The choice of breast prosthesis, or selecting a suitable prosthesis for each patient and that.
Compare the outcome of breast augmentation by placing prosthesis with the end result of a culinary dish: same ingredients every chef prepare a different dish. A little cooking, a little frying a sprig of laurel... small differences that make a difference. The there will be delicious, sophisticated, tasty and even unpalatable ( for example if you burn any of the condiments or the whole plate ).
Similarly each surgeon, the same patient would get a different result... there are nuances, taste, sensitivity, surgical skills, knowledge of which technique is to be used in each case and, in particular, the type of response in capsule formation and scarring.
First one patient each surgeon can choose a certain volume, one or other prosthesis, one access road, a site for placement... however, each of these choices are not as important in isolation but the key is its combination, the choice and conjunction of all these factors give the desired result. Our goal is to achieve natural breasts, both in their shape, size, symmetry and mobility.
One of the concerns that accompany most of the patients who come to our clinic is that type of prosthesis is to put. The question does not specifically refer to the same brand, that too, if not all the other features that they may vary. Below we will list and discuss some of the variables of the prosthesis.
It is very variable and ranges typically between 125cc and 450cc. The choice of the size of the prosthesis is very difficult. In principle there is no size that suits but a desire for forms that relate to the image of femininity that each patient has. The method we use to define the size of the prosthesis is placed prostheses of various volumes in unpadded bra until you find one with which you are best.
Currently the filled prosthesis used cohesive silicone gel and of physiological saline. The choice is usually made by the surgeon and responds more to the experience you have with each. We preferably use silicone prostheses filled with cohesive gel. They have the advantage over silicone oil if it wears or breaks the solid membrane does not leave your content if not continuous cohesive and does not migrate;is more, if we click one prosthesis and compress will get a bubble that will return when fully inserted to stop doing. It is therefore no longer necessary to change the prosthesis after 8 or 10 years and just annual reviews will be convenient for completeness. This can be assessed accurately by MRI. Moreover, these prostheses are more natural to the touch than serum.
The Whey have the advantage of the minimal incision is needed to introduce them as standing deflated and filled once inside the breast and, moreover, if wearing bag containing whey contents is reabsorbed by the body smoothly. However, they have their drawbacks among which include the possible loss of content per valve (can deflate, ie lose some of its content, one or two prostheses ), the highest hardness and weight ( are harder to touch) and sometimes cause certain thermal sensations ( may give local sensation due to cold to warm more slowly than the body) or sound ( water movement ).
There are other stuffed prosthesis methyl cellulose, but not used in Spain and we do not employ.
It is the membrane forming the bag into which the gel content or serum remains. It can be laminated silicone, polyurethane and study, titanium (it is investigating possible use ).
It is another point of controversy. The surface of the prosthesis can be flat or rugosa. At present about 30 % of Spaniards put plastic surgeons smooth muscle prosthesis below. While virtually all rough prosthesis placed above it, ie, below the gland or the pectoral muscle fascia. The choice that each must be reasoned and, as is logical, justified by studies that demonstrate or substantiate the choice.
Historically the evolution was as follows: The first silicone prosthesis used were of smooth surface and placed directly underneath the gland with a high rate of capsular contracture. To remedy this I was investigated and it turned out that the rough prosthesis caused capsular contracture smaller number and less intense ( with prosthesis directly under the gland ). Later the stakeout position of the prosthesis and saw the submuscular position was more appropriate because the implants they would not be in contact with the gland and, therefore, with frequently contaminated milk ducts ( pollution is a possible cause of capsular contracture). As is logical, and always fleeing the capsular contracture is thought that under the muscle and rough prosthesis would disappear almost dreaded capsular contracture. It was not exactly so although I decreased considerably in number and intensity.
In this position ( submuscular ) and with this type of prosthesis ( rough ) some problems began to emerge: first, whether the prosthesis amount- was difficult to lower them again ( to be roughened remain attached ) and, secondly, the prosthesis had different response depending on whether or not giving massages and of course, the moment they began to be. If not the massage prostheses are more or less firm, projected the gland and the result can be wonderful, except that little gland, remain firm in this case you have, yes, but also immobile: on the beach, lying is typically as prosthetic breasts. If things have improved gland, since the gland lateralized and gives a more natural look.
If you want to get the prosthesis to move in the pocket we created, then it is necessary to mobilize the prosthesis as soon as possible. In this case the roughness of the prosthesis to stimulate the body to produce an external capsule ( normal ) and a capsule that surrounds directly to the rough surface of the prosthesis;this would mean that the body is transforming the rough prosthesis in a smooth surface. To avoid this extra work we prefer smooth surface prosthesis placed under the muscle.
However, there are some situations in which we prefer to put this site rough ( submuscular ): when the patient has thoracic deformities that may favor the displacement of the prosthesis ( pectus excavatum, pectus carinatum, thoracic asymmetries... ). In such cases the adhesion of the prosthesis prevents unwanted displacement of the prosthesis.