Breast Augmentation

Advantages of Breast Augmentation Surgery

Let us look at the cases in which it is indicated:

Our Breast Augmentation Method in Madrid

Insufficient breast development during adolescence, deflated and ptotic breasts following pregnancy or breastfeeding, or simply the desire for greater breast volume may lead many women to seek this procedure, which can be performed alone or in combination with other procedures to achieve a more significant improvement:

The best plastic surgeons are guided by classical beauty standards while knowing how to personalise these for each individual case. Every breast and every woman is unique.

Dr. Guilarte, as a skilled plastic surgeon, shares his approach: “I always keep in mind the perfect balance between my patients’ proportions and physique, so that I can present the implants I consider most suitable for them and allow them to decide which one makes them feel most like themselves.” The aim of breast augmentation surgery is to find the right balance between what you desire for yourself and what is most appropriate for your anatomy. While this is a personal decision, a strong understanding between patient and plastic surgeon is essential.

What should we consider when taking the first step?

Pre-operative Advice for Breast Augmentation

Every breast augmentation is different because every woman has her own unique characteristics. Perfection and naturalness depend on the patient’s own perspective. Achieving her full satisfaction is one of our primary objectives, from the first month through to years after the procedure:

First Consultation

At your first consultation, Dr. Guilarte will conduct a comprehensive assessment: the evaluation of the shape and size of your breasts, their symmetry, skin firmness, fat distribution, the presence of stretch marks, the development of the inframammary fold, and your general state of health will all form part of the initial assessment prior to a more thorough examination of your breasts (in some cases, a mammogram and/or breast ultrasound may be requested).

The first step will be to determine the desired shape of the new breast — in other words, how you want your breast to look in terms of height and projection. Equally important is the selection of the most appropriate implant: anatomical or round, assessed using physical sizers and the Crisalix 3D Digital Simulator.

Once the type of implant has been decided upon, the appropriate volume for that specific implant type will be determined — in other words, shape is decided first, and volume second.

Please bear in mind that this step takes approximately 30 minutes and is a fundamental and cornerstone aspect of achieving the desired result and volume in breast augmentation.

Simulation allows you to see the result before undergoing surgery

Two types are available: Physical simulation with sizers and Crisalix 3D Digital Simulation

To assist with this process, Dr. Guilarte will carry out a volume trial using physical sizers (simulation implants) that will give you an approximation of the result you will achieve after breast augmentation surgery (while dressed), followed by a 3D digital simulation showing what your breasts will look like (without clothing).

Whenever breast augmentation does not require any additional complementary surgery, we will take a 3D photograph of your breasts using our Crisalix 3D digital sensor and show you how your breasts will look undressed — your result — with the implant the doctor has determined is best for your particular case based on your preferences. During this simulation, we will fine-tune the optimal height, projection and volume for your case. “It is very common to focus on volume, when what truly matters is choosing the implant shape that will give us the result we are looking for. In this simulation, therefore, we will not only assess volume but also the desired shape, trying implants of greater or lesser projection, taller or shorter profiles — it is not all about volume.”

More information on 3D simulation and virtual reality, and how to carry out a photographic trial from home.

In more complex cases where additional procedures are required alongside augmentation to achieve our individualised objectives, the Crisalix system cannot be used, as it does not encompass all the configuration parameters needed to cover every possible case.

Understanding the type of surgery you will undergo

Dr. Guilarte will explain the different surgical techniques available for augmentation mammoplasty, as well as analysing the various options or combination of procedures best suited to achieving the desired size and shape.

At our clinic you will find comprehensive information on the different surgical techniques available.

Dr. Guilarte will present the options available for your situation, together with the risks and limitations of each. It is essential to carefully evaluate your overall anatomy — beyond the breasts themselves — in order to determine the ideal breast implant for your individual case.

Preparing for surgery and the post-operative period

At the end of your consultation, you will be given instructions on how to prepare for your breast augmentation procedure.

It is important to know which antiseptic gel to use when showering prior to surgery, which foods and fluids are appropriate before and after the procedure, how smoking affects surgical outcomes, and which medications, iron supplements and vitamins are suitable or should be avoided.

All pre-operative questions should be fully addressed before the procedure begins.

It is essential that you feel relaxed and have all the information you need. If you are concerned about how long the results of your cosmetic surgery will last, please be aware that one of the greatest advantages of breast augmentation with anatomical implants is that the result is more stable over time, as the gel is not only cohesive but also form-stable, as you can see in the images below.

Choosing the right breast implant

Breast Implants Available at Clínica Guilarte

The new volume and shape of the breasts is achieved through the placement of breast implants. Choosing the volume and shape of a breast implant is no simple task — the ideal of beauty is entirely subjective, and it is not enough to simply choose an attractive image of a breast or select a size at random.

The implant type, the height-to-projection ratio, and the implant size must be determined by the amount of existing breast tissue, as well as your personal preferences. You should inform your plastic surgeon of the appearance and cup size you would like to achieve, but do not allow the surgeon to make all the decisions on your behalf. During your simulation and/or volume trial, you should take a proactive role in selecting your implant — in each case it is generally possible to choose between two or three implant types, but you must opt for the one you truly want. Make sure, during the result simulation or volume trial, that the final appearance of your breasts is compatible with your body contour and, above all, with your lifestyle.

Key characteristics of breast implants:

In general terms: a higher projection means the implant protrudes further forward, while a lower projection tends to result in a wider implant. Projection is a key factor that affects the aesthetic profile and overall appearance.

Breast Implant Size

Implant size refers to its volume — the amount of filling material it contains. It is measured in cubic centimetres (cc), a unit of volume indicating how much substance occupies a given space. One cc is equivalent to one millilitre (ml), so a 300 cc implant contains 300 ml of filling. Lower-volume implants tend to produce a more subtle enhancement, while larger implants offer a more dramatic visual change.

The relationship between implant volume and bra size can be a source of confusion. Although there is a general connection, there is no direct conversion between the cubic centimetres of an implant and the final bra size, as bra size depends not only on implant volume but also on breast shape, chest width, and other anatomical factors. In addition, bra size comprises two measurements — the chest circumference (number) and the cup (letter) — so the impact of implant volume may vary from patient to patient.

Other Important Characteristics of Breast Implants

In addition to type, projection, shape and volume, you should also consider the material from which the implant is made — in other words, its filling. The implant filling is typically cohesive silicone gel or saline solution (increasingly less common). The surface texture must also be considered: smooth or textured.

The Implant Brand

Dr. Guilarte exclusively uses breast implants by MENTOR (Johnson & Johnson) and occasionally by Polytech, Motiva and B-Lite. We do not use second-tier implants from other manufacturers, as using only the highest-quality breast implants is a fundamental principle for us. The more stringent requirements imposed for approval on the American market, combined with the greater experience and long-standing track record of these implants in both Europe and the USA, are the reasons why we almost exclusively use MENTOR. Regardless of the doctor’s preference, you should know that Mentor is the most prestigious implant brand both nationally and internationally, and the implant of choice among the leading plastic surgeons.

Please be aware that all implant brands mentioned offer a guarantee against rupture and against capsular contracture for the first 10 years.

Please bear in mind the following principle stated by the doctor:

How is the breast implant inserted?

The incision approach for breast augmentation is a subject of some debate, as each option has its own advantages and disadvantages. For this reason, the patient’s preferences must be carefully considered alongside her anatomy, as the best option will emerge from weighing both factors together.

In general, the incision for augmentation mammoplasty is made in the inframammary fold, around the areola, or at the axillary level. The choice of incision site will depend on what has been agreed with the doctor during the consultation, once the advantages of each approach have been explained.

The goal when choosing the incision site is to ensure that the resulting scar is virtually invisible.

INFRAMAMMARY FOLD INCISION:

The incision is placed in the inframammary fold — that is, in the crease between the breast and the abdomen. This approach is by far the most commonly used, as it provides direct access to the lower portion of the breast and behind the mammary gland. It is undoubtedly the most “clean” approach and therefore carries the lowest rate of capsular contracture. It also offers the greatest visibility during submuscular dissection, and facilitates the placement of high-volume implants.

AXILLARY INCISION:

The main advantage of this technique is that it leaves no scar on the breast — it is concealed in the armpit and is therefore imperceptible. It is a very good option for cases where the breast has a good shape and a large volume increase is not required, as access is more limited. The most important aspect of this technique is that it must be performed with the assistance of an endoscope — that is, endoscopically, using a tube and camera — in order to properly release the muscle under direct visualisation in the lower and medial portion. This is essential to ensure that, once augmentation has been performed, the implants do not move when the pectoralis muscle contracts, and that the implant is able to expand the lower pole of the breast. We do not perform axillary augmentation blindly.

PERIAREOLAR INCISION:

This technique involves an incision around the areola, specifically along its lower half. It is used less and less frequently, as it carries a higher risk of capsular contracture and/or implant infection. The nipple and areola are the most bacterially contaminated areas of the breast, which is why this approach carries the additional risk of potentially contaminating the implant, which may over time lead to capsular contracture. We use this technique when some form of mastopexy or breast lift is required, or when breast remodelling is needed in cases of tuberous breast. We emphasise that the periareolar approach is currently discouraged due to its higher risk of capsular contracture and/or implant infection, and that at Clínica Guilarte our preferred approaches are the axillary route and the inframammary fold.

Is the implant placed above or below the muscle?

In theory, implant placement depends primarily on the pre-operative characteristics — specifically, on the thickness of the breast tissue. This will determine whether the implant is placed beneath the prepectoral fascia (subfascial) or beneath the pectoralis muscle (submuscular); subglandular placement is never used, as it is associated with a higher incidence of capsular contracture. However, this is not an absolute rule, as the thickness of your breast tissue today may change over time — what is currently 3 cm may become 1 cm, compromising the long-term result.

For this reason, Dr. Guilarte performs all of his procedures using a DUAL SUBMUSCULAR plane (dual plane), as this technique offers the best long-term evolution, providing more durable results and a more natural appearance by making the implant less visible. This plane involves placing the implant beneath the muscle, releasing it in the lower and medial portions so that contraction of the pectoralis muscle does not cause the implants to move.

Clínica Guilarte Surgical Protocol

The 14 key points for maximum safety in breast augmentation

The world’s leading expert on breast augmentation safety, Dr. Deva, sets out 14 key points to follow in order to achieve the highest possible safety standards and minimise complications:

All 14 of these points are strictly adhered to by our team, along with many additional measures based on our knowledge and experience, all implemented with the aim of safeguarding your wellbeing and achieving the best possible outcome.

Our Breast Augmentation Technique

Surgical technique used by Dr. Guilarte

Dr. Guilarte follows the latest safety and efficacy criteria in breast augmentation surgery. Adhering to these standards is essential to reduce the risk of complications and promote the earliest possible recovery for our patients.

The most important aspect of this surgery is to be respectful of the tissues — that is, to carry out the dissection along the precise tissue planes in order to avoid tissue damage and bleeding. This careful dissection along the exact plane will reduce the risk of complications; while complications can still occur, the aim is to minimise them as far as possible.

Implants are always placed in a dual submuscular plane, as it is well established that this approach carries a lower risk of capsular contracture, delivers a better immediate aesthetic result, and provides the longest-lasting outcomes.

We isolate the implant from potential contaminants using the no-touch technique — these include the areola-nipple complex, the patient’s own skin, and the surgeon’s gloves. To achieve this, we cover the nipple and areola with a sterile dressing, change gloves immediately before inserting the implant, and introduce the implant through a sterile sleeve that prevents contact with the skin and the surgeon’s gloves.

We do not generally use drains, as we irrigate the surgical field with the procoagulant agent Amchafibrin® (tranexamic acid). Following dissection of the implant pocket, we thoroughly rinse the pocket with saline solution, and once the pocket is “clean” we irrigate it again with this procoagulant agent, which significantly reduces bleeding and eliminates the need for drains.

Following your procedure, you will receive 3 doses of intravenous antibiotics, which means you will need to remain hospitalised for 24 hours. These 3 doses are essential in order to prevent potential infection and/or capsular contracture.

Post-operative Care After Breast Augmentation

After breast augmentation surgery, you may feel somewhat tired — this is perfectly normal. After 24 to 48 hours, you will be able to resume a near-normal daily routine, with certain restrictions on physical exertion.

A sensation of tightness may persist for up to a week; however, between 3 and 5 days after surgery you will be able to return to normal work activities, as any discomfort is well controlled with the prescribed medication. During the first few days, you will need to take an antibiotic to prevent both infection and capsular contracture.

The morning after breast augmentation surgery, any dressings will be removed and replaced with a specialist post-operative bra, and you will have your first physiotherapy session in your own room to accelerate your recovery and make it as comfortable as possible.

Please be aware that your breasts will be more sensitive than usual for 2 to 3 weeks after surgery. The appearance of the scars will also change over time — initially they will appear pink, but after approximately six weeks you will notice them fading to match your skin tone.

Breast augmentation surgery will not affect your ability to breastfeed should you become pregnant. Similarly, you should continue with the mammographic screening appropriate for your age, but remember to inform your doctor of the presence of breast implants.

Before and After Breast Augmentation Photos

We recommend visiting the Before and After Breast Augmentation Photo Gallery to view patient results before and after surgery.

It is very important to look at breasts with a pre-operative shape similar to your own, and to determine which volume best matches your preferences. Take screenshots on your phone or photographs of your computer screen to show the doctor at your consultation.

It is also important to assess all three views of each case, as it is in the lateral and three-quarter views where upper pole fullness and the projection achieved are best appreciated.