Breast Augmentation

Cosmetic mammary augmentation is one of the most commonly performed cosmetic surgical procedures on women. Dr. Lev uses an incision in the breast fold (inframammary) and the implant under the breast tissue (sub-glandular) position. The medical term for the procedure Dr. Lev uses for breast implantation is called "Subfascial Breast Implant Surgery."

Subfascial Breast Implant Surgery
The subfascial placement of breast implants has many of the advantages of submuscular position without lifting the muscle attachments from the ribs. The subfascial placement has become the preferred position for the placement of breast implants in our practice. The advantages and disadvantages of this position compared to above and below the pectoral major muscle are discussed. The clinical experiences with more than 1000 breast augmentations in the subfascial position are reported. The indications for this technique are proposed. The incidence of complications are described from clinical experience and compared to other methods. The longest term of after surgery observation has been more than three years. The average time of observation of these cases has been about eighteen months. We have used the subfascial position through axillary, areola and inframammary incisions. As implants are placed routinely below the muscle through the umbilical approach, it can be done through that incision as well.

The subfascial position prevents the stuck on appearance caused by the interruption of the clavicle to nipple line just as the submuscular does. It is a little less potent in this because it is not as thick as the muscle.

The subfascial position prevents rippling above the areola just as the submuscular position does and probably as well.

The SF (subfascial) position does not push the implant down as the muscle does in the submuscular position (SM). This pressure of the muscle provides some hemostasis right after surgery. This force of the muscle also massages the breast implant and may help keep it soft. It also prevents the rising up and too early healing of the inferior breast pocket at the inframammary fold by the muscle pressure pushing down the implant against the area of the fold. It may help prevent capsule contracture by pressing the implant down. All these factors are logical and reasonable and clinically seem to be correct but are unproven and may or may not be important.

The subfascial is definitely less injury to the patient than the submuscular. It has less morbidity. The patient is less uncomfortable. Also it prevents the muscle movement that is sometimes visible after submuscular.

Basically there are two kinds of implants, both consist of a silicone shell, but can be filled with saline solution (salt water) or with silicone gel.

Dr. Lev feels that gel-filled implants are softer, feel more natural, are lighter and their rate of deflation is very small (less than 2%). He feels they are safe. The brand of silicone implants Dr. Lev uses are Silimed or Eurisilicon.

Saline-filled implants have the lowest rate of capsular contracture (hard breast), but are heavier, do not feel so natural, and deflate from 5% to 20% of the patients completely and in a higher rate partially.

The anesthesia is general, performed by an M.D anesthesiologist. It is an inpatient procedure requiring an overnight stay in the hospital. The surgery takes about 90 minutes.

For 2 weeks after surgery: No driving, do not lift anything over 5 pounds, sleep on your back, do not make love and do not elevate your elbows higher than your shoulders.

You will probably feel somewhat tired and sore for several days following the operation, and your breasts may remain swollen and sensitive to physical contact for as long an 2 months. It is advisable to stay at least 7 days after surgery in Costa Rica. Wearing a bra is important starting the day after surgery.

Undergoing any invasive surgical procedure means running the risk of complications like the effects of anesthesia, infection, swelling, bleeding, pain, and delayed healing. In addition, there are potential complications specific to breast implants. These complications include: Deflation of the implant, interference with mammography, contraction of the scar tissue capsule around the implant (capsular contracture).

About Silicone
Silicones are a family of chemical compounds. They are made from silicon, a naturally occurring element found in sand, quartz, and rock. Next to oxygen, silicon is the most common element in the earth's crust, and becomes silicone when it is combined with oxygen, carbon, and hydrogen. Depending on the arrangement of the molecules, silicones can be manufactured in a variety of forms, including oils, gels, and solids. Silicones have been part of the consumer industry for over 50 years.

Because they can be manufactured in various ways, silicones appear in a wide variety of products that most of us use everyday, such as hairspray, suntan lotion, and moisturizing cream, to name just a few of the consumer products that contain one form of silicone called dimethicone.

The applications of silicone, whether used as an oil, gel, or solid, are equally extensive in the medical field. For example, the lubricating qualities of silicones make them ideal for coating surgical needles and suture thread, as well as the inside of syringes and bottles used for the storage of blood and intravenous medicines. Protective silicone coatings have also been used in pacemakers and heart valves.

Other medical devices utilizing silicones include: artificial joints, catheters, drainage systems, facial implants, tissue expanders, and breast implants. Silicone products have been shown to be biocompatible, reliable, flexible, and easy to sterilize, making them an ideal choice for both implantable and non-implantable medical devices.

Safety issues concerning the use of silicone in medical devices have primarily focused on the possible link between breast implants (both saline-filled and gel-filled) and certain illnesses, including breast cancer and connective tissue disorders (also referred to as autoimmune diseases such as lupus, scleroderma, and rheumatoid arthritis).

Silicone materials have been tested extensively in laboratory studies, as well as clinical studies (those that study human health). Of the one to two million women who have received breast implants, much scientific evidence has already been gathered.