Breast Reconstruction Surgery in Rio de Janeiro, Brazil (2024)

Breasts are the greatest symbol of femininity, and changes to their size ad position can hinder a woman’s self-esteem

Introduction to Breast Augmentation with a Silicone Implant

This is one of the most performed surgeries at our clinic of plastic surgery located in Rio de Janeiro – Brazil. Many women have the problem of having to wear bras and bathing suits with filling to hide their small breasts.

If this is your case you’re not alone, this is the most performed plastic surgery worldwide. Every month we receive several patients bothered with the size of their breasts.

Thus, we presently choose to use:

1. implants used in a dual plane
2. the muscular sling whenever necessary
3. the internal bra to project the implant more
4. fat grafting in the breasts
5. a larger cleavage plane to mark the space between the breasts
6. the smallest scar possible

How is the appointment to have breast-augmentation surgery?

Our appointment for this type of plastic surgery is very thorough, since first of all we have to take detailed measurements of the chest to determine the size of the breasts, the space between them, the thickness of the mammary gland, spine deviations, rib projection, and many other factors such as the thickness and width of the greater pectoral muscle. Additionally, the size of the areola and nipples must also be proportional.

Only after listening to and examining our patients will we be able to suggest the best technique. We always show before-and-after photos and videos to help you decide the shape and size you want.

Below are a few tips to help make these important choices.

How do I pick the shape of the implant?

Round shape

This is the most popular implant size among our patients, since it better defines the upper pole of the breasts. When we hold a round implant, we notice the top side looks the same as the lower part. It’s as if you split a ball right down the middle.

If the curvature is very intense, we call this a round extra-high-projection implant. If the curvature is slightly less intense, we will call this a round high-projection implant.

Anatomical shape

It is the most requested by discrete patients that want a less-pronounced upper pole. This is less requested by Brazilians and more requested by Europeans. For very thin patients with a very pronounced rib cage, we usually suggest they need a slight slope on the upper part of the implant.

When closely examining an anatomical-shape implant, we will see that the upper part is a tilted straight line, and the lower part is rounded off. In other words, they are different from each other. This upper ramp is what will enable a more natural look.

Conical shape

It is composed of two tilted straight lines, one on the bottom and one on the top, and has an intermediate shape that will enhance the upper pole of the breasts a little less in comparison to the round implant, besides resulting in a better definition than the anatomical implant. It happens that this shape is only manufactured with a Polyurethane lining, which means it may be used under the mammary gland but not under the pectoral muscle.

A novelty that has had great impact in the shape and size of the scar is the use of the so-called Ergonomix implant, manufactured by only one company. We will talk about it during your appointment.

Differences between these two implant positions.

1 – Submuscular Plane Implant: also known as dual plane (partially submuscular):

We believe this is the best plane to position the implants, since it:

1. offers greater stability of long-term outcomes
2. grants greater projection of the implant
3. leaves a greater distance between the mammary gland and the implant
4. enables the use of the pectoral muscle to hold the implant weight

The main studies on the DUAL PLANE began with a US surgeon called John Tebbets, since this is the only plane that allows for a speedy recovery and the ability to lift your arms at the end of the procedure.

Moreover, there are numerous advantages, which we describe below.

Advantages of the fast-track recovery implant positioned in a dual plane.

The indications to place the implant in this plane are:

1. capacity to raise your arms on the same day and faster return to your activities
2. the patient quickly resumes playing sports and going to the gym
3. it maintains a more projected upper pole for an extended period
4. stabilizes the implants and maintains the results for more time
5. we also use it in mastopexy cases in order to use the muscles to support the implants
6. for very thin patients that need an extra barrier between the skin and the implant so the implant isn’t visible
7. patients that have developed capsular contracture in the subglandular plane and have to change the plane
8. patients with a strong history of familial breast cancer that need a barrier between the mammary gland and the implant

2 – Subglandular Plane Implant

We haven’t usually indicated this plane because the entire weight of the implant will rest on the skin and mammary gland, which will atrophy over time possibly making the implant perceptible (rippling).

The post-op pain and discomfort last just a few days, but the patient will not be able to raise her arms and the recovery period to drive, work and practice sports will be longer. The disadvantage of this plane is that in very thin patients with no mammary tissue, the implant could become perceptible with time.

Besides less support with time, we believe there is a greater probability of rippling of the implant, visible when the patient bends forward. When there is enough mammary tissue, these waves don’t appear, but when the patient has no or very little breast volume, we indicate the submuscular or dual-plane position.

What is the difference between the brands?

Here in Brazil, we have about ten brands, with different qualities and prices. We usually work with 3 implant brands to be able to indicate the most appropriate brand for the patient’s chest.

We must observe the following criteria when picking a brand:

Biocompatibility Index:

The better the implant, the smaller the chance of having thickening and capsular contracture.

Reology:

This is the study of the properties of the material used in the manufacturing of the implants (silicone), where you can measure its viscosity and cohesiveness. In other words, implants without enough gel density could deform more as time goes by, and very dense implants could result in an artificial touch. The gel hardness or density varies a lot from one manufacturer to the other.

Base of the Implant:

Some manufacturers have an excessively wide implant base with little height (projection). Others have the technology to manufacture a narrower and taller implant. Consequently, we can have two 300-ml implants with completely different shapes and outcomes, depending on the brand picked. Usually, the narrower the chest is, the narrower the base of the implant should be.

Manufacturer Warranty

It’s what the brand offers as a guarantee in the event of implant ruptures, rejection or infection.

Implant change interval

Before, we used to talk about a mandatory implant change after 10 years. Nevertheless, the advancements in the manufacturing of implants were such that no one talks about an expiration date anymore. In other words, this should only be done if there are indications that the external membrane is too thin or will rupture.

What are the implant projections?

We have noticed that the best outcomes are with the tall or extra-tall projection.

One of our greatest differentials is that we listen carefully to our patients. Some come to us seeking a more striking upper pole, in the so-called ball shape. Others are more discrete and ask for a sensual, feminine upper pole but without calling attention. Other patients ask for a shape and size that DON’T look like there is an implant.

What are the different shapes?

Round implants are the most popular, but that does not go to say that anatomical implants don’t yield good results. We will cover your preferences at the appointment. One of the brands most indicated by Dr. Alexandre is called Ergonomix, which has a few advantages. We seldom indicate the conical shape. Our most indicated implant is the round one or the thigh projection Ergonomix, followed by the extra-high projection round implant and the anatomical one.

Scar location to perform the breast-implant plastic surgery:

There is the axillary approach, which hides the scar well but, in our opinion, allows for less control over the structures close to the breast sulcus. We have indicated this approach for patients that work as models and cannot afford to have a scar under the breasts.

We have not indicated the axillary approach much at our clinic, since it’s closer to the nipple and yet far from the breast sulcus. It’s very important to reinforce the internal bra, since it allows for a greater projection of the upper pole of the breasts.

The inframammary approach is the one most commonly indicated by Dr. Alexandre Charão, since it is the only approach through which we will be able to create the muscular sling, the internal bra, and the dual-plane approach for a fast-track recovery, all with numerous advantages regarding the definition of the upper pole, durability of the results and a speedy return to your activities.

How to reduce the size of the scar in breast-implant surgery:

Throughout the years, we have developed a proprietary technique that allows for the reduction of 30% to 50% of the inframammary scar size. We carefully pick the implant brand and cohesiveness so it can pass through a reduced incision and reassume its shape when it reaches its final position.

It is common for us to use the fat graft to obtain a better upper pole and more cleavage, enabling a reduced implant size. Smaller implants need smaller incisions, and thus leave smaller scars.

Following this, we use a special suture thread with several micro-spikes per linear centimeter, and when we apply tension to this suture the scar is reduced. Finally, we use surgical tape or a special dressing that doesn’t have to be changed and immobilizes both sides of the scar, making it thinner.

Our way to help you:

We will know how to listen and explain what the best shape and projection will be best for you. The photos shown during your appointment will help you be sure of the decision you made. Additionally, we always have a second appointment before breast-implant surgery, when we can answer your questions and change the size and projection, if necessary.

We do not work taking several different sizes to the operating room because you will be sedated and will not be able to participate in the decision-making process. We like to point out that well-informed patients have more safety: use as many appointments as you see fit to answer all your questions.

Our differential:

You will receive precise information at the first appointment with Dr. Alexandre Charão. He will examine, you so he can draw up a surgical plan (technique, size, shape, projection), and observe the harmony between the breasts and the size of your chest.

It is common for us to use the dual plane (fast-track recovery), with a muscular sling, internal bra, fat grafting and a highly reduced scar, all through the Fast-Track Recovery. All our patients are followed by a Physiotherapist, who will use Taping and Laser LED and teach you the exercises to raise your arms.

Every patient receives a highly-humanized assessment, without the use of simulators (that do not simulate precisely the outcome),