have decreased tenderness or tingling in the breasts, it will happen in a couple of weeks. The scar will be hard and reddish the first 6 weeks, then with the indicated care it will resume the same texture of the skin of the areola. It is recommended to perform annual control mammograms, they should be practiced in a radiological center with experience in reading projections taken for the breasts with augmentation prostheses.

Occasionally the implants may rupture or leak, due to trauma, strong compression or wear of the implant due to friction between the implant and the breast. If the implant has saline solution inside it, it will be reabsorbed by the body without complications. If the implant is made of silicone gel, the gel can be contained by the implant capsule. Any rupture of the implant requires removal and replacement. It is for this reason that monitoring with your family surgeon is essential. In some patients, capsular contracture can be found: which refers to the scar tissue that forms around the implant, making the breast feel hard or altering its shape. This is a reaction that depends on the organism of each patient. The treatment is based on a strict massage regime; in very few cases it is necessary to release the capsule surgically.

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Dr. Juan Esteban Vargas
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