WHAT ARE NORMAL BREASTS?
BREAST COMPOSITION
The breasts are formed with glandular tissues, connective and fatty tissue stroma with lactiferous ducts (to drain the milk to the nipple), arteries and veins, lymphatics and nerves, all of which are found underneath different qualities of skin that envelop the breast.
The breasts are situated over the Pectoralis Major and Minor Muscles.
Subcutaneous fat and intraparenchymal fat produce the softness of the breast and influence the shape and contours of the breast. But the shape also depends on the elasticity of the skin. A young females breasts are made up of more glandular tissues than fatty tissues, therefore making the breasts firmer. Glandular tissue gradually gets replaced by fatty tissue as the years go by. Therefore breasts with more fatty tissue than glandular tissue are less firm.
Pregnancies, breast feeding, diets, getting older and other factors also affect the shape of the breast.
As well as these factors, gravity also affects the upper pole, leaving it emptier.
BREASTS DO NOT HAVE MUSCLE. NO GYM ACTIVITY WILL INCREASE THE SIZE OF YOUR BREASTS.
BREAST SIZE
The lower pole of the breast has convexity from the nipple until the inframammary crease, and should measure between 5 and 7 centimeters.
The upper pole of the breast should have less volume and a soft convexity between the clavicle and the nipple and should measure between 19 and 21 centimeters.
The diameter of the areola should measure between 3.5 and 4.5 centimeters.
THE BREAST ARE NEVER EXACTLY SYMMETRICAL, THEY ARE ALWAYS DIFFERENT.
YOUNG BREASTS ARE ELEVATED AND FULL IN THE UPPER POLE BUT WHEN THE BREAST IS EMPTY AND FALLEN, IT IS A SIGN OF AGING.
DO I HAVE PTOSIS BREASTS/FALLEN BREASTS?
There are a lot of mechanisms that can produce a change of the position of the breast.
Ptosis is a result of the imbalance between the content of the breast and the skin. This causes the nipple to fall below the inframammary crease and below the horizontal line that passes at the height of the middle of the upper arm. The breasts fall down and the upper pole become empty.
Gravity, hypertrophy (increased breast volume), obesity followed by the loss of weight and changes in the amount of breast milk due to pregnancies cause stretching and loss of the elasticity of the skin and its attachment.
The breasts become saggy and often with stretch marks.
BREAST ARE CONSTANTLY CHANGES THEIR SIZE AND SHAPE.
INDICATIONS:
You will benefit if you have:
- Sagging breasts, the size of the breast is not important.
- If you have hypertrophy plus ptosis.
- If you have breasts that have changed after pregnancy or the loss of weight.
- Breasts with nipples bigger than 4.5 centimeters.
- Saggy and heavy breasts that produce marks on the skin from the bra.
- Lack of self esteem.
CONTRAINDICATIONS:
We will not operate if we believe that your objective is not realistic. IT IS IMPOSSIBLE TO OPERATE ON PEOPLE WITH EXAGERATED OR FANTASY EXPECTATIONS. I recommend you read the chapter “Psychological Aspects of Plastic Surgery” of this website.
- If you have poor health, above all cardiovascular and mental disorders we cannot operate.
- Those patients who smoke should stop completely at least one month before the operation because this operation may produce the loss of tissues.
- Patients who are addicted to drugs or alcohol.
- Patients who worry too much about small defects that in reality are very minute.
- Patients who will not accept the final scaring. ALL OF THESE OPERATIONS LEAVE SOME SCARING AND THE QUALITY OF THESE SCARS DEPENDS ON MANY UNKNOWN FACTORS.
SURGICAL OBJECTIVES:
- Restore the breasts to a young and attractive shape.
- Make the breasts firmer with a more natural shape.
- Reposition the nipple-areolar.
- Adjust the volume.
- Eliminate excess skin.
PLANNING THE SURGERY
BEFORE THE OPERATION
First you must undergo a complete medical examination. Then we will be able to give you in writing, the modifications that are suitable for you. We always do a photo session as a fundamental part of evaluating your case.
WITHOUT PHOTOS WE DO NOT OPERATE. IT IS ALSO VERY IMPORTANT THAT YOU REMEMBER THAT ALL THE INFORMATION YOU RECEIVE IN WRITING, SHOW AN ESTIMATION OF THE FINAL RESULT.
Between you, the patient and me the Plastic Surgeon, we should agree on the results that we are able to achieve.
- We ask for blood tests regularly.
- We always ask for a mammograms.
- If you have the flu or are menstruating, please communicate 3 days beforehand.
- Do not drink alcohol at least 24 hours before operating.
- Do not take ASPIRIN 15 days before operating
- Organize your activities so that you are able to rest after the operation.
- Do not drive your car for at least 30 days after the operation.
- Only begin physical exercise gradually 2 months after the operation.
ANESTHESIA:
- The first choice is General Anesthesia.
PROCEDURES:
- MASTOPEXY is a surgical procedure that aims at lifting the breast.
- There are different techniques depending on each individual case.
- All the following aspects must be considered: the degree of ptosis, nipple-areolar position, breast volume, breast parenchymal distribution, the inframammary crease, possible constrictions, facial attachment and the skin and tissue quality.
- Many of the techniques used here are also used in Reduction Mammaplasty. More information about these techniques can be found in the chapter “Reduction Mammaplasty”, also on this webpage.
- In some cases the Liacyr Ribeiro technique is used, to fill the upper pole.
- In other cases the Inferior Central Pedicle technique is used, normally when the breasts are very large.
- When there is minimum Ptosis, breast implants may be used.
REMEMBER THERE WILL ALWAYS BE SCARING.
- The most common technique leaves a scar similar to an anchor, situated around the nipple-areolar then moving down the center of the lower pole and a horizontal part below the breast.
- Operating time is estimated around 3 hours. Outpatient, being able to go home within 24 hours. Optional drains.
RECOVERY:
- It is an outpatient surgery.
- 24 hours of bed rest.
- After these first 24 hours you may be able to start to walk around.
- Eat well, food high in protein and lots of vitamin C.
- You must keep the sterile tapes in place for 24 hours.
DO NOT WORRY IF IN THE FIRST DAYS YOU HAVE.
- Bruising and swelling, which can be more prominent on the second day.
- Some discomfort when lifting your arms.
- Generally you do not need drainage.
- If you are in pain, take analgesics, BUT NEVER TAKE ASPIRIN, BECAUSE IT CAUSES BLEEDING.
- We give antibiotics to prevent infection.
- Full showers can be taken from after 2 to 3 days.
- Stitches can be removed from 7 days after the operation.
- Sterile tapes and or bandages are to be changed every 3 days during a 2 week period.
- For 30 days a special elastic bra is to be used.
- From 2 weeks onwards we indicate 10 lymphatic drainage sessions to help the recovery process, eliminate toxins and improve the circulation.
- As the days go by you will begin to feel better and better but be careful, this does not mean you are ready for intense physical activity. Take extra care with the arms as you can easily make the stitching come undone.
- You should be able to return to everyday activities 2 weeks after the operation and drive a car 1 month after.
- Intense physical activities can be taken up again some 60 days after the operation.
- Full recuperation of your sensitivity can take place within a few months time.
- The scars will be hidden behind your bra o bikini top. Generally they get better throughout 1 and 2 years, but they are permanent. Inframammary scars can be seen. Periareolar scars are not as visible.
THERE ARE MANY UNFORESEEN AND INDIVIDUAL VARIATIONS (such as wide and hypertrophic scars, depending on many factors such as the genetics of the patient.
- Sun bathing should be avoided for at least 3 months.
- Any increase in fever or if the area becomes red, or if there are any other unusual signs, contact your doctor or plastic surgeon immediately.
- Naturally, because of ones anxiety to see the final result, the first couple of days one can be somewhat depressed. But this is temporary. BEING PATIENT IS FUNDAMENTAL.
FINAL RESULTS:
Generally the results obtained are similar to what was planned.
More than 95% of women are happy with the long term results. They feel a lot better with their new image, proportional breasts, better form and volume, self-esteem and happiness.
With the techniques mentioned earlier, the physiology of the breasts is preserved, including breastfeeding and the sensation of the nipple.
YOU WILL NOT SEE YOUR FINAL RESULT UNTIL 12 TO 18 MONTHS AFTER THE OPERATION.
POSSIBLE COMPLICATIONS:
They are rare, BUT REMEMBER, THERE IS NO PLASTIC SURGERY WITHOUT RISKS OR POSSIBLE COMPLICATIONS (even if they are minimum, they still exist). SMOKERS HAVE A HIGHER RISK FACTOR.
- · HEMATOMAS: Occurs between 0.5 – 3 %. If not reabsorbed, it shall be removed.
- · INFECTION: Occurs in 2.2% of patients. Generally due to Staphylococcus Epidermidis. We always give antibiotics during the operation and for 5 to 7 days afterwards. Local culture is recommended, followed by antibiotics, draining and occasional removal of the implant.
- · NIPPLE-AREOLAR PROBLEMS: Due to blood supply and changes in the sensation.
- · WIDE AND HYPERTROPHIC BREAST SCARS: 1.4%
UNSEEN COMPLICATIONS: Will be corrected later, also seeking the planned final result.
