| Q·
DOES BREAST-ENLARGEMENT SURGERY LEAVE SCARS? |
A·
Fortunately, in this surgery scars can be placed to be as inconspicuous
as possible, which is very convenient in the first months. The following
description of the several stages scars inevitably go through will help
you gain a better understanding of the scarring process:
A- IMMEDIATE
STAGE: For the first 30 days, the scar has an inconspicuous appearance.
In some cases, a mild reaction to the stitches and/or dressing may occur.
B- INTERMEDIATE
STAGE: The intermediate stage extends from the 30th day to the 12th
month and is characterized by the natural thickening of the scar, which
shifts in colour from reddish to brown, then to gradually lighter tones.
This is the most unfavourable stage, causing patients the greatest anxiety.
Since there is no means of speeding the natural scarring process, it
is important to keep in mind that optimal appearance is only achieved
at the late stage.
C- LATE
STAGE: The late stage extends from the 12th to the 18th month. The
scar gradually flattens and becomes lighter in colour until it eventually
achieves its definite look. With regard to the scar, any assessment
of the final outcome should only be made after this period.
| ·
Q: WHERE ARE THE SCARS PLACED? |
·
A: Some surgeons place the scars in the inferior breast pole and in
the crease where the breast meets the thorax, while others place them
around the areola, or in the armpit. Since they are quite inconspicuous,
a plunging or “thoroughly revealing” neckline can be worn
as early as the first days following surgery. Scars will fade with time
(see previous answer).
| ·
Q: I HAVE HEARD THAT SOME PATIENTS ARE LEFT WITH UNUSUALLY PROMINENT
SCARS. |
·
A: Some patients are prone to developing hypertrophic or keloid scars.
This tendency can be evaluated to a certain extent at the initial consultation,
when you will be asked several questions about your medical history
and your family’s characteristics, which are of great help to
the prognostic evaluation of scars. In general, this scarring complication
is unlikely to occur in fair-skinned people, while dark-skinned people
are more prone to it. However, this is not an absolute rule. As was
mentioned, the analysis of your medical history, your family’s
characteristics, and any scars you might have from previous operations,
will facilitate the prognosis.
| ·
Q: CAN HYPERTROPHIC/KELOID SCARS BE CORRECTED? |
·
A: Various medical and surgical means enable surgeons to improve the
appearance of unsightly scars at the appropriate time. However, this
complication should not be confused with the intermediate stage of the
scarring process. Any doubts concerning the development of your scars
should be addressed with your surgeon, who will evaluate their condition.
| ·
Q: WHAT WILL MY BREASTS BE LIKE, WITH REGARD TO THEIR SIZE AND
FIRMNESS? |
A: Augmentation
mammaplasty is a surgical procedure to enhance the volume, shape, and
firmness of a woman’s breasts. Since silicone prostheses are available
in many different sizes, the choice of the new volume depends only on
the size of the thorax. Thus the surgery can be planned to make the
breasts in better proportion with the rest of the body, thereby enhancing
the patient’s overall figure shape. The new breasts will go through
several stages of development:
A- IMMEDIATE
STAGE: The immediate stage lasts 30 days. In this time period, although
the breasts have a much better appearance, their final size and shape
have not been reached yet. Keep this in mind: BREASTS WILL NOT LOOK
“PERFECT” AT THE IMMEDIATE POST-OPERATIVE STAGE.
B- INTERMEDIATE
STAGE: The intermediate stage extends from the 30th day to the 3rd
month. In this time period the breast begins to approach its final shape.
This stage is characterized by some swelling, which varies with each
patient; in addition, the appearance of the scar is well in the transition
phase (see answer 1). Nevertheless, most patients are already euphoric
with the result, and we usually have to tell them to wait until the
late stage, when optimal appearance will eventually be achieved.
C- LATE
STAGE: The late stage extends from the 3rd to the 18th month. This
is the period when the breast achieves the definite result regarding
shape, firmness, volume, sensitivity, scar, etc. Photos of the patients
are usually taken by the end of this stage, and compared to those taken
before surgery. The degree of elasticity in the skin of the breast and
the volume of the implant both play a very important role in the outcome.
The balance between them varies with the patients.
| ·
Q: WHEN WILL I HAVE THE DEFINITE RESULT? |
·
A: Although the immediate result is very good, the breasts will only
reach their final shape at the late stage of development (see previous
answer).
| ·
Q: WHAT TYPE OF SWIMWEAR CAN I WEAR AFTER SURGERY? |
·
A: During the immediate, intermediate, and late stage, any type of either
one- or two-piece swimwear, providing the top is not too tight-fitting.
Obviously, after maturation of the scars, the choice of more revealing
bathing suits will depend only on your own judgement.
| ·
Q: WILL A SUBSEQUENT PREGNANCY AFFECT THE RESULTS? |
·
A: Your gynecologist will tell you whether pregnancy is advisable or
not. The results can be maintained, providing your weight gain is controlled
by this specialist throughout your new pregnancy. Since the breast implant
is placed “outside the breast tissue” (i.e. it is inserted
either directly under the breast tissue or beneath the pectoral muscle),
pregnancy does not usually affect the results of breast enlargement.
| ·
Q: IS THE POST-OPERATIVE PERIOD PAINFUL? |
·
A: In general, NO. Once you follow your doctor’s instructions
– mainly concerning the moving of your arms in the first days
–, you will feel quite comfortable during the post-operative period.
Any occasional pain or discomfort can be relieved with the analgesics
prescribed by your doctor. Do not do any self-medication.
| ·
Q: ARE THERE ANY DANGERS ASSOCIATED WITH THIS SURGERY? |
·
A: Serious complications from augmentation mammaplasty are rare, not
only because each patient is properly prepared for this surgery, but
also because we ponder whether the use of silicone breast implants is
advisable, and consider all the risks and complications associated with
this procedure.
| ·
Q: WHAT TYPE OF ANESTHESIA IS USED? |
·
A: General, epidural, or local anesthesia, depending on each case.
| ·
Q: HOW LONG DOES THE SURGICAL PROCEDURE TAKE? |
·
A: It usually takes 90-120 minutes to complete. However, the operating
time should not be confused with the length of stay in the Surgical
Center, which also involves both preparation for anesthesia and post-operative
recovery. Your surgeon can tell you the total amount of time.
| ·
Q: WHAT IS THE LENGTH OF HOSPITALIZATION? |
A: 12-24
hours.
| ·
Q: WILL DRESSINGS BE USED? |
·
A: Yes. Elastic, shaping dressings, especially adapted for each type
of breast. They are to be changed by the patient herself, without any
difficulty, every day from the third day post-operatively.
| ·
Q: WHEN WILL THE STITCHES BE REMOVED? |
·
A: Usually, the stitches are removed by the 8th day after surgery.
| ·
Q: WHEN WILL I BE ALLOWED TO SHOWER? |
·
A: In some cases, as soon as the day after surgery. It all will depend
on your post-operative recovery and the type of dressings used. Your
doctor will give you special instructions for showering.
| ·
Q: WHAT IS THE POST-OPERATIVE PERIOD LIKE? |
·
A: You should bear in mind that your breasts will go through several
phases (see answers 1 and 5) before the expected result is eventually
achieved. Therefore, however anxious you may be to have the outcome
before its due time, you will have to be patient while your organism
spontaneously resolves all the immediate short-term effects that will
inevitably catch the attention of someone who will not refrain from
making a thoughtless remark, like “IS IT REALLY GOING TO GET BETTER?”
Needless to say, any questions or concerns you may have along this time
period should be addressed with your surgeon, who will give you all
the necessary explanations to ease your anxiety.
| ·
Q: WHEN CAN I RETURN TO MY EXERCISES? |
·
A: It depends on the type of exercises. Lower-limb workouts can be resumed
in 10-15 days, excepting high-impact workouts. In general, exercises
involving the thorax will have to wait until at least 30-45 days after
surgery.
| ·
Q: WHAT IS CAPSULAR CONTRACTURE? WHAT CAUSES THE BREASTS TO FEEL
HARD? |
·
A: Capsular contracture is an excessive tightening of the natural fibrous
capsule (i.e. scar tissue) around the implant, causing the breast to
feel hard to palpation. This problem occurs in some patients, requiring
removal of the implants through the same incisions that had been made
for their insertion. In the case of inflatable implants, some leakage
may occur in a small number of cases, requiring their revision. Since
the fibrous capsules around inflatable implants are very thin and rarely
cause hardening of the breasts, in some cases the implant can be felt
by slightly palpating the area. In the case of leakage, the implant
is more strongly felt. Later, surgeon and patient can discuss the advisability
of removal or replacement of the implant, a different method of insertion,
or other procedure that best corrects the problem. No matter how skillfully
the surgery has been performed, capsule contracture or deflation of
the prosthesis occasionally occur, as a result of an atypical reaction
of the patient’s organism to the silicone prostheses.
The surgeon is not liable for additional costs incurred in re-operation
that may be required because of capsule contracture, firm to hard breasts,
or late rupture and/or deflation of the prostheses. Technical innovations
in plastic surgery have substantially reduced the number of patients
with capsule contracture.
| INSTRUCTIONS
REGARDING BREAST-ENLARGEMENT SURGERY |
A) PRE-OPERATIVE
INSTRUCTIONS:
You will be doing yourself an invaluable favour by reading the following observations concerning the inevitable questions all candidates for breast-enlargement surgery ask their plastic surgeons.
