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Frequently Asked Questions


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Inaccuracies and falsehoods in Cosmetic Surgery

We are aware of the enormous discrepancies of criteria that abound between different specialists, centres or companies, when concentrating on Cosmetic Surgery and each one of its treatments. As a medical activity in the Private Health Sector, the conflict of interests between the commercial world and the ethical problem does not always lie on the side of safety, professionalism or in the interests of the patient. This situation creates an enormous lack of confidence in the patient wishing to have Cosmetic Surgery treatment. Our philosophy is very clear. The patients are always first, their interests and their needs, in conjunction with the efficiency and safety of our treatments. To this end the medical facet of our activity is supreme. However, in contrast to our practice, many other centres or professionals offer information that is inexact, slanted, market oriented or even completely false and self interested, practising dangerous procedures that are ineffective or obsolete. To prevent unscrupulous actions we list a series of statements that, in our opinion, are inadequate, deceptive, or mere lies, that are frequently used at other centres to manipulate the wishes of the patient to a commercial and unethical end. Some of these are even popular among the very clients of these centres of Cosmetic Surgery, and become the regular thoughts and petitions of these same clients. Naturally, we completely rejects all the statements that can be read under the title of Inaccuracies and Falsehoods for every group of our treatments.

Is my case customary in secondary surgery?

Although the possibilities are numerous, it is true that certain situations are repeated more frequently among those cases received by our Specialists requiring repair. Among the problems resolved with us are the following:

-Encapsulated breast implants: cases of breast augmentation considered lost or irreparable, because they have been operated on once or more occasions in the past and appear hardened, deformed or painful.
-Submuscular implants: cases of breast implants inserted under the muscle that because of its poor characteristic result or a complication, need repairing.
-"Upward and downward movement implants": Cases of breast enlargement in which the technique has not been correctly executed and the implants move up and down with the arm movement or the contraction of the pectoral muscle, named as elevator breasts.
-Dislocated or malpositioned implants: Which are eccentric from the theoretical ideal center of the breast mound landmarked by the nipple, leading to grotesque look of the breasts.
-Misjudgement in implant selection: The width of the implants do not match the theroretical ideal size of the breasts base therefore produce lateral prominence or alternatively cleavage shortage of the implants.
-Renewal of implants: Because they are aged, broken, deficient from the beginning or because the volume is inadequate.
-Mastopexy: Insufficient, poor cosmetic result, or have suffered a complication.
-Sagging breasts: Cases of sagging breasts for which the treatment has only been a breast enlargement, inadequately performed and without having received specific treatment for the sagging.
-Breast reduction: Poor quality cosmetic result, insufficient elevation, slight volume or having suffered complications.
-Neck Lifting: Patients having received obsolete rejuvenation treatments, such as simply stretching the skin. Facial rejuvenation would have to be redone and also the neck would have to be treated which, in many cases does not receive the necessary dedication.
-Eyelids: Cases in which bags have not been completely removed or a cosmetic or even functional distortion has appeared.
-Rhinoplasty: Inadequate nasal corrections that are not very natural or are insufficient, causing breathing problems, sometimes due to poor cosmetic judgement, reconstructions in multioperated noses.
-Otoplasty: Shortage of approximation to the head, deformities, cartilage injuries, skin shortage.
-Liposuction: Poor performances that require removal of skin, technically deficient performances with under or over correction.
-Abdominoplasty: Spare skin, skin necrosis, insufficient muscular work.

Dimensions and Volume of breast implants

It is neither serious nor professional to use a bra size as a benchmark in the result of a breast enlargement operation. The size of the implant is neither calculated in units of volume (cc or ml) or weight (gr), which in itself, is not of great use. Much more important than the volume are the measurements. Implants have a base or diameter and a height or projection at the peak. In reference to these measurements, implants can have a low, medium, high or very high profile that respectively mean that for equal volume they have more diameter and less projection and so on until they can be of a very narrow diameter and very high projection. Choice should be selected in relation to the breadth required by the patient's breast that then determines the diameter of the implant. The projection can then be established in accordance with the wishes of the woman and the particularities of each breast (volume, excess of skin etc.) The same implant could be suitable for one woman but incorrect for another, so that size cannot be compared between two cases. It must be considered that the final result is the sum of the volume and shape of the patient's breast plus those of the implant. The key to our excellent results is that our Specialists carry out an anatomical examination on each patient, calculating the dimensions of their breasts and choosing the implant that is best adapted to her needs and preferences.

What type of anesthetic is most suitable in breast enlargement?

Without hesitation we recommend using the safe techniques of a general or total anesthetic. In a breast augmentation operation the greater safety, absence of pain and best results are obtained by general anesthetic practised in an authorised hospital. Although they continue to be performed in other centres, breast enlargement operations under supposed local anesthetic are a high-risk procedure in the opinion of our team of specialist surgeons and anesthetists. There are several reasons for rejecting local anesthesia. Firstly, because the necessary dose of anesthetic that has to be administered into the breasts is so high it can become toxic, possibly causing serious complications. Also because the application of a local anesthetic is by deep injection into the breasts which is terribly painful; subsequently, on occasions, the anesthetist is obliged to improvise and to apply an uncontrolled general anesthetic which is very dangerous. Finally, we reject these practices under a false local anesthetic because it only allows limited internal work to the Specialist therefore leading to unsatisfactory results, which nowadays is no longer adequate or suitable in relation to modern knowledge. For your safety and in order to achieve the best results, we recommend a general anesthetic in breast augmentation operations, with a day case stay in the clinic.

Do breast implants correct sagging or empty breast?

Many patients benefit from breast implants in order to improve the shape of their breasts, especially if they are lacking content or pendulous. If the sagging is light, breast enlargement can effectively correct the problem.

Is it true that I have to massage my breasts after implants enlargement?

Sometimes we recommend that physical treatment be applied to improve the natural look of the result, to be started once the initial recuperation period of the post operative tissue has passed. This treatment can be performed by the patient herself on a regular basis; occasionally a professional physiotherapist may be required. It consists in spending a few minutes each day massaging the implants, with a view to obtaining an even more natural texture and movement of the breasts. Modern implants are unlikely to require these massages as a routine basis.

Complications of breast implants

In our experience and practice a breast enlargement is the safest operation in Cosmetic Surgery. Many patients fear encapsulation or capsular contracture. This consists in a hardening of the implants due to the scar that the organism has created around it moves and compresses the implant, producing a hardened texture that is at times painful with a highly visible exterior spheric deformity, including making the upward displacement of the implant. It remains a little known process, although we know how to avoid it: using modern implants, bloodless and meticulous surgical skill of the surgeon, refinement of the surgical techniques, strict postoperative rest of the patient, sometimes with the addition of postoperative massages etc. With all these measures we can feel proud to state that capsular contracture is uncommon in our surgery. The few cases that do present the symptoms are to a slight degree and can always be treated. Bleeding and haematoma are equally rare and can be avoided using a meticulous technique and strict postoperative rest. Infections in the implants are extremely exceptional, although possible, and can be managed in a straight-forward manner by removing the affected breast implant, that can undergo delayed insertion few months later.

What must I know about breast implants?

Following the debates that have arisen in the last two decades, a surplus of information has been circulated surrounding breast implants, much of which is inexact, confusing or contradictory. We want to help resolve these doubts held by patients interested in breast augmentation, offering a series of details and the philosophy expounded by our Specialist. Please read all the content in the specific section about breast enlargement.

Can I live a normal life with breast implants?

Yes. Women with breast implants can live without the sensation of bearing the implants or having been operated on. They can practice all kinds of normal activities, fly in planes, including most common sports, (gym, aerobics, jogging, tennis, cycling, swimming etc.) including a fully satisfactory sex life.

Can the breast implants break?

Top quality breast implants such as those used by our Specialists have been subjected to so many manufacturing tests that a premature rupture is practically unheard of. Implants can withstand severe traumatism, changes in air pressure in plane travel and all kinds of manipulation without being damaged. Should the content come out there is no need for alarm as it is entirely made up of silicone, as is the outer shell of the implant, the latter already being in contact with the natural tissue.

Design of breast implants

Following the development of numerous models throughout the 50 years of technical and medical scientific improval of breast enlargement procedures, the leading implant and the one recommended by consensus of experts all over the world is made of cohesive silicone gel as filler inside, and a anti-leakage multilayer barrier of silicone shell outside. This outer surface can be microtextured also called smooth, or can be macrotextured also called textured or rough. There are models with spherical profile and other models with tear-drop or anatomical profile.

Technical datasheet for breast enlargement

-Anesthetic: total
-Surgical time: 1 hour
-Hospital stay: day case
-Proximity stay: 2 days
-Postoperative pain: 4 (scale from 1 to 5)
-Postoperative bandages: 1 week, then elastic brassiere for 4 weeks
-Sick leave: 2 weeks
-Complementary treatments: infrequently massages
-Cosmetic recovery: 1 month 60%, 3 months 80%, 6 months 90%, 12 months 100%
-Scars: around or inside the areola, alternatively under the breast; concealed

This information is indicative only and does not represent an obligation with customers. This technical datasheet is based in statistical means for large groups of patients, with the variability that implies. Medicine and Surgery are not exact Sciences so it is not possible to stablish the most suitable management for each individual case until the moment the Specialist can evaluate the patient. One medical and/or surgical process can't be predictable 100%, so our Medical Team could modify the management plan at any time, based on the requirements that could be considered as necessary.

Does the sensitivity of the nipple and areola change after breast enlargement ?

Either with areolar or submammary fold surgical approaches to insert the implants it is possible to retain maximum sensitivity in the areola and nipple. Temporarily an enlargement in sensitivity in the area can be felt or, more infrequently, a reduction in sensitivity, which returns to normal after few weeks or months. It is extremely uncommon that sensitivity remains impaired as a long-term complication.

Can a mammogram be taken if I have breast implants?

When it is necessary for you to have a mammogram and other imaging studies you only have to advise your doctor and the technician performing the test that you have implants. The reliability of the test is the same for women who have been operated on. Mammograms are not necessary as a regular control of the breast implant.

Do breast implants avoid the need for breast elevation?

Many patients benefit from breast implants to improve the shape of their breasts, especially if they lack content or sag. If sagging is only slight, a breast enlargement can effectively correct the problem. However, if breast are too low, only use of breast implants leads to awful results. In those cases it is mandatory the use of breast elevation or mastopexy, with or without implants.

How long do breast implants last?

It is not possible to ascertain with certainty the foreseeable duration of breast implants because the available statistics refer to a wide range of factors including different brands, positioning factors, techniques involved, the patient biologically herself etc. Besides, the manufacturing of the product periodically improves. The degradation of breast implants is mostly biological and not mechanical, since the device suffers disintegration at the end of its lifetime due to the immune cells of the surrounding tissues in a slow and progressive period of years. Currently we are changing implants that have been inserted in the patient for between 10 to 20 years. It can even happen that a woman may have a torn implant and is not aware of the situation for years either, in the shape or through symptoms. It can be said that breast implants are not lifetime devices and will need replacement throughout woman's life, without this supposing any kind of health risk to the patient even in case of undiagnosed rupture. The exchange or replacement procedure of breast implants that are aged or already ruptured is considered routine surgery that can be carried out at any age and on every patient.

What is the ideal size of my breasts after implants enlargement?

Choosing the size, shape and type of implants used by our Specialists is based on the personal preference of each patient, their anatomical characteristics and the technical aspects of the operation. The most important thing is that the patient is able to transmit to the doctor her ideal, the size she would most like, and for the Specialist to then provide compatibility between the desires of the patient and choosing the most suitable implant. You will be able to rely totally on all our team who combine a wealth of experience in breast enlargement.

What is best for breast implants: submuscular, subfascial or subglandular placement?

Several surgical techniques have been developed regarding the anatomical plane where breast implants are placed.

- Total Submuscular: The pectoral muscle fully wraps the breast implants. This technique is inadvisable because is likely to produce capsular contracture (hardening, displacement and visibility of the implant, sometimes disturbances or pain), upwards displacement of breast implants and dynamic mammary distortion also called elevator-breast.

- Partial Submuscular: The breast implants are covered at their upper part by the pectoral muscle; the rest is under the gland. Its main disadvantages are its surgical aggressivity, the extreme postoperative pain, a long recovery period with higher chances of bleeding and the possibility of dynamic mammary distortions, though has low capsular contracture (hardening, displacement and visibility of the implant, sometimes disturbances or pain) rate and overally is an acceptable technique that might have very individual and particular indications. Despite being a quite safe and very popular technique worldwide, nowdays it is in decadence before other options.

- Subfascial: The fascia (thin fibrous shell) that covers the pectoral muscle is lifted up to be used as wrapping structure for the breast implants. This technique is considered optimal in current surgical state-of-the art since allows suitable prevention of capsular contracture (hardening, displacement and visibility of the implant, sometimes disturbances or pain), avoids dynamic mammary distortion and reduces the likelihood of other complications, easing the recovery period to a short, much safe and almost pain-free stage.

- Subglandular: Despite being a technique with low aggressivity it is inadvisable due to high rate of capsular contracture (hardening, displacement and visibility of the implant, sometimes disturbances or pain) and other issues with the breast implants.

- Intraglandular: Strictly proscribed in practical use since the weight of the breast implants lies on the breast skin and gland therefore producing breast ptosis (drooping).

Must the breast implants be checked up?

Between 6 and 12 months after the operation the patient will be medically discharged. From that time on the patient does not need to undergo routine checks. The patient is the first person to detect the need for a long-term revision. With us you may rest assured that our Specialists will be at your disposal at any time.

Will there be any visible scars following the operation of breast enlargement?

The incisions into the areola produce scars of a very good cosmetic quality that, if necessary, the patient can hide permanently using micropigmentation techniques. When the line of the lower furrow on the breast is the area for the insertion, the incision is hidden by the natural fold of the breast itself.

What type of breast implant is best?

We use different brands and designs of implants in order to be able to select the most suitable model for each case. In general, and this is accepted nowadays at a scientific level, we consider that the breast implant should have a filling of silicone gel of cohesive degree, with a multibarrrier shell, in some cases preferently of rough or textured surface, and naturally, officially approved by the European Union.

What kind of bra is most suitable for the implants after breast enlargement?

In the first few post operative weeks a support bra composed of elastic or cotton tissue that is cupped and feels very comfortable is recommended. Once fully recuperated the patient can use any bra she feels comfortable in, providing it does not mark the skin and she is happy with it. Underwired bras can be used on occasion but are not suitable for daily use. If the patient feels like it she can go braless.

What size shall I be after breast enlargement?

A brassiere is neither a valid nor reliable measurement. Bra sizes are indicated by means of a number in relation to the outline of the lower part of the breast, followed by a letter (A, B, C,&) that is the cup size. The outline of the lower part of the breast should not be substantially transformed following the operation, but the cup should increase. In any case a woman can use two different bra sizes and both can be perfectly suitable, so that this form of measurement is not going to help us to evaluate the volume of breast tissue in the final result.

What are the differences between spherical or round and anatomical or teardrop profiles of breast implants?

In order to simplify concepts can be said that there are two profile shape groups of breast implants, the spherical profile, also called round shaped, and other with anatomical profile, also called teardrop shaped. With both models patients can achieve excellent results, although current surgical trends and preferences of patients make it slightly more requested the anatomical profile. Nipple downwards both profiles have identical shape and provide the same breast effect, being the differences between their results visible in the upper half of the breast; these differences are more remarkable the more slim or skinny the patient is.

- Spherical Profile: The traditional breast implants profile shape is round shaped. These prostheses are round shaped at their lower half and equally round at the upper part of the breast; their main disadvantages are their less natural results at the upper part of the breast and the shortage in filling that mammary upper pole and cleavage. Despite of their disadvantages they are still a very popular option and suitable for most patients.

- Anatomical Profile: The modern breast implants profile shape is teardrop shaped. These prostheses replicate the original structure of a natural breast, being round shaped at their lower half and differentially wedge shaped at the upper part of the breast and the cleavage; their main advantages are their more natural results at the upper part of the breast and the fullness in filling that mammary upper pole and cleavage. They are breast implants for patients seeking the most optimal results, especially those cases in need of full breast shape replacement (very small or hypoplastic breasts) or with specific shortage of breast tissue at the upper mammary pole.

What are low, medium, moderate, high and extra high profiles of breast implants?

Breast Implants Profile Height
In order to simplify concepts can be said that there are two profile height groups of breast implants, the low profile, also called flat shaped, and other with high profile, also called prominent shaped. With both models patients can achieve excellent results.
- This is not an absolute value in breast implants; it is rather a ratio between profile projection length (distance from the prosthesis rear side and the maximum projection point or peak of the implant) and width of the prosthesis base.
- This means that, with the same base width, low profile implants projection is shorter (lower) than those of high profile; with such same base width high profile implants have longer projection (higher).
- With equal base width low profile implants provide less projection and less breast size than high profile implants; with such same base width patients obtain with high profile implants larger breast size and longer projection than with low profile implants. - Low profile implants are therefore, in equal volume, wider and flatter than those of high profile; high profile implants, under equal volume comparison, are narrower and more prominent than low profile ones. - Two implants may have the same base width and be one of low profile and the other high profile, and in turn two implants may be the same projection length and have low and high profiles respectively. - Talking about low profile implants equates to discuss about broad-based implants; and talking about high profile implants equals to mention narrow base implants. - This explains the null importance of nominal volume (cc or ml) or weight (gr) of the implants at the time of their selection, since these parameters only indicate the amount of liquid or mass that can be inside the prosthesis, which give no indication of their suitability for individual patients, they would simply be nonspecific measures of gross amount. The critical selection of the ideal implant for each patient should be made on the basis of their dimensions (base width, profile height), not by weight or by volume. - There exist numerous intermediate profile height ratios between the lowest and the highest, with different names depending on the manufacturer concerned (flat, low, moderate, intermediate, high, extra-high, etc.), but always keeping this concept about the relationship between projection height and base with. - The lower profiles are best suited for situations where the implant will have on top a significant amount of glandular tissue (women with medium or large breasts) or due technical reasons a lot of tension is not desirable in the tissue, and so the implant must make room in the projection for the set to fit perfectly. They are also suitable for women with large breast width, which therefore need quite wide implants, and not seeking a too large breast size. - The higher profiles are preferable in cases which the implant will have on top small amounts of breast tissue (very small or hypoplastic breasts) and the prosthesis is aimed to replace the majority of missing breast volume. They are also adequate for women with small breast width, which therefore need quite narrow implants, and seeking a quite large breast size.

Can breast implants cause any illness?

No. Exhaustive scientific studies reveal there is no relation between breast enlargement operations and illnesses of the breast such as tumours or any general problems of the organism.

What are the differences between smooth and textured or rough surfaces of breast implants?

Breast implants surface can be smooth or textured (rough).

- Smooth Surface: The traditional breast implants surface is smooth. This kind of surface eases surgeon’s work during the introduction of the prosthesis into the breast pocket, however these implants have higher rate of capsular contracture (hardening, displacement and visibility of the implant, sometimes disturbances or pain), are more likely to dislocate from their ideal location and are typically associated with seroma cases (fluid accumulation around the implant that may produce swelling and disturbances). Despite of their disadvantages they are still a reliable option for many patients.

- Textured Surface: Modern breast implants incorporate texturization or rugosity at the outer surface with the aim of reducing the rate of capsular contracture (hardening, displacement and visibility of the implant, sometimes disturbances or pain); they also help to the attachment against the breast tissues therefore preventing dislocation of the prosthesis from their ideal location and seroma (fluid accumulation around the implant that may produce swelling and disturbances). The rugosity can be of a variable degree from microtextured (low rugosity) to macrotextured (high rugosity); the higher the texturization the lesser the probabilities for the previously mentioned complications to appear. They are breast implants for patients seeking the most optimal results, especially those models with highest texturization at the surface.

Is breast enlargement a safe operation?

It is the most requested treatment by our patients because of its quality, the results obtained by our Specialists and the attractive price. We have considerable experience in understanding the desires of our patients to undergo this type of operation. The degree of satisfaction for the woman is total and remains with the passing of time. In our experience given the incremented number of breast enlargement operations we perform and due to the professionalism of our Medical Team, the success in breast enlargement is practically assured.

Are the breast implants placed beneath or above the muscle?

Traditionally and in the early years of breast enlargement the implants were placed between breast and pectoralis muscle, this was named the subglandular positioning of breast implants, however with traditional breast implants this technique produced high rate of hardening or capsular contracture also named encapsulation, artificial outcomes and other complications Nowadays and with modern implants the Specialists have two safer options to locate them that offer low rates of capsular contracture and both equally brilliant in their cosmetic results: under the pectoralis muscle named as submuscular, and under the pectoralis muscle fascia named as subfascial.

In the submuscular placement the implants lie between the ribcage and the pectoralis muscle. This technique is more painful and aggressive, somehow more likely to suffer postoperative bleeding, requires suction drains and in some patients may produce muscular visibility with contraction.

When the implants are subfascial they lie between the fleshy belly of the pectoralis muscle and the thin layer of fibrous tissue that covers all muscles named fascia, this fascia is separated from the muscle which itself stays intact. This procedure is almost painless after few days and in any case the pain level is low since it is much less aggressive, is unlikely too bleed, no suction drains are required and, obviously, no muscular distortions may happen since the muscle remains untouched.

Most recommended method nowadays is the subfascial placement of breast implants. Numerous scientific studies demonstrate this superiority, making the intervention safer, the postoperative period more comfortable and the recovery quicker, with the highest excellence in the cosmetic outcome of the breast enlargement in terms of natural shape and touch.

Our prime concern is the patient and their safety, and we therefore defend the location beneath the muscle fascia as first instance and all-purposes technique, leaving the submuscular placement of implants for atypical or troublesome situations and medically indicated cases. Subglandular technique or non-modern implants are disregarded and excluded from our portfolio of technical options.

Can other procedures also be performed in the same breast enlargement operation?

This is quite a normal practice and many patients request it. There is no reason not to perform another surgical technique at the same time as a breast enlargement. The insertion of breast implants is compatible with almost all other interventions performed by our Specialists.

Is it possible for the breasts to sag due to the weight of the implants?

With the passing of the years aging of the breasts is inevitable, which is demonstrated by sagging. This process mainly affects the natural tissue and to a lesser extent the inserted implants. This enlargement procedure is generally performed on women with little natural breast tissue, and the sagging in the breasts can be considered practically imperceptible on patients who have undergone this operation. Modern breast implants self-attach to the surrounding tissues, therefor the patient can feel free to opt for the size she wishes, no matter how large it is.

What is capsular contracture or encapsulation of breast implants?

Around the implant a scar is formed, which is natural and beneficial for the outcome of the operation. The phenomenon known as capsular contracture means that this scar shrinks and contracts the implant, leaving it a firm and hardened texture. Years ago the problem occurred in a high percentage of patients due to obsolete implants and low skill in techniques, and nowadays it is still a potential problem with implants inserted above or underneath the muscle, however unlikely thanks to modern implants and current trends in surgical refinement. We have unbeatable statistics in breast enlargement that makes the problem of encapsulation almost obsolete in terms of symptomatic levels. The risk for it to appear is higher in patients not keeping the recommended resting period, whenever significant bleeding might be present, when the skin is tight and not elastic and in tuberous or tubular breasts. Should the situation arise we have effective treatments to resolve the problem, with massages and potentially with surgery.

Can the difference between each breast be corrected in a breast enlargement?

Slight breast assimetry is normal in almost all women and, not only does not need correction but is unfeasible, to try and do so usually leads to inadequate results. If the difference is considerable our Specialists can improve the breasts by introducing implants of a different size or volume, or by other combined techniques. If the assimetry is a complex one, some differences will always persist.

High, medium and low cohesivity breast implants, which one is best?

From a starting point let's state that all the breast implants available in Spain and other European countries fulfill the standards according to the European Community legislation that requires them to be cohesive, and therefore they offer maximum guarantees with little or no quality difference among brands and manufacturers, however cohesivity or density of the inner silicone gel is a key factor to be focused on. The higher the density of the inner gel is, the less likelihood to produce visible waves named rippling, the longest duration of the implant and the safest in case of rupture, always keeping maximum naturality in the touch feeling to the operated breasts. That is the reason why different degrees of cohesivity or gel density do exist. High cohesivity gel implants are more modern and most recommended, since much better performance is obtained with them rather than with medium or low cohesivity breast implants. In the theoretical situation of a rupture or leakage of the implant, they all may leak small amounts of silicone that themselves are not a health threaten thought are not desirable, high cohesivity implants as well as in other models but in significatively lesser amount than in low or medium cohesivity ones. Leakage of silicone means no risk for the patient (unless the implant remains unchanged for many years, which is practically impossible), as silicone is already in contact with patient's tissue at the outer shell of the implant, being a product perfectly tested and safe. This situation remains unchanged in the case of leakage from inside of the implant, as it is silicone as well as the outer shell, being that leakage confined in the scarry or fibrotic shell grown around the prosthesis which is named the capsule and thus not spreading to the rest of the organism. Medium or low cohesivity implants are not risky or unsafe implants, however highly cohesive silicone gel filled implants offer the highest guarantee for patient's health.

Can a breast enlargement affect the back?

The size of the breasts is in total harmony with the body in operations performed with us, no matter how large, medium or slight you wish to enlarge your breasts. Our Specialists always look for a result that will be in proportion to the width of your ribcage. The burden on your back and shoulders will not produce overload since modern implants are firmly attached and they do not add abdnormal weight to your breasts. Feel free to opt for the breast enlargement you wish with no fears to feel uncomfortable.

Which is the best channel to introduce the breast implants?

The most common areas used in the international practice of breast implantation are in the areola, the lower furrow of the breast or the armpit. The preference of the majority of Specialists and also of the patients is through the areola or periareolar. The incision is made on the edge of the darker skin of the areola where it is joined with the normal skin, or in omega shape through the areola and not touching the nipple if the areola is pale or pinky so that it is perfectly disguised. If the areola is too small, the incision is made along the line of the furrow under the breast, also an excellent region for breast implantation. Through the armpit or axillary approach is not the most advisable means because of the technical difficulties the surgeon can sometimes find on correctly inserting the implants, as they may be placed too high, the high rate of complications like postoperative bleeding and the likeliness of fully losing sensitivity in the nipple.

What happens during pregnancy and breast-feeding after breast enlargement?

Pregnancies for women carrying breast implants show no difference or peculiarity due to this situation. Many women who have undergone a breast enlargement operation go on to have future pregnancies and children without any incident. Breast-feeding is neither adversely nor advantageously affected by the implants because the implant is a static element and does not release particles that could be absorbed in the milk. The silicone is not liposoluble so that if there were a leak from the implants there would be no risk of any kind.

What is best for breast implants: areola, submammary or axillary insertion scar?

Several surgical techniques have been developed regarding the anatomical location of the incision where breast implants are introduced.

- Areola: This technique is considered optimal in current surgical state-of-the art since allows meticulous surgical technique with low rate of complications, full access to all breast pocket areas and suitable insertion of breast implants, in addition to preservation of sensitivity. In the mid and long term the areola access and its varieties (periareolar, transareolar, omega, w, etc.) guarantees the patient total free will about any breast procedure or replacement. Areola incision is the first choice in all cases in which the anatomy makes it feasible.

- Submammary: The incision placed at the submammary fold is a second level option with good performance, though inferior to the areola incision; should be reserved for those cases in which the areola incision is unfeasible.

- Axillary: This technique is inadvisable due to high rate of sensitivity loss, malpositioning of breast implants, likelihood of postoperative complications and essentially for being a restrictive technique through a blind and practically unfeasible access.

Inaccuracies and falsehoods about Breast Enlargement

A breast augmentation with a local anesthetic is better or safer than with a general anesthetic - FALSE
It is exactly the same if a breast implant is inserted above or beneath the muscle - FALSE
It is better to perform the breast enlargement under the muscle because of lesser rate of capsular contracture with modern implants - FALSE
Breast implants must be completely enveloped by the muscle - FALSE
Saline filled breast implants are better than silicone filled ones - FALSE
There are better implants available other than those made of silicone gel - FALSE
The contraction or encapsulation of the breasts is always inevitable or impossible to correct - FALSE
Breast implants last for life - FALSE
Air travel is not allowed for bearers of breast implants - FALSE
Breast implants have to be frequently changed - FALSE
The best introduction channel for breast implants is under the armpit - FALSE
The result of a breast enlargement is going to be a determined bra size - FALSE
Women bearing breast implants experience problems when having a mammogram - FALSE
If I have breast implants I will have problems to have a baby - FALSE
If I have breast implants I cannot breast feed my baby - FALSE
Breast implants are nowadays lifetime devices that need no replacement - FALSE

What are the differences between saline solution filled and silicone gel filled breast implants?

Modern breast implants can be filled with silicone gel or with saline solution (body water).

- Saline Filled: Their main advantage is the biocompatibility of the filler in case of leakage, rupture or at the end of the prosthesis lifetime, since the serum filler is a fluid normally present in human body and therefore naturally resorbed with no issues; also the replacement procedure is simpler since the surgeon has to do little surgical toilet. Their cons are the possibility of early deflation and their likelihood to produce rippling (visible and palpable wrinkling), coldness in the winter, bubbling (audible or felt) and water balloon touch feeling; all the former more probable in slim or skinny patients. They are breast implants for patients who really wish to say no to silicone.

- Silicone Gel Filled: Silicone gel molecules may have different degrees of bonding between them; this is the so-called degree of cohesivity. Ancient breast implants models were filled with non-cohesive fluid silicone and this lead to different complications, specially rippling (visible and palpable wrinkling), leakage through the shell and dissemination of the silicone in case of rupture of the implant or at the end of its lifetime. Modern breast implants are filled with cohesive silicone gel in a variable degree of cohesivity: low, medium, high and ultrahigh. The higher the cohesivity the lesser the probabilities for the previously mentioned complications to appear. Silicone gel filled breast implants eradicate, prevent or reduce the complications traditionally associated with saline filled implants, especially early deflation and rippling (visible and palpable wrinkling), producing natural touch feeling. Their main disadvantage comes at the end of the prosthesis lifetime, requiring a deeper surgical toilet though this is a safe routine procedure. They are breast implants for patients seeking the most optimal results, especially those models with ultrahigh cohesivity.

Official Approval of breast implants

The breast implants that we use are guaranteed by the stamp of officially recognised authorization and quality issued by the European Union. This stamp guarantees that the manufacture of implants adheres to the highest standards and that the manufacturers carry out the pertinent quality control tests (resistance, wear, impermeability, stability etc.) Only in this way can the best guarantees be offered to the patient.

Structure and composition of breast implants

Breast implants are composed of an external covering and an internal content. In all models the outer covering is made of silicone, and it is the area where manufacturers have striven to improve the duration and quality of their product.

The main differences in terms of composition can be found in the interior; these can be made of silicone gel or saline serum (other substances such as hydrogel or soya oil have been withdrawn from the market). Implants filled with silicone appeared initially and, even after many years of experience, continue to be the ones that offer the best results and greater safety.

In spite of all the controversies arising years ago, most of them unfounded, silicone gel implants continue to be the best and no other substance has managed to supplant them. We recommend silicone filled cohesive gel implants.

Serum implants are not recommended by our Specialist because they are colder in winter, they sometimes produce liquid sounds, the breast shows folds called rippling, the touch is artificial and, in general, they empty prematurely thereby offering a short duration, particularly if we compare them with the silicone implants. It must be remembered that even saline serum implants have an outer covering made of silicone, which is the part that is in contact with the patient's tissue.

Silicone is a substance widely used in medicine and surgery, and forms the manufacturing base of various kinds of implants (ophthalmology, vascular, orthopaedics, breasts, buttocks etc.) It is perfectly biocompatible and allergy to silicone is practically nonexistent. There is no rejectio of saline.

Silicone has no relation to immune illnesses or those of the breast and neither hastens nor prevents cancer of the breast. It is perfectly compatible with breast-feeding and should the covering tear, it does not dissolve into the maternal milk and therefore is not passed on to the baby. Examination by mammogram is perfectly viable with the same degree of reliability.

Certain implants exist with an especially dense and coheseive silicone interior; these are called cohesive gel implants. These are recommended by our Specialists because they are safer and reduce the likelihood of visible waves on the breast called rippling.

Can a breast elevation be performed together with a breast enlargement ?

Naturally, it is one of the most popular operations. The problem presented by pendulous breasts, lacking volume, following one or more pregnancies is very common, and our Specialists are accustomed to dealing with both problems together. An elevation of breasts is performed at the same time as introducing breast implants to support the necessary volume.

What are tubular or tuberous breasts and how do they influence breast implants?

This term is applied to an anomaly present in certain patients whose breasts are not only small but also have a special structure. It refers to breasts constrained by a fibrous covering, giving the breast a conical shape, with excessive elevation of the lower furrow, a large areola and with a ruptured aspect, having insufficient skin in the medial area of the breast. In the majority of cases it is possible to obtain excellent results using breast implants and other surgical applications on the gland. Our Specialists have wide experience in the correction of breast anomalies, and thus they know these cases have a higher risk of capsular contracture or hardening and displacement of breast implants, as well as requiring a new surgical procedure after some months to improve the result.

Insertion channel of breast implants

Implants can be inserted through the areola, through the submammary fold under the breast, under the armpit and other methods mentioned purely as anecdotes (the tummy button, that requires using a saline implant giving deficient results) or by means of an incision made for a mastopexy or breast elevation. It is a consensus among Specialists that the recommended insertion way should be through the areola since it produces the best quality scar, does not alter sensitivity, offers the lesser rate of complications and superior cosmetic results of the placement for the implants, is perfectly hidden and allows for any signs to be totally eliminated with micropigmentation. If the areola is very small then it is recommended insertion via the fold under the breast. Under the armpit is not recommended because of high rate of total loss of sensitivity on the nipples, the high rate of complications like bleeding or malpositioning, the scars are totally visible when wearing sleeveless clothes in summer, and also because the implants tend to sit rather unnaturally high and move when contracting a muscle. The operation is essentially the same in any case. No special technique is involved if using any of a variety of approaches. The use of an endoscope is completely unnecessary in breast enlargement and is only a marketing complement used for commercial purposes in certain centres.

Are breast implants safe?

One of the biggest fears most common in women who are considering undergoing Cosmetic Surgery on their breasts is the safety of the breast implants. This natural fear is greatly increased by the different information circulating around that is often confusing, inexact, contradictory or quite simply false. The use of breast implants to enhance the shape of the breast began at the beginning of the 70´s and developed importantly in the 80´s in the USA before arriving to Europe during that decade.
At the beginning the manufacturing of the implants was not as perfected as it is today and the technique was not mastered as highly. There existed, as in all pioneer surgical techniques, a lack of profound knowledge and any long-term results regarding breast enlargement. In consequence the results were not the best, the duration of the implant was brief and the complications excessively frequent.
Fortunately, nowadays scientific knowledge on breast implants is in a phase of stability. Following various controversies, the introduction of different models and materials for implants and after using various techniques in the operation, it can be said that, at this moment, our surgeons have at their disposal enough research and information to know which is the best way to practice breast enlargement, reducing poor results to a practically insignificant percentage.
It can also be said that breast enlargement is nowadays the operation that gives most satisfaction to its patients and, of course, is the most practiced operation in the field of Cosmetic Surgery.
In spite of this situation there are still many professionals and centres that do not adhere to these principles and who persist in performing inadequate techniques that logically lead to disastrous results.
We use the best knowledge available to Medical Science when practising breast implants.

What is the shell of breast implants?

All models of breast implants have a shell made of silicone elastomer, some of them with a valve to be filled. Modern breast implants incorporate an anti-leakage multiple layer barrier shell, being optimal those implants with specific manufacturer’s technology proved to obtain long-term sealing of the filler and maximum extension of the prosthesis lifetime.

Is there any relation of pregnancy, breastfeeding and illnesses with breast implants?

There is no relation between having breast implants and pregnancy or breast-feeding. Many women who have had this operation have babies and breast-feed with no difficulty.

It has been proven that breast implants are not implicated in breast illnesses, tumours or immune deficiencies, even if they tear.

The examination and early cancer diagnosis of the breast, as well as mammograms, are perfectly feasible and effective when practised on women with breast implants.

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