Breast Augmentation R24R

Everything you need to know about Breast Augmentation Rapid Recovery R24R

Breast augmentation with silicone implants

When to consider augmentation with silicone implants?

Silicone implant surgery increases or restores the size of the breast using silicone implants.

Considered one of the most popular and performed cosmetic surgery procedures, breast augmentation has a long and successful history of satisfying women who have improved, recovered or restored balance to their appearance.

From Dr. Júlia Melo's perspective, the goal of breast augmentation is to improve a patient's natural proportions and create a more symmetrical and aesthetically breast profile, but the procedure is performed to suit a woman's individual needs, considering aesthetic patterns and symmetries.

There is no “typical” breast augmentation patient, and women choose to have the procedure for many different reasons – having bigger breasts is just one of them.

Breast augmentation with a silicone implant is one of the most effective procedures for correcting visible breast asymmetry and breast implants can be used to help correct deformities in tuberous breasts. If the patient has mild ptosis, it can be improved through augmentation, whereas moderate to severe ptosis may require an associated mastopexy (breast lift).

The following are also common breast augmentation goals:

  • Improve the shape and volume of the breast;
  • Improve body image, symmetry and balance;
  • Improve the fit of clothes;
  • Provide the appearance of a lifted breast;
  • Rejuvenation after postpartum breast deflation.

When to consider a breast augmentation with silicone prosthesis?

If you want to look more fitted or more attractive or want your clothes to fit better. When pregnancy, weight loss or aging affect the size and shape of the breasts or when you want to correct breast asymmetry. If you are in good health, have a positive attitude and realistic expectations, you are a good candidate for this procedure.

After all, what is R24R?

24-hour recovery was developed more than 20 years ago by Dr John Tebbetts in Dallas, United States.

The technique is safe and follows a protocol:

  • Preoperative education and appropriate implant choice;
  • Anesthesia without a hangover;
  • Modified surgical technique for less bleeding and reduced pain;
  • Specific intraoperative and postoperative medications;
  • Muscle relaxation exercises;
  • At R24R, patients can move their arms, drive, wash their own hair, carry up to 15 kilos and carry out other routine activities without discomfort 24 hours after the procedure.

The difference between the technique begins with the choice of the implants according to the desires and characteristics of each patient. With the chosen prosthesis, detailed planning is carried out, including the incisions, position of the prosthesis, construction of the store, position of the muscle and internal bra.

The surgical procedure itself is careful, we follow a protocol with 14 safety points. We avoid bleeding by trying to previously cauterize the blood vessels, the technique is atraumatic, with specific material, we use a funnel to delicately introduce the prosthesis, we do not use molds or drains and we close the store in layers.

Who is the R24R suitable for?

R24R is recommended for women who want a faster recovery and need to return to their routine activities more quickly. It is also recommended for women who are sensitive to pain and are afraid of a traumatic post-operative period. The R24R technique has many benefits, it is a well-established and safe technique. Make sure your surgeon is qualified to perform it.

The initial consultation

During your initial consultation, you will have the opportunity to discuss your goals and desires. Dr. Júlia Melo will evaluate you as a candidate for breast augmentation and clarify what this procedure can do for you. By understanding your goals and medical condition, alternative and additional treatments may be considered.

Your complete medical history should be discussed at your initial consultation, including information about previous surgeries, current and past medical conditions, medication use, allergies, family history, and current mammogram results. Your breasts will be examined, measured and Dr. Júlia Melo will take photos for medical records and 3D simulation, to help you choose the ideal implants. The current size and shape of your breasts, the desired size and shape, the quality and quantity of breast tissue, the quality of the skin and the position of the nipples and areolas will be considered. If the breasts are sagging, either due to age or weight loss, a mastopexy can be performed in conjunction with the procedure.

If you are planning to lose a significant amount of weight or become pregnant, be sure to say this during your initial consultation. It may be recommended that you wait some time before undergoing surgery, as these conditions may affect the long-term outcome of the surgery.

In the initial consultation, also, Dr. Júlia Melo will discuss with you about all possible approaches and associations for your procedure, about the result that can be expected, the risks and complications, the anesthesia and hospital options and all the costs that will be involved in the breast augmentation.

Choosing the type of silicone implants

There has never been a better time to undergo a breast augmentation with silicone implants, as we have more options than ever to help you customize your new look.

Whether you'd like more curves or just a little lift, there's always an option for you. Here are some options you can expect during the consultation process:

Shape: The types of silicone prosthesis can be classified according to their shape: round, conical and anatomical. Dr. Júlia Melo will help you choose the shape based on your existing proportions and your goals. Patients with tuberous breasts and a short lower pole have an excellent indication for the use of anatomical prostheses, in addition to patients who want more natural results. Patients who want round, defined breasts are recommended round implants.

Profile: Prostheses are classified into profiles according to their projection (the distance from the base to the point of greatest projection). Contrary to what many think, the greater projection does not increase the cervix upwards, it actually increases the projection of the breasts forward. Considering the same base, we work with 4 types of profile: low, moderate, high and super high. The smaller the profile, the more natural the result of the surgery. It is important to analyze the shape of the breast, skin elasticity, base of the chest and position of the areolas to choose the most appropriate projection.

Volume: Breast implants with silicone prosthesis vary greatly in volume. Many patients require breast implants of different volumes for each breast; This helps to achieve the best possible symmetry. The volume you choose depends on the size of your breast, your personal goals and the recommendations will be discussed by Dr. Júlia prior to surgery in an evaluation consultation where photos will be taken and measurements and needs will be meticulously analyzed through 3D simulation.

Surface: There are textured, smooth and polyurethane-coated prostheses. The textured prosthesis has lower contracture rates in a subglandular plane, less migration and rotation of the implant. Placing the silicone prosthesis implant in a submuscular pocket balances the risk of contracture between the smooth and textured surfaces. The smooth surface forms a thinner envelope and has slightly higher contracture rates in the subglandular pocket. The polyurethane-coated implant has low contracture rates and is generally used in subglandular planes due to its high adherence. Dr Júlia prefers the use of microtextured implants.

Store plans:

Subglandular: Advantages:

  • Good projection and shape;
  • Prevents distortion in muscular or active patients.


  • Increased frequency of contractures;
  • Implant margins may be palpable in patients with thin parenchymal coverage. (very thin patients).
  • Greater elongation of the lower pole of the breast (the areola is positioned higher and the distance from the areola to the inframammary fold).
  • Hypermobility of prostheses.

Subpectoral: Advantages:

  • Low contracture frequencies;
  • Thicker breast tissue coverage;
  • Good preservation of nipple sensitivity.

Less elongation of the lower pole with maintenance of neck projection.


  • Greater possibility of lateral displacement over time.
  • Breasts may contract during contraction of the pectoral muscle;
  • Prostheses can become high, with ptosis (falling) of the breast tissue over the prostheses, known as snoop nose or waterfall.

Dual plane:

The dual plan combines the advantages of both plans. The upper pole subpectoral coverage provides thicker tissue coverage. As the lower pole of the prosthesis is subglandular, the implant-parenchyma interface increases, which expands the lower pole and reduces the formation of waterfall deformity.

It also seeks to reduce the displacement of the implant, and has less contraction of the breasts with the contraction of the pectoral muscle.


Through the R24R and Mastogrip course with Dr. Thiago Cavalcante in Balneário Camboriú, Dr. Júlia improved on the Grip Plane, which is the Dual Plane plane with greater lateral support and stabilization of the implants.

Factors that influence the type of procedure recommended for you include:

  • Medical history;
  • Goals for breast augmentation;
  • Existing breast tissue;
  • Preferences related to the size and positioning of the incision.

Dr. Júlia Melo and team's goal is to help you achieve the best results and make your surgical experience as easy, safe and comfortable as possible.

Preparation for implant surgery with silicone prosthesis

Dr. Júlia Melo will provide complete pre-operative instructions and answer any questions you may have. It is important to take a detailed medical history and perform a physical examination to determine your suitability for surgery.

You will need to stop smoking at least six weeks before undergoing surgery to promote a better recovery. Avoid taking aspirin and anti-inflammatory medications. Regardless of the type of surgery being performed, hydration is very important before and after the procedure for a safe recovery. Nutrition is an important part of a good post-operative period.

Avoid alcoholic beverages 5 days before and 15 days after surgery. Eat a protein-rich diet 7-10 days before surgery.

  • Stop using oral contraceptives for 10 days before surgery.
  • Stop using anabolic steroids for 3 months before surgery.
  • Do not perform any dental or mucous membrane procedures in the first 45 days. Tell your doctor first, and they will advise you how to do it if it is essential.
  • Preoperative fasting is 8 hours.

The surgery

On the day of surgery, bring comfortable, light and easy-to-wear clothes. The patient must take all of her printed exams to the surgical center. You must also carry a surgical bra with you for the procedure.

It is important to remember personal hygiene items. However, avoid valuables as there are no members of Dr Júlia's team in the room during the surgery.

Avoid applying moisturizer in the 24 hours before surgery.

Surgical planning is done before surgery, and Dr. Júlia will confirm with you the size of the prosthesis and plan the incisions.

A nurse will accompany you to the operating room where the anesthetist will begin the preparation.

Medications will be administered for your comfort during the surgical procedure. In our rapid recovery protocol we opted for total intravenous general anesthesia, which is the safest anesthesia for this procedure. The patient is fully monitored, including the BIS that monitors her level of consciousness. Waking up from this anesthesia is calmer and with less incidence of nausea and vomiting, ensuring a more comfortable and faster recovery.

After cleaning and placing drapes, an incision of approximately 4 cm is made in the inframammary fold. When the breast tissue and pectoralis major muscle are lifted, a pocket is created in the breast area and the implant is placed. Our preference is the Grip Plane plan, due to the advantages it presents.

An option to complement the placement of silicone implants is fat grafting, a process in which the surgeon removes fat from the patient, using liposuction, from a part of the body that has fat (such as the abdomen, thighs or flanks), and injects it into your breasts to symmetrize or improve the contour and shape of your breasts.

After the breast implants are placed, sutures will be used to close the surgical incisions. We routinely use barbed suture to make the internal bra, which helps to fix the breast inframammary fold in the correct position, giving better support to the prosthesis. This same thread is used to close the layers, and finally, the skin is closed with a non-absorbable suture that does not need to be removed.

We use a sterile and waterproof bandage. You will not need to change bandages, and you will be able to shower on the same day as the surgical procedure.

We use a soft bra that will be placed after the procedure and used for the first 15 days. After this period you will be able to use the bra of your choice.

Immediately after surgery, a feeling of pressure in the breasts is common. Dr. Júlia Melo will prescribe some medications to alleviate any discomfort that the post-operative period may bring, in addition to guiding arm elevation exercises that will help with the lymphatic drainage of the breasts, reducing discomfort.

The diet is started immediately after returning to the room, while still in the hospital, before leaving the hospital.

You can expect to walk on your own within a few hours after surgery, and after a short period of observation, you may be allowed to go home unless you are instructed to remain in the hospital for a while longer for observation and rest.

Silicone care

Once you have breast implants, you should keep in mind that you will need to have mammograms, ultrasounds or MRIs periodically for medical monitoring. In these exams, ruptures and abnormalities will be detected, which, in most cases, are not possible to detect in a common medical consultation.

Future pregnancies or weight changes may affect results, and secondary surgery may be necessary to correct this changes.

Nothing can stop the normal aging process; Over time, breast tissue will change. You can help prevent unnecessary sagging by wearing a bra with appropriate support for your activity level.

Breast augmentation recovery time

You should be able to walk without assistance immediately after surgery. It is very important that you walk a few minutes every few hours to reduce the risk of thrombosis in your legs. It is vitally important that you follow all care instructions provided by Dr. Júlia Melo. This will include information about wearing compression garments, taking an antibiotic if prescribed, and only performing the level and type of activity considered safe post-operatively. You will also be given detailed instructions about the normal symptoms you will experience and any possible signs of complications. It is important to realize that the amount of time it takes to recover varies greatly between individuals.

R24R Protocol:

  • Aerobic activities that increase the heart rate above 100 bpm (beats per minute) must be suspended for 15 days.
  • Do not lift weights with your arms and legs (bodybuilding) for 21 days.
  • It is permitted to lift and hold children up to 15kg.
  • Hiking is permitted after 24 hours.
  • Running and cycling after 3 weeks.
  • Exercises with weights after 30 days.
  • Crossfit and contact sports only after 6 weeks.
  • Driving allowed after 24 hours.
Dr. Júlia Melo instructs her patients to stay in touch. For safety, as well as the most beautiful and healthy result, it is important to return to the office for post-operative follow-up and whenever you notice any changes in your breasts. Don't hesitate to contact her if you have any questions or concerns.


It is important for women with breast implants to keep in mind that while breast implants are intended to last for many years, replacement may be necessary. After breast implant surgery, you must undergo a periodic examination to monitor your implants.

Silicone gel-filled breast implants have come under scrutiny for years, but after collecting detailed and meticulous research and data, the U.S. Food and Drug Administration (FDA) approved for use in breast augmentation plastic surgery, finding no link between silicone implants and connective tissue disease, breast cancer or reproductive problems.

Implant-Associated Anaplastic Large Cell Lymphoma (BI-ALCL) of the breast is a very rare and treatable type of lymphoma that can develop around breast implants. According to the most recent data, the risk of an association between breast implants and ALCL is extremely low. In a March 2015 study published in Plastic and Reconstructive Surgery, 173 patients were identified through a review of the global literature with BI-ALCL since the initial case report in 1997.

Most patients who developed BI-ALCL had an excellent prognosis after surgical removal of the breast implants and scar tissue capsule. Continued follow-up after any breast implant surgery is suggested and important for the patient's health, but patients who notice pain, lumps, swelling, fluid collections, or unexpected changes in breast shape, including asymmetry, should contact their plastic surgeon.

Surgical techniques for breast augmentation and all breast implants are continually refined, increasing the safety and reliability of the procedure. Dr. Júlia Melo will provide you with the information you need to make an informed decision.

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