The most frequent questions regarding breast enlargement /breast augmentation by Dr.Alexander Aslani, Director and Chief Consultant Plastic surgeon of Cirumed Clinic Marbella.

Dr.Aslani,Marbella: Generally the indication depends on the amount of breast tissue the patient has The less breast tissue, the more favourable it is to go behind the muscle.

Dr.Aslani,Marbella: Yes, this is possible. Requests for that are frequent to save hospital costs for the breast enlargement, be careful with submuscular augmentations who may require substantiative pain relief. In planning a breast augmentation, this has to be taken into account.

Dr.Aslani,Marbella: Infection. Occurrence depends very much on the access used. Incidence will be between 2-3 %. This is in the nature of surgery with a foreign body.

Dr.Aslani, Marbella: No. This is outdated. There is no preset implant removal times any more, as long as you haven´t got problems, they can be left in.

Dr.Aslani, Marbella: A normal foreign body reaction against the implant. This is only problematic once exceeding a certain degree.

Dr.Aslani, Marbella: Generally speaking yes. Beware of emptiness on top though, in the breast that is full in the lower pole and flat on top, it may not be the wisest solution.Different women expect different results from a breast augmentation. Some find the look a little bit to natural afterwards.

Dr.Aslani,Marbella:This depends very much on where the implant is positioned. Positioning behind the muscle heralds a longer recovery time, which can well take a few days.
To mitigate that, I routinely inject a long acting local anesthetic before finishing the breast enlargement. This anaestetic is naturally injected before the implant is put into position, to avoid accidentally piercing the implant.
This injection does considerably alleviate the pain caused by positioning of the implant behind the muscle.

Dr.Aslani:Smooth surface implants are suspected to increase the risk of capsular contracture in breast enlargment, which seems to be much lower with textured implants.

Dr.Aslani:Generally speaking, this is not true. It depends on implant and soft tissue development.In selected cases of breast enlargements, however, that might very well be the case. This is a problem of gravity and not a problem of the implants as such.

Dr.Aslani:The three most common and popular accesses are the armpit, the nipple and the fold underneath. There are differences in preference from the side of the surgeon as well as the patient.

Dr.Aslani:Generally yes. This will depend a little bit on the incision used for the breast enlargement. If introducing the breast from underneath the fold or from the armpit, there should be no problems with breast feeding, Even the periareolar access (cut from the nipple) should not normally present problems, but there is a potential for it.

Dr.Aslani:The breast implantsthemselves do not harden….what you refer to is most likely capsular contracture. Every patient will get capsular contracture at some stage, the question is just to what degree. More than mild degreees can be seen in about 5% of cases, with occurrence of the problem being more common if the breaqst enlargement is carried out with positioning of the breast implants on top of the muscle. However, occurrence of capsular contracture is still a possibility after breast augmentation, although getting increasingly rare. Know about it, but don´t worry about it too much generally breast enlargement is an operation with an enormous degree of patient satsfaction, whatever problem occurs, we are here to manage it.

Dr.Aslani:Roughly one hour.Again, depends on the case.

Dr.Aslani:Yes, breast uplift and implants can of course be combined. However you need to undrestand that this makes the procedure a lot more complex and scarring will be involved, to what degree depends on the case. Nevertheless, my overall experience with combining breast uplifts with implants is very positive. It can be a very rewarding operation.But patients have to be aware that revision rates for breast augmentation with implants are generally afre higher than for breast enlargement alone.

Dr.Aslani: No, i personally don’t. I think that the long term advantages of cohesive gel implants are so overwhelming that in breast augmentation that I do not see any space for saline implants.That is of course y personal opinion.

Dr.Aslani: The profile describes the relation of diameter vs projection of the implants. High profile implants in breast enlargement create a lot of projection. Many women find the sound of this appealing, however, I feel it tends to look rather fake, the bigger problem is that after the breat enlargement the breast can have a fairly large gap. Low profile implants do not induce a lot of projection, so for most breast I suggest moderate high profile implants, which tend to give the most pleasing results in breast enlargement. Regarding the texture, smooth and textured breast implants are used in breast augmentation.
I personally do not use smooth surface implants, because the herald a higher risk of capsular contracture.

Dr.Aslani: Well, recently there has been a lot of attention for macrolane, which is basically filling the breast volume with hyaluronic acid. This can be a very attractive option for patients dreading a surgical breast augmentation, however, indications are somewhat limited as well as the possible amount of augmentation. A very spectacular variation is aesthetic breast augmentation with autologious tissue, which can be harvested from the buttock or the abdomen as a so-called”free-flap”. I have had patients showing interests in that because in makes the use of actual breast implants unnecessary, but it is a very extensive operation, and i think the cases where the extensice theatre time and surgical distress for the patient is justified in relation to the relatively straightforward breast enlargement with breast implants is fairly limited.

Dr.Aslani: Feasible yes, although success rates are very variable.Free fat transplants, so called fat grafts, have a very variable survival rate. Percentage of revascularisation seems to be very variable. if patients are happy to accept the risk of that happening and especially if they want fat removal (liposuction) elsewhere in the body, it may well be an interesting option. However, the results of fat grafting remain difficult to predict and I guess that this is a problem we are not likely to solve short-term.

Dr.Aslani: With the last generation cohesive gel implants, this is very difficult to say. There is no preset timespan for removal/replacement of breast implants any more.