Dr. Tiago Baptista 
Fernandes
Plastic Surgeon
UP HPA

Dr. David Carvalho Rasteiro 
Plastic Surgeon
UP HPA

Mammoplasty.
The Surgery

HPA Magazine 15

It is currently the most performed plastic surgery in the world - 1,862,506 in 2018 (most recent data) - having undergone an increase of approximately 40% from 2014 to 2018.
The term mammoplasty refers to different types of breast surgery: volume increase, volume decrease or breast lift. The main reasons that lead women to seek this surgery are:
· Breast changes after pregnancy;
· Desire for greater self-confidence and self-esteem, through a more socially harmonious body, which is characterized by a larger breast;
· Disproportionately small or disproportionately large breast;
· Correction of breast development asymmetries which occurs during adolescence with significant asymmetry;
· Seeking greater satisfaction in the couple's intimate relationship. 

AUGMENTATION MAMMOPLASTY 
The technique involved in breast augmentation surgery, varies according to each case and naturally also, with personal taste. The main variables are:

• Shape of the implant: anatomical or round;
• Location of the implant: in front of or behind the muscle;
• Entry point of the implant: areolar, infra mammary or axillary.

It is established nowadays that there are many women who want a more natural result, so that having implants is not noticed by others. Anatomical implants placed behind the muscle, has gained predominance with lean women who have very small breasts, especially in young women between 18 and 30 years of age. 
In other cases, the motivation is to have more volume in the upper part of the breast (provided by round implants). This is usually more requested by young mothers, bothered by the shape of the breast after pregnancy and breastfeeding. In these cases, another type of prosthesis may make sense.
The volume of the implant is totally personalized and not according to any example that the woman may have, since the width of the chest and the pre-existing volume will dictate the width and projection of the prosthesis.
Technology has evolved and at the HPA Group the UP HPA team has a three-dimensional simulation system. These are precious assistants in preparation for surgery, both for the patient and for the surgeon.
Much discussed by the scientific community and even sociologically, the question persists of whether it is a purely aesthetic intervention, or a surgery with a curative purpose.
Although some cases are purely of an aesthetic nature, where the desire is just to have additional volume, we consider that most of our patients, seek this surgery to also improve their self-esteem, diminished for various reasons, or to correct asymmetries in breast development. Many of these changes significantly affect women's psychological health, and are included in the definition of the World Health Organization: “health consists of perfect physical, mental and social well-being” ...
Driven by social networks, magazines, influencers and actresses, the female breast, continues to play an important role as far as female beauty is concerned. 
It is not surprising, therefore, that in today's society this is the most sought-after surgery, even considered important for the improvement of the couple's sexual life.
Nowadays, as a result of more and more information available, women are aware that results will not be eternal, either due to aging and sagginess as the years go by, or by the so-called capsular contracture, that is, the reaction that our body creates around the implant - the capsule. This capsule over the years tends to increase, creating the said contracture, which may justify its surgical correction.
It is therefore accepted that 10, 15 to 20 years after the first augmentation, breast rejuvenation surgery will be needed. 
The first breast augmentation surgery performed in Portugal, dates back to 1967, by Prof. António Maria Baptista Fernandes, it is normal that over the decades, technology related to the materials used has undergone a constant evolution, such as the consistency and safety of the gel. The greatest evolution in the last two decades, has been the lightweight of the new implants. 
Breast augmentation is also very often associated with breast lift or mastopexy. This surgery is then known as augmentation mastopexy and consists in the removal of excess skin, through incisions around the areola only. Incisions might need to be more extensive in cases of additional flaccidity.
As mentioned above, the durability of the result depends a lot on the elasticity of the skin, and there is no doubt that the lightweight implants used today, are of paramount importance, for greater longevity. Also, in terms of recovery, it has been very interesting to note that weight reduction, decreases postoperative discomfort and accelerates the return to active life. Depending on the woman's profession, returning to work could be between 5 to 15 days, most frequently after one week.
But there is also a solution for those who are not interested in the placement of silicone implants, but would like to increase breast volume. This can be done during the same surgical procedure by removing unwanted fat from another part of the body through liposuction and applying it to the breast. However, it is essential to be aware that this procedure will only be possible for a moderate increase, and it may be necessary to perform this surgery more than once as a result of partial resorption that always occurs in fat graft surgery. 

DEMISTIFYING MAIN MYTHS:

• Breastfeed is possible with implants; 
• They do not last just for 10 years, although the result does not last forever, as the body ages;
• Traditional breast exams can be carried out through-
• out the years, including mammography and ultrasound;
• Breast augmentation does not cause cancer of the mammary gland;
• There may be an alteration of nipple and skin sensitivity, but in a low percentage and is less frequent with placement through the mammary fold (under the breast)

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REDUCTION MAMMOPLASTY & MASTOPEXY 
Reduction mammoplasty and mastopexy or breast lift are other types of surgery. They are more complex where the intension is to reduce and / or raise breasts that are disproportionately large or saggy. 
A reduction mammoplasty surgery is of great satisfaction for both the patient and surgeon. The result is an improvement in shape, a decrease in breast weight and consequent relief from postural complaints. Do not forget that this surgery involves scars in strategic places and care must be taken in the post-operative period. 
It must be emphasized that one of the biggest current public health problems is obesity. The desired weight loss and consequent generalized flaccidity motivates many consultations and visits to a plastic surgeon.
The type of breast surgery that best counters flaccidity is called mastopexy or breast augmentation. Excess skin is removed and, if necessary, a silicone breast implant can be placed, to obtain a more feminine and sensual result.
Preoperative exams are necessary, of which we high-
light mammography and breast ultrasound.
This surgery is usually performed under sedation with local anaesthesia. A simple breast augmentation is an intervention that usually lasts 30 to 60 minutes and a mastopexy lasts between 90 to 150 minutes.
We emphasize the importance of making sure that the Clinic is licensed by the Health Regulatory Authority (visibly placed certificate) and also by plastic surgeons (the name of your plastic surgeon can be confirmed on the website of the national doctor’s board: www.ordemdosmedicos.pt/medicos-registados-na-ordem-dos-medicos