Breast augmentation in Valencia

1. In a breast augmentation surgery, the process of marking and pre-design before the intervention is crucial, as we will mark the anatomical references that will allow us to optimize the position of the implants intraoperatively. It should be noted that although we generally observe the breasts during everyday life in a standing position, during surgery, the patient remains in a supine position (lying on their back), so the anatomical references change position when lying down, which gives even more importance to the marking in a standing position. We will mark the midline, the position of the prostheses, the margins of the breast pocket that we will design, the point of access to the pectoral muscle (in case of placing the prostheses in a subpectoral plane), and the position of the scar.
2. Once the marking is done, the process of general anesthesia begins. A peripheral venous access will be taken to administer the medication, the patient will be positioned on the operating table, and the anesthetic medication will be administered.
3. The breast operation begins by making an incision at the planned point of entry, either submammary, areolar or axillary. Then, the breast pocket is prepared, which is the technical name for the space in which the prosthesis will be housed. This pocket can be made in front of the pectoral muscle (subglandular), below the fascia of the pectoral muscle (subfascial), and below the pectoral muscle (subpectoral). To avoid bleeding during the intervention, an electrosurgical device is used at all times during the dissection, which allows us to control any type of hemorrhage.
4. Once the breast pocket is prepared, we perform an intraoperative measurement of the width of the space generated, which allows us to choose the prosthesis that fits more precisely to the anatomy of our patient. We always have three sizes of prostheses in the operating room, which have been previously selected and agreed upon between the patient and the surgeon; and the only difference between those 3 prostheses are around 3-6mm in width.
5. Then, the breast pocket is washed with an antibiotic solution, which includes Vancomycin, Gentamicin, and physiological saline, with the aim of maximizing the cleanliness and asepsis of the procedure. In addition, various scientific studies have concluded that there is a lower incidence of complications, such as capsular contracture and infection, when this type of washing is done prior to the implantation of the prostheses. Also, the prostheses are immersed in this same antibiotic solution before implantation. We will also apply antiseptic (chlorhexidine) to the skin around the point of entry of the prostheses.
6. After placing the prosthesis in position, final adjustments are made, the groove is anchored (if necessary) to help maintain the scar in its position, and the scar is closed with an intradermal suture that will minimize the resulting scars.
7. Finally, we will place a compression dressing, which will help keep the prostheses in position, reduce inflammation and the risk of bleeding.

There are generally 3 types of approaches (or scars) in breast augmentation surgery in Valencia, which can be located:

• In the submammary crease: In this case, the scar will be hidden in the fold that forms at the bottom of the breast. In that position, the scar is covered by the lower pole of the breast, being practically imperceptible. Therefore, whenever it is possible to perform this type of approach, and our patient agrees, it will be our first option.
• In the areola: In this case, the scar is made on the lower edge of the areola. The reason for placing it in that position is that the scar is camouflaged in the transition between the pigmented skin of the areola and the skin of the rest of the breast.
• In the armpit: In this case, the scar is positioned on the posterior edge of the fold that forms the pectoral muscle in the armpit; away from the breast. However, using this type of technique, it is essential to use saline implants (which are inserted deflated and filled with physiological saline once placed). In addition, the axillary route does not allow precise adjustments of prosthesis placement and the submammary crease, as the access is far away.

Our preference, therefore, is to individualize the type of approach according to each patient, taking into account their anatomical features and also their personal preferences.

The type of anesthesia necessary for breast surgery is general anesthesia, usually using a less invasive type of intubation than usual, using a laryngeal mask.

Performing breast surgery with local anesthesia and sedation can involve a great deal of discomfort for the patient, discomfort and pain during the procedure, less precision, and a higher risk of contamination of the prostheses.

Breast augmentation with prostheses is a procedure that, when performed in the appropriate conditions of safety, has limited risks. However, the fact of introducing an artificial material into the body (the breast implant), can imply a series of complications or problems in the medium and long term, which can condition the need to replace the prostheses.

Below are some of the main possible short-term complications (in the first month):

• Infection of surgical wound or prosthesis: This is a very rare complication caused by the invasion of the wound or prosthesis by bacterial flora. It is very rare for this complication to occur more than 2 weeks after surgery. To reduce the risk of occurrence, we perform intraoperative washings with antibiotics and antiseptics of the breast pocket and prescribe preventive antibiotics during and after the operation.
• Hematoma or bleeding: At the end of surgery, there will be no bleeding point thanks to hemostasis using electrocoagulation. However, during the postoperative period, a sneeze, a cough, a vomit, a bad movement or sudden effort, can cause some small blood vessel of the breast pocket to start bleeding. If that happens, and there is a drain, the blood will be evacuated and if the bleeding subsides with compression, nothing else will be needed. If the patient does not wear drains, we will have to go to the operating room to drain the blood clots accumulated.

As for long-term risks, which are also the possible complications that can condition the need to replace the prostheses, the following are found:

• Late seroma: It consists of the accumulation of serous fluid in the cavity where the prostheses are housed. Normally, the seroma usually subsides spontaneously with anti-inflammatory and preventive antibiotic therapy.
• Prosthesis rupture: Although it is a very infrequent complication with 5th generation prostheses (currently used), it is a complication that can occur. Thanks to the capsule that surrounds the prostheses within the body, it is highly unlikely that the silicone, even with broken prostheses, migrate to other parts of the body.
• Capsular contracture: When we introduce breast implants in the body in a breast augmentation surgery, the body creates a circular scar that surrounds the breast implants and keeps them isolated from the blood circulation. That scar is called capsule. Over time (generally between 10 and 20 years), the capsule thickens, and may compress and deform the implants, causing an aesthetic alteration. This is not an essential condition to change the implants if there is no pain. Sometimes, the thickened capsule causes pain due to compression or inclusion of a sensitive nerve branch, which clearly indicates the need to replace the implants. In very isolated cases, contracture can appear early (in less than 5 years), or not appear until very late stages (beyond 20 years).
• Prosthesis rotation: After the breast surgery, the prosthesis can rotate slightly. In the case of anatomical prosthesis, due to their shape, a rotation, however slight, can cause a perceptible deformity. In the case of round prosthesis, for a perceptible rotation to occur, the prosthesis must rotate completely, a situation that is very unlikely, but more frequently associated with the use of large size prosthesis.

In addition, in recent years, a rare complication, anaplastic large cell lymphoma, has been discovered, which is associated with a type of prosthesis that has been removed from the market a few years ago (Allergan macrotextured, surface called Biocell). In several recent studies, an incidence of this complication of 0.28% was observed in patients with breast implants removed from the market (Allergan macrotextured, Biocell surface). While microtextured implants had an incidence of 0.002%, or 1 in 36730 women with implant.

Bibliografía

1. Santanelli di Pompeo F, Sorotos M, Clemens MW, Firmani G; European Association of Plastic Surgeons (EURAPS) Committee on Device Safety and Development. Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL): review of epidemiology and prevalence assessment in Europe. Aesthet Surg J. 2021;41:1014–1025.
2. Loch-Wilkinson A, Beath KJ, Magnusson MR, Cooter R, Shaw K, French J, et al. Breast implant-associated anaplastic large cell lymphoma in australia: a longitudinal study of implant and other related risk factors. Aesthet Surg J. 2020;40:838–846.

Breast augmentation surgery in Valencia can be done on an outpatient basis (without spending the night in the hospital) or with 1 day of hospitalization. In this sense, the decision depends on each patient, as the safety of performing the procedure on an outpatient basis is guaranteed and is a common mode of procedure. However, many patients prefer to spend the night in the hospital to increase the sense of security provided by postoperative hospital care.

Generally, patients from farther provinces tend to opt for staying overnight in the hospital (since they would have to spend the night in a hotel anyway), but those from nearby provinces such as Albacete, Teruel, Castellón, Alicante or municipalities of Valencia often choose to perform the procedure on an outpatient basis.

In the postoperative period of breast augmentation in Valencia, there are a series of measures that allow optimizing recovery and reducing the possibility of complications:

• After the operation, we will place a compression dressing, which must be kept in place until the first examination we perform in the clinic, which will take place 48-72 hours after the operation. Afterwards, we will change the dressing for a more comfortable compression bra, which should be worn 24 hours a day for 1 month, only removed for personal hygiene
• Sleep on your back (face up) for at least 3 months. Sleeping on your stomach or side should be avoided, as these positions can cause the implants to move and produce a deformation of the breasts.
• Avoid carrying weight with your upper limbs, and do not raise your arms beyond the horizontal line. These restrictions should be even more strictly followed when the implant is placed under the muscle.
• Daily care: Apply chlorhexidine to the steri-strips (tape) covering the incisions
• Take the prescribed medication: Usually, an antibiotic to prevent infection of the wounds and analgesic medication to optimize pain control.
• Do not drive until 15 days have passed since the operation
• From one month after the operation, you can resume sports activity that involves making efforts with your arms.
• Once the stitches are removed, moisturizing cream should be applied to the scars and the scars should be protected from sun exposure for one year (even on cloudy days) to ensure the best possible healing.

We regularly receive patients for breast augmentation from other regions, although patients from adjacent provinces such as Albacete, Castellón, Teruel, or towns in Valencia. In all cases, in addition to in-person visits, we offer the possibility of direct and constant contact, and follow-up by video conference.

The postoperative period of a breast augmentation in Valencia is usually not painful. The time when there may be more discomfort is during the first night after surgery. However, to prevent this, our anesthesiologist performs a long-lasting block of the sensitive nerves in the chest area to reduce pain in those first hours. In addition, we will prescribe sufficient pain medication to achieve adequate pain control during the early postoperative period. It is very important to strictly comply with the schedules of the analgesic regimen so that they can achieve their optimal effect.

When it comes to having a breast surgery in Valencia, there are no relevant reasons to justify the procedure at any specific time of the year. Especially in the summer, when exposing to the sun in underwear or bikini, it is recommended to apply sunscreen even under clothing or swimwear, as UV radiation negatively affects the evolution of scars, can worsen their results and can penetrate synthetic fabrics.

What should be taken into account is that after surgery, a period of rest is necessary in which no effort is made with the arms for at least 2 weeks (depending on each case and each type of activity or work).

After undergoing a breast augmentation in Valencia, the results are immediately visible. However, after the breast surgery, there is a significant inflammatory process (especially if the implants are positioned in a subpectoral plane), and the breasts will present an unsightly appearance and a hard consistency until that inflammatory process subsides.

Generally, a month after surgery, the inflammation will have subsided almost completely, and the result will resemble the final one.

However, the final aesthetic result will be the one we observe at 6 months after the operation, as during that early postoperative period, the skin can stretch, the implant can shift slightly, and there is a slight degree of inflammation that also needs to subside.

The most determining factor that will affect the length of sick leave after a breast augmentation in Valencia is the type of physical effort that must be performed at work. An office job, that does not involve physical activity or carrying weights, could be resumed up to a week after surgery, although two weeks of rest would be more advisable, as it is the time when the stitches would be removed.

In the case of jobs that require greater physical effort, the optimal recovery period is 4 weeks after surgery, to try to ensure that there is no displacement of the implants caused by those efforts.

However, another determining factor of the postoperative physical recovery time should be taken into account, which is the plane in which the implants have been placed. When the implants are located below the pectoral muscle, they will be more affected by physical efforts, but when they are in a subglandular or subfascial plane, physical activity can be resumed earlier, as the movement of the pectoral will not compress the implant.

There is a myth that breast implants can burst when a person with breast implants travels by plane. This myth was popularized in Spain as a result of a series of news that emerged in relation to the actress Ana Obregón, however, there is no scientific basis to justify this possibility.

Anyone who has undergone breast augmentation surgery can travel by plane without fear of increasing the incidence of complications due to having breast implants.

Before providing a direct answer to that question, it should be taken into account that when it comes to breastfeeding, in the general population, there is a certain percentage of possibilities that a healthy woman may not be able to breastfeed (regardless of whether she undergoes surgery or not).

The risk of interference with breastfeeding depends on the type of surgery performed, especially whether the surgery involves the cutting of the glands or lactiferous ducts.

In the case of a breast augmentation in Valencia, as long as the approach is through the submammary or axillary groove, the risk of interference with the ducts that transport breast milk is nonexistent. When the approach is made through an areolar incision, it is possible that some lactiferous ducts are cut, but only a very small fraction of them, so the interference with breastfeeding is also very rare.

In the case of treatment of tuberous breasts, one of the surgical steps involves the opening of the breast gland to achieve its expansion, so the risk of interference with breastfeeding is greater than in a simple breast augmentation. In the case of a breast lift with implants or mastopexy, or a breast reduction, the T-scar implies a greater possibility of interrupting the ducts of the glands that produce breast milk, so the risk of not being able to breastfeed is greater.

During pregnancy and breastfeeding, it is common for significant changes to occur aesthetically in the breasts. Generally, there is an increase in size that after breastfeeding, decreases significantly, favoring the sagging and falling of the breast glands. However, these breast changes do not occur in all pregnancies.

Therefore, when pregnancy occurs after a breast augmentation surgery, there is a possibility that a worsening of the aesthetic result will occur as a result of the changes associated with pregnancy and breastfeeding. However, this aesthetic worsening does not happen in all cases.

For this reason, our recommendation is that if pregnancy is expected in the medium term, the breast surgery should be delayed until it is known with certainty that no more children are planned, in order to ensure results and avoid the need for secondary surgeries.

Although there is the belief that artificial interruption of breastfeeding can prevent the aesthetic alteration of the breast secondary to breastfeeding, the pregnancy itself, without breastfeeding, can be enough to produce a notable worsening of the aesthetic of the breast after a breast augmentation in Valencia.

After a breast augmentation with implants, the popular belief that implants should be changed every 10 years is a false myth that has nothing to do with reality. Breast implants should be replaced only when complications related to the use of the implants, such as Baker grade IV capsule contracture, or implant rupture arise.

These complications usually appear around 15-20 years after the surgery. However, there are also rare cases in which these complications can appear early, before 5-10 years, and other cases in which they can appear late, beyond 20-30 years.

After breastfeeding is completed, 3 to 6 months should be waited before undergoing a breast augmentation in Valencia, (Castellón, Albacete, Teruel).

The cost of a breast augmentation in Valencia can vary depending on the type and brand of implant used, the anatomical variations that each patient presents, and the techniques that must be used, which can condition a longer surgery time. A breast augmentation operation in Valencia has the following approximate costs:

• Breast augmentation with round implants: 5000-5600€
• Breast augmentation with anatomical implants: 5600-6200€
• Correction of tuberous breasts with round implants: 5600-6200€