• Placement of breast implants retromusculares
• Breast Reduction
• Breast lift or mastopexy
• Breast Reconstruction
• Reconstruction of areola and nipple
first results were presented in the international congress of plastic surgery in 1963, from then the implants gained popularity and only in the United States, mas of one million and a half women already they received mammary implants.
The wrapper of the protheses is a set of polímetros of silicone. The quantity of polímetros determines the consistency and characteristics of the silicone altering his flexibility and permeability.
The types of implants can be classified in:
1. Implants of silicone with smooth coverage.
2. Inflatable protheses with saline solution.
3. Prothesis of silicone with coverage of polyurethane.
4. Prothesis of silicone texturized.
5. Double prothesis lumen.
6. Triple prothesis lumen.
7. Prothesis implants – expansor
Those who mas are used are the texturized protheses because they are those that fewer capsular contractions cause.
The exit ramps to the surgical plane antero – muscular and retro – muscular they can be across four routes:
1. Route Axilar: The advantage of this route is of not leaving scars in the mammary gland. But the disadvantage is 9 % of asymmetry in the ruts inframamarios due to the difficulty to liberate the low fibers of the pectoral one.
2. Route Areolar: The advantage of this route is that the scar can be camouflaged in the complex areolo-mamilar. Disturbances of sensibility are frequent in postoperatory immediate, such as hiperestesias, hipoestesias, alterations in the tactile perception and in the erection of the mamilo, coming back to the normality between two and six months. Scarcely 15 % presents alterations of sensibility after two anuses related to big implants.
3. Route Inframamaria: this route is chosen when the areola has less than four centimeters of diameter, the disadvantage of this method is the evident scar the first months.
4. Umbilical route: By this ramp of alone access the inflatable protheses can be placed, that is to say of saline solution.
The location of the implants, antero or retro muscular it depends on the quantity of mammary and adipose fabric of every patient. It is preferable retro-muscular in the too thin patients, to obtain a result mas naturally.
Complications: Bruise from 0,4 to 9.5 %, extrusion and break of the implant less 1 %, voidance is the principal complication of the inflatable protheses is from 0.5 to 76 %: disturbance of the sensibility and pain from 15 to 50 %, infection of the 1 to 4 %, muscular contraction can appear from three days up to anuses after the placement of the implant.
Several auxiliary procedures have been tried to avoid the contraction as the inter-operative use of corticoides, administration oral route of vitamin And and massages in the postoperatory one, without it has been demonstrated that this improves statistically the capsular contraction.
The mammary implants do not have any paper in the etiology of the mammary cancer, as well as it does not accelerate the evolution of a mammary cancer. The mammary implant can interfere with the precocious diagnosis of the cancer of breast, for impeding the accomplishment of the mamografía.
The surgery lasts approximately 2 hours, leaving the minor possible scars and to obtain a perfect proportionality with the thorax, the hips and the abdomen of every patient is the ideal result that both the surgeon and the patient must achieve.
In postoperatory the use of antibiotics, antinflamatorios is an agent chief executive, as well as the long use of a strip, that I recommend minimum for one month, as well as the lymphatic drainages.
It is the fall of the mammary glands, and of the nipple below a horizontal imaginary line that happens for the half of the arm. The mammary gland and the fat are supported in his normal position by the skin; this when it is distended by pregnancies, with the consistent nursing or by growth exaggerated in patients that children have not stretched, or in obese patients who have slimmed and for action of the gravity, this skin loses elasticity, producing the PTOSIS IT WOULD SUCK or the fall of the breasts.
Depending on the degree of ptoses and between the quantity of fat and of mammary gland to be withdrawn the ideal technology will be chosen, always thinking of leaving the minor scars and less perceptible. The examination of the breasts must be careful, looking for nodules or other pathologies that they could counter
indicate or reaffirm the need of surgery. Therefore the radiological evaluation preoperatoria is mandataria as well as the examination anatomopatológico of the retired gland. In spite of there being increasingly technologies and modifications, always we have to fight against the scars, which can turn hipertroficas or queloideanas.
The complications exist like in all the surgeries, the most difficult to resolve: they are the necrosis of the areola, which can happen in the big hypertrophies, in the smoking patients. Another important complication is the loss of sensibility, which in most cases they are of reversible character, and also they happen in the big hypertrophies. Minor complications, they are the bruises, infections, mas with the antibiotic coverage it is very under the index of this complication.
The most frequent complication they are the scars hipertroficas that in spite of there being increasingly complementary treatments for this has not been achieved to avoid completely. The investment of the nipples, asymmetries in the form of the breasts, also they are complications, but these of less complicated resolution.