T

ummy tuck (also known as abdominoplasty) is the cosmetic surgery consisting of the removal of excess skin and abdominal fat and the correction of muscle flaccidity. This situation of excess skin and relaxation of the abdominal wall usually occurs in patients who have had weight gain and subsequent loss or in women who have had several pregnancies. The abdominoplasty achieves a flatter, firmer abdomen and a narrower waist.

Surgical procedure

The intervention is performed under general anaesthesia, making an incision above the pubic hair that extends towards the hips. The skin of the abdomen is released and, if necessary, the abdominal muscles are tightened with sutures. The excess skin is pulled down and removed.

Postoperative

After the surgery, the patient will wear a special belt, reinforced with a bandage, according to each individual case. The scars around the navel and in the lower abdomen will improve with time. However, in some cases, it is necessary to perform a scar revision with local anaesthesia.

Complications

Possible (although rare) complications include loss of vitality (necrosis) of the skin above the pubis that may require longer postoperative treatment. Likewise, seromas and/or hematomas may appear that require evacuation.

Who is the ideal candidate to undergo a tummy tuck?

The ideal candidates to undergo a tummy tuck are those women or men who have a relatively good silhouette but who are concerned about the accumulation of fat or excess skin on the abdomen and that does not improve despite diet or physical exercise.

This surgery is especially useful in women who have had several pregnancies, after which the skin and abdominal muscles have relaxed and have not recovered their initial tone.

Loss of skin elasticity in older people may also be better, a situation frequently associated with moderate obesity. Those patients who must lose a lot of weight should postpone the surgery, as well as the patients who intend to have future pregnancies since during the surgery the vertical muscles of the abdomen are tightened and they can relax again during it.

If there are previous scars on the abdomen, this surgery may be contraindicated or the scars may change position. In other cases, this surgery manages to eliminate them.

T

he breasts are two glandular organs located on the anterior wall of the thorax. However, in some cases supernumerary, usually incomplete breasts (just a trace of the nipple) can be identified along the lateral line of the body, towards the abdomen. Internally they are sweat glands modified to produce milk.

The mammary gland consists of two fundamental elements:

1. The glandular acini or glandular lobes, where the milk-producing cells are located.
2. The ducts, a set of tubular structures that converge into canaliculi (larger ducts). These ducts are responsible for carrying milk from the glandular lobes to the nipple.

The nipple is in the centre of a dark area called the areola.

At the base of the areola-nipple complex, a specific type of cells are located, surrounded by radial muscle fibres that allow milk to escape under certain stimuli.

The rest of the breast is made up of connective tissue (collagen and elastin) and adipose tissue (fat), as well as arterial, venous, and lymphatic vessels and nerves.

In addition, the breasts also have lymphatic vessels that go to small round organs, the lymph nodes, which are part of the immune system, responsible for defending the body.

Lymphatic drainage from the breasts occurs mainly to the axillary lymph nodes.

Aesthetic procedures in the breast

Breast enlargement

One of the methods to achieve an increase in breast volume is by implanting a breast prosthesis behind the existing gland. There are other methods that use tissues from the body itself and that are used, above all, in Reconstructive Surgery.

The breast implant can be placed behind the gland itself and in front of the pectoral muscle, or behind it, depending on each specific case.

The prostheses that are used can be filled with cohesive silicone gel or physiological solution, the outer covering of the prostheses can be textured, microtextured or smooth. Some possible local complications, such as bruising, infection, intolerance to sutures, capsular contracture, etc., will require adequate treatment but have an extremely low incidence.

Fat transfer to breast

Thanks to the great advances in technology applied in medicine, fat transfer has emerged, becoming one of the most innovative methods that currently stands out in cosmetic surgery, thanks to the fact that it is a safe technique that helps to rebuild or regenerate areas like the breasts through the increase of its volume.
This procedure consists of extracting fat from those areas where it normally accumulates such as the abdomen or thighs. In this way, the complete silhouette of body contour is redesigned and in turn, it is possible to reshape the breasts as the autologous fat is placed in them.

Breast lifting

B

reast lift surgery is among the most commonly performed aesthetic procedures. This surgical procedure allows raising sagging breasts upon the chest of the woman by modifying the size, contour, and elevation of the breasts.

What causes sagging breasts?

After the years and pregnancies, the breast tissue rarely recovers its initial turgor. Through plastic surgery techniques that have been perfected over the years such as mastopexy, breast loss has an effective and lasting solution.
Weight and gravitational action, the atrophy that the mammary gland undergoes over the years and skin tightening after processes such as pregnancy, lactation, weight changes and ageing, are the main causes of sagging breasts.

Is breast lift the solution for sagging breasts?

Since the breasts are attached to the pectoral muscle by connective fibres and there are no muscles to support them, there are no exercises to help lift them. The only solution is surgery. The technique of breast lift is called mastopexy and consists of removing excess skin to reduce the relationship between the skin envelope and the glandular content. As a consequence of the intervention, the nipple rises and the areola returns to its original size.

The surgical procedure

Depending on the amount of skin tissue that needs to be removed, different techniques are used, and only in cases where the mammary gland has greatly decreased its volume, silicone implants are inserted so that the breasts recovers its initial size. This happens, especially, in women with small breasts and both the implant insertion and the skin resection are made through a cut around the areola.

When the breasts are larger and more skin has to be removed, in addition to areolar resection, a perpendicular cut is made between the nipple and the breast groove and, in severe cases, the skin is cut from the base of the breast. Because mastopexy has been practised for many years, surgeons have over time refined the design of the cuts to increasingly disguise scars.
The intervention usually lasts three hours and requires one or two days of hospitalization.

How can I prevent sagging breasts?

To prevent breast loss, it is important, when playing sports, to wear an elastic bra. If the breasts are not firm, the movement can atrophy the connective fibres that hold them to the pectoral muscle, especially when it comes to large breasts.

B

reast enlargement surgery consists of the placement of prostheses or implants under the mammary gland or under the pectoral muscle in order to increase breast volume.

Breast implants are one of the most used tools in plastic surgery and their utility is either for aesthetics and reconstructive surgery.

Who can be a candidate for breast enlargement?

Regarding the aesthetic indication, the cases of women with little breast development and to achieve breast augmentation and repositioning in patients with sagging breasts due to pregnancy or significant weight loss are considered.

In terms of reconstruction, it is indicated when looking for symmetry in patients with breasts of different size and shape or for patients who have lost their breasts as a result of surgery to treat cancer of the mammary gland.

Special considerations

There are several factors that you must consider before making the decision of undergoing this aesthetic surgery:

1. Have a complete breast development.
2. Have a medical evaluation from the specialist.
3. Have any associated pathologies under control.
4. Discard any active mammary pathology by mammary ultrasound and/or mammography.
5. Do not smoke or have stopped the habit 3 weeks before the procedure.
6. Discontinue medications that alter coagulation (aspirin, for example).
7. A woman who has a breast implant should have a checkup with her doctor once a year as part of her routine breast evaluation.

Types of implant

When a woman decides to have an operation such as breast enlargement, she faces an important decision. What type of prosthesis should I wear? As you may well know, there are different types of breast implants, which implies having to decide which will be the most convenient for you. Not all are equal and the specialized person of your intervention will be the one who best advises you.

Silicone implants

They are one of the most widely used types of prosthesis, and also the most recommended.

One of the main reasons for its recommendation is that in the event of a break in the prosthesis cover, it is very difficult for the filling to spill. In the event of a rupture, a decrease in the volume of the breasts will not be appreciated, therefore it is recommended to perform an MRI periodically to help detect ruptures.

In addition, the gel facilitates a much more natural appearance.

Saline implant

This type of prosthesis is made with physiological serum, it is a serum composed of water and salt that is used as a filler in the breast prosthesis. In case of breakage of this type of implants, this material is reabsorbed naturally.

Like silicone prostheses, saline implants also have a texture similar to natural tissue, but they have a drawback, which is the possibility of their deflation. They are somewhat harder than silicone ones and sometimes cause temperature changes in the area.

The surgical procedure

The surgeon will position the implant under the breast, usually under the pectoral muscle. The implant can be placed through four routes that leave different scars: the submammary, at the level of the lower sulcus of the breast, periareolar, around the lower edge between the areola, axillary, in one of the armpits and umbilical folds, which is used for the saline prosthesis.

B

reast reduction (also called reduction mammoplasty) is a surgical procedure to decrease the size of the breasts, by removing fat, breast tissue and skin, making them smaller, lighter and firmer.

When is breast reduction indicated?

It is aimed at women with large breasts, who may present some problems due to this excess weight, such as back and neck pain, skin irritation under the breast and respiratory problems. The purpose of reduction mammoplasty is to provide a woman with smaller breasts and with a shape more proportional to the rest of her body.

Does it affect breastfeeding?

In this type of surgery skin, breast tissue (gland) and fat are removed. In theory, it does not affect breastfeeding because we leave enough gland for milk and it remains connected, so operated women can breastfeed normally.

The amount of milk does not depend on the breast reduction, nor on the surgery, nor on the amount of the existing mammary gland. There are women who without having surgery have very small breasts and when they have children they give them a lot of milk. Others who have very large breasts and give little milk.

The surgical procedure

Of all the breast surgeries, such as augmentation, lifting and reduction, the latter is undoubtedly the most complex. In terms of time, it takes between three and four and a half hours, which is twice or triple that of breast augmentation surgery. The surgical procedure is described as follows:

1. Incisions outline the area of the excess tissue to be removed.
2. Excess skin and fat are removed. The nipple and areola are then moved to a new and higher position.
3. The incisions are brought together to reshape the now smaller breast.
4. Sutures are placed around the areola and can extend downwards and horizontally under the breast crease.

Preparation and recovery for breast reduction

For breast reduction surgery, no special preparation is required, but the same as any surgery, including pre-operative examinations.

Patients leave the clinic the next day after surgery and must remain a few days with relative rest. After that time, you can start doing your normal daily life.

Sometimes a silicone tube is left in the armpit as a drain for three or four days, never more than a week.

During this time, you must wear a special sports bra that is very firm, even when sleeping. After this time you can go back to wearing a normal bra, but clearly smaller.