Breast Augmentation
From Dr. Federico Macaya


Cosmetic mammary augmentation is one of the most commonly performed cosmetic surgical procedure on women.

I use an incision in the breast fold (inframammary) and the implant under the breast tissue (sub-glandular) position.

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

I think that gel filled implants are softer, feel more natural, are lighter and their rate of deflation is very small (less than 2%), I personally think they are safe. You may find more information about silicone later in this page.

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 outpatient procedure, the surgery takes about 90 minutes. The patient spends about 4 hours in the clinic.

For 2 weeks after surgery: No driving, do not lift anything heavy (no more than 10 pounds), do not have marital relaltions, do not elevate your elbows higher than your shoulders, and sleep on your back.

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.

Wearing a bra is important starting the day after surgery.

It is advisable to stay at least 7 days after surgery in Costa Rica. I recommend the Las Cumbres Inn, where you will receive personal attention, required medications and transportation to and from surgery. I visit my patients at Las Cumbres frequently following surgery to check on your recovery.

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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).

Replacement or revision surgeries.

Calcium deposits in the tissue capsule around the implant.

Changes in nipple and breast sensation.

Shifting of the implant.

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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 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. Hairsprays, suntan lotions, and moisturizing creams are just some 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.

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As the following clinical studies indicate, the likelihood of developing breast cancer does not seem to increase with the use of silicone breast implants. A 1986 University of Southern California study published in Plastic and Reconstructive Surgery investigated over 3,000 women in Los Angeles area who received silicone breast implants between 1959 and 1980.

Results found no increased risk of breast cancer following breast implant surgery compared to standard incidence ratios.  A 1992 five year update of this study followed the same group and confirmed the original findings.

A 1992 University of Calgary study published in the New England Journal of Medicine investigated over 1,000 women in Alberta, Canada who received silicone breast implants between 1973 and 1986.  This study did not find an increased risk of cancer among women who had received breast implants, although the length and completeness of follow-up, would have allowed the detection of such a risk.

A 1996 Georgia, New Jersey, and Washington study published in Plastic and Reconstructive Surgery, investigated over 2,000 women with breast implants. The results of this study are consistent with those of the Los Angeles and Alberta studies, finding no association between silicone breast implants and breast cancer.

In the 1998 Edition of Advances in Plastic and reconstructive surgery all the literature revision shows no relation between breast implants and any cancer or connective tissue disorders.

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Connective tissue disorders (CTDS) are described as a group of generalized disorders affecting  the  connective tissues (i.e., fat, bone, and mucous).  It has been theorized that silicone breast implants may increase the risk of developing a CTD.  As the following clinical studies indicate, actual statistical information has provided no significant evidence that silicone breast implants greatly increase the risk of developing CTDS.

A 1993 University of Texas, Houston study published in the Annals of Plastic Surgery  investigated 603 women undergoing reconstructive breast surgery between 1986 and 1992. In this study 250 women had breast reconstruction with silicone gel-filled breast implants and 353 women had breast reconstruction utilizing their own tissue.  Results of this preliminary report found that "the incidence of autoimmune diseases in mastectomy patients receiving silicone gel implants is not different than in patients who had reconstruction with autogenous [patient's own] tissue." (7), A 1994 Mayo Clinic study published in the New England Joumal of Medicine compared 749 women who had breast implant surgery between 1964 and 1991, with 1,498 women who did not have breast implant surgery. Study results showed "no association between breast implants and the connective tissue diseases and other disorders that were studied."

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