Breast augmentation-above or below the muscle ?

There are ongoing debates as to whether it is more advisable to place the implants in breast augmentation on top or below the breast muscle.

As in most cases involving aesthetic surgery, there is no single right answer.
The main reason for subpectoral (under the muscle) placement is as follows:
1. The muscle covers the implant, thus capsular contracture (“breasts that feel hard”) is less common.It has become rare anyway, but the cases that I usually see are breast augmentation on top of the muscle. Another theory is that should capsular contracture occur it may be less obvious to be detected.
2. For the same reason, rippling (wrinkling) of the implant is less apparent.It is never completely evitable though.If patients will normally notice such rippling on the lower pole and side.
3. Mammograms are more accurate.
4. In very small-breasted women, the outline of the implant is less visible.As a rule of thumb, if the thickness of breast tissue is less than 2 inches, submuscular placeement is mandatory.
5. Muscle tissue is well perfused. Perfusion is the best combat tool against infection, the most dreaded risk in breast augmentation .

The argument for subglandular breast augmentation (under the breast tissue) placement is as follows:

1. If any degree of ptosis is present, a subglandular implant lifts the breasts much better.
2. Lower risk of postoperative bleeding is involved.
3. Significantly less postoperative pain occurs.
4.  Breast augmentationcan be performed with intravenous sedation and local anesthesia, which is a safer alternative to general (complete) anesthesia.

There are no precut recipes for te best procedure in breats augmentation, but a lot ofsuitable solutions for different patients.

For more info please visit www.cirumed.es

Dr.Alexander Amir  Aslani, MD, EBOPRAS

Hospital:

Director and Chief Surgeon
Department of Plastic, Aesthetic and Reconstructive Surgery
Hospital Quiron Malaga
Avda.Imperio Argentina, 1
E-29004 Malaga
Spain
www.quiron.es
www.cirumed.es

Are polyurethane coated implants better in breast augmentation ?

Lately polyurethane coated breast implants have received increased attention in breast augmentation surgery. The theory behind this is that the fine coating should prevent capsular contracture.

Whilst I think that this is a very interesting approach, I have encountered a few problems with the use of these implants, namely the use for slightly larger incisions and I have experienced that they are somewhat difficult to remove if one wants or has to exchange the implant for instance, for a bigger one, not an unusual event in breast augmentation surgery.

No implant prevents capsular contracture, and I currently reserve the use of polyurethane coated implants for cases where revisional surgery for capsular contracture after breast augmentation is mandatory.

If breast implants in breast augmentation are positioned below teh muscle primarily the chances of capsular contracture are generally very low. Most cases of capsular contracture are encountered once breast augmentation is combined with breast uplift surgery.

Dr.Alexander Amir Aslani, MD, EBOPRAS

Private practice:
Cirumed Clinic
Avda.Ramon y Cajal 7-4°
E-29601 Marbella/Malaga
Spain
Phone:+34 607 307 515
info@cirumed.es
www.cirumed.es

Choosing implant size in breast augmentation

Choice of size is a difficult, but important factor in breast/breast enlargement surgery. 
To my experience, it can go two ways, but from a practitioners point of view it is much more frequent to see patients asking for bigger implants than having it the other way round.
I think a contributing factor is especially that many patients orientate on “celebrity”-examples of patients who have had more than one breast augmentation and in that case tend to look “over”operated indeed.
It is impossible to try a breast implant on like a shirt. You dont get this opportunity in breast augmentation. Several factors need to be considered.
1. Dissatisfaction with breast size is the number one cause for re-operation in breast augmentation surgery. Nevertheless, it is not a revision for a surgical complication because everything may have gone very well.
2. You cannot plan a cup size,a cup size is just a letter. It is more important to gather together photographs of your likes and dislikes when it comes to breast size, shape and form. Different brands of manufacturers will have different cup sizes for the same breast.
3. Sizing implants slipped into your bra can give you a relative estimate of breast implant volume.The tend to look a bit “stuck-on”. Most surgeons, who frequently perform this operation will have a set of sizing implants available for you to examine and place in a bra.
Go for the feeling in size and not for the look.
4.Remember that in breast augmentation there are factors that cannot be changed, like for instance the width of your sternum. Breast enlargement gives you a bigger breast and a certain
Change in shape. However, you cannot buy a breast “of the shelf”
5.The choice of projection and implant shape, be it teardrop or round, will depend on the shape of your breast before the operation and position on the implant. I frequently observe that patients translate a solution from a friend they might know and who has had a breast augmentation to themselves.This does not work this way. Every body is different and everybody is individual.

Read more about  breast augmentation here.

Dr.Alexander Amir Aslani, MD, EBOPRAS

Hospital:
Director and Chief Surgeon
Department of Plastic, Aesthetic and Reconstructive Surgery
Hospital Quiron Malaga
Avda.Imperio Argentina, 1
E-29004 Malaga
Spain
www.quiron.es

Private practice:
Cirumed Clinic
Avda.Ramon y Cajal 7-4°
E-29601 Marbella/Malaga
Spain
Phone:+34 607 307 515
info@cirumed.es
www.cirumed.es

Macrolane……alternative use to breast enlargement

Macrolane is currently undergoing a certain hype as being the non-surgical alternative to traditional breast enlargement.

There are good indications for Macrolane and some patients are indeed suitable for that, but it has to be borne in mind that not everybody is. Nevertheless I do see a promising potential for the substance in the treatment of for post-surgical irregulaities , for instance, following liposuction.

Such irregularities are not entirely unusual especially after extensive liposuction and sometimes not easy to treat, and I do think that Macrolane significantly adds to our instrumentarium in these cases, offering a less invasive solution for many cases. Nevertheless, Macrolane will not be able to permanently treplace breast augmentation surgery as many pateints looking for it falsely hope. It is an addition to the surgeons armatorium in breast augmentation, not a replacement.

Read more about macrolane here

Dr.Alexander Amir  Aslani, MD, EBOPRAS

Hospital:
Chief Surgeon and Head of Department
Department of Plastic, Aesthetic and Reconstructive Surgery
Hospital Quiron Malaga
Avda.Imperio Argentina, 1
E-29004 Malaga
Spain
www.quiron.es

Private practice:
Cirumed Clinic
Avda.Ramon y Cajal 7-4°
E-29601 Marbella/Malaga
Spain
Phone:+34 607 307 515
info@cirumed.es
www.cirumed.es

Choosing implant size in breast augmentation

Choice of right implant size is most decisive in breast augmentation surgery.

Although generally it is a procedure heralds an extremely high degree of patient satisfaction, many patients tell me that that if they did the procedure again they would go to a larger size.

To request a smaller size is very unusual.

Most patients tell me the like the swollen look directly after the operation, and are a bit disappointed with the size decrease once the swelling goes. Dissatisfaction with breast size remains the number one cause for re-operation in breast augmentation.

I tell every patient not to go into breast augmentation requesting a specific breast size and cup size because fixation on a ceratin cup size, which differentiates from the final size, can lead to dissatisfaction with your final result.

I routinely show patients pictures of the effects certain implant sizes have on certain breasts,making clear that the result of a breast enlargement cannot be bought “off-the-shelf”

I avoid the use of sizing implants, except for special request. since the look distracts from the final result.

Cup size measurement is extremelyinaccurate but as a rule of thumb every 150-200 cc’s of volume you will go up a cup size. Bear in mind that is a rough estimate.

Remember that breast augmentation cannot or only moderately alter anatomical fix points such as distance between nipples and gap between breasts, these things can be influenced, but not on a “you-wish-I–deliver”basis. Some anatomical variables have to be taken into account.

I personally regard breast augmentation as one of the operations with the highest degree of patient satisfaction, and as long as abovementioned considerations are taken into account, I intend to keep it that way.

Dr.Alexander Amir  Aslani, MD, EBOPRAS

Hospital:
Chief Surgeon and Head of Department
Department of Plastic, Aesthetic and Reconstructive Surgery
Hospital Quiron Malaga
Avda.Imperio Argentina, 1
E-29004 Malaga
Spain
www.quiron.es

Private practice:
Cirumed Clinic
Avda.Ramon y Cajal 7-4°
E-29601 Marbella/Malaga
Spain
Phone:+34 607 307 515
info@cirumed.es
www.cirumed.es