Breast Augmentation Operation
Almost all patients applying for breast augmentation operation use the same common sentence; “I no longer want to use a push-up bra.”
Breast development starting with the adolescence continues for many years. In some people, breast size remains quite small and disproportionate with the body structure, due to mostly genetic features. And in some people, involutional atrophy, i.e. breast tissue loss occurs, due to different reasons such as pregnancy, breastfeeding, and weight gain-loss. In such cases, it is possible to attain the ideal breast tissue with breast augmentation.
Which techniques are used in the breast augmentation procedure?
Breast augmentation can be performed through breast implants, injection of the person’s own fat tissue as fillers or ready-made fillers to the breast.
What do you think is the ideal breast augmentation method?
It is not possible to give a clear answer to this question, as the method to be used is decided based on the patient’s breast volume, ribcage anatomy, desired augmentation amount, and preference. Although there has been a tendency among patients towards breast augmentation with their own fat tissue, this technique is often inadequate in augmenting very small breasts. It should also be kept in mind that in case of a large- volume fat injection, the fat will have the risk of displacement towards the bottom of the breast and it will melt to a certain extent.
The ideal group of patients for breast augmentation by fat injection is those who want to enlarge their normal or near-normal breast tissue. Breast implants are more suitable for large volume increases because the shape of the silicone is similar to the structure of the breast, due to the structure of the implant and it both provides breast augmentation and a more youthful appearance, pushing the breast tissue forward.
Which incision techniques are used in breast implant placement and where are the silicones placed?
Breast implants can be placed through the incisions made along the sub-mammary crease, along with the lower half border of the brown area around the nipple (areola) or under the armpit. Silicone implants can be placed directly behind the breast tissue as well as under the muscle which is taking place behind the breast tissue. Although it is said in recent years that the membrane in front of the muscle behind the breast is lifted and the breast implant is placed here, this is not always possible in practice. In another technique that is increasingly gaining popularity, the upper part of the breast implants remains behind the muscle and the lower part behind the breast, and this is called the Dual plan. Even if this technique has superior aspects compared to other techniques, your doctor will recommend the most suitable technique based on your breast anatomy and the selected prosthesis.
Do silicones burst?
We come across with this question quite often. Progress in the production of the new generation of silicones has been so fast that videos, showing that these prostheses do not burst despite a car passing over, are published on the Internet.
Silicones are quite long-lived and do not need to be replaced every 5-10 years, on the contrary to the common belief. The same silicone can be used safely for decades. Silicones can only burst, due to the penetration of cutting and sharp objects. It is a very slight possibility that silicones burst in case of conditions such as sleeping face down, hitting somewhere, receiving a blow or falling.
Is breastfeeding possible after having silicones?
It is more advantageous in terms of the continuity of breastfeeding to place the breast prosthesis through an incision to be made along the sub-mammary crease in patients who are planning to breastfeed later. In this method, by entering directly under the breast, the breast is separated from the chest wall without any damage to the mammary glands and breast implants are placed in the prepared pocket.
As for incisions around the areola, this technique is not recommended for people, who might breastfeed later, because some breast tissue should be cut to form a pocket behind the breast tissue.
What is Capsule Contracture?
As breast implants do not belong to the body, the body forms a capsule structure around the silicone over time and locks it in order to protect itself. The capsule formation occurs gradually over time and becomes stable. In some people, capsule contracture, which is the capsule’s contraction to compress the breast prosthesis, may occur. Although it is not completely clear why it occurs, a number of factors, such as the powder in the surgical glove, some microbial agents, the accumulation of blood around the silicone, are blamed on the development of capsules.
Progressive and/or continuous pain, replacement of the silicone implant and serious deformities require a surgical intervention. The deformation is corrected by removing or cutting the capsule.
Should my prosthesis be tear-drop or round?
When viewed from the side profile, the breast gains fullness rising gradually from the upper side to the nipple. In tear-drop prosthesis, which is produced to mimic this shape, the purpose is to mimic the normal breast tissue anatomically. Although tear-drop prosthesis provides a more natural appearance in thin patients with very low body mass index, round prostheses are still used more often worldwide.
Natural-shaped breast augmentation with round prostheses can also be achieved in thin patients, by using the behind muscle plan. There is a common view that the tear-drop prosthesis can rotate in the breast and subsequently, the breast shape can be deformed due to reasons such as long-term use, pregnancy, and pressure on the breast (face down sleep). When round prosthesis is used, this rotation of the silicone implant in the breast will not cause any deformation because the volume of the round prosthesis is evenly distributed on all sides.
How do you decide on the prosthesis size?
Perhaps the most critical point in breast augmentation operation is the selection of the implant, which will provide the shape and volume that the patient desires. Some patients request a very outstanding breast size, while some patients say that they desire a little fullness and a bigger size will annoy them. Although the changes to be formed in the breast tissue, as a result, the selected prosthesis is demonstrated to the patents with the help of technological devices, this method is not reliable, due to some parameters which are not taken into account.
In my own surgical practice, I first talk to the patient, who is going to be operated, and try to figure out what size she desires, and request her to try certain sizes of the prosthesis in the bra, that she desires to wear after the operation. I evaluate the prosthesis selected by the patient according to the rib cage, the base width of the breast, the features of the breast skin and tell my opinion whether it is appropriate or not. After discussing these issues, the volume of the prosthesis to be placed on the patient is determined and I complete the operation by trying and comparing this prosthesis with a smaller or larger size.
Short notes about the operation
** The operation lasts for 1-1,5 hours on average. The patient is hospitalized for 1 night following the operation and in case a drain is placed, it is usually removed on the next day.
** After the removal of drains, a shower can be taken on the 3rd-5th day.
** Although placement of the prosthesis behind the muscle causes more pain and movement restriction, recovery is achieved in 5-7 days on average. After the operation, surgical bras are used and they are recommended to be worn for at least 2 months.
** While activities such as walking are returned 1 week after the operation, it will be good to give a 1,5-month break to the exercises including arm movements.
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