Breast Augmentation

Breast augmentation with prosthesis is one of the most common operations in plastic surgery today.

Breast augmentation using prosthesis is performed in two main groups of patients.

– Patients without adequate breast development or having asymmetric breast structure.

– Patients with breast tissue loss and asymmetry after pregnancy / lactation or severe weight loss.

Correct choice of patient groups

The first group of patients in the two groups mentioned above are usually young and have no children. The breast sizes of the patients in this group are proportionally small with the body structures. This situation, which is noticed more with the clothes on, forces the patients to wear a supported bra. Again, in this group of patients, the breast size and shape are frequently asymmetrical. Some patients may have a slight deformity in the chest wall in addition to breast size. In this sense, the most common condition is the increased inclination of the chest, and therefore the nipple ends are more externally oriented on both sides.

Patients in the second group are older and often have children. Many indicates that, during pregnancy and lactation, their breast size increased substantially. Patients with inadequate breast size before pregnancy were happy with breast size and shape during pregnancy. However, after the pregnancy / lactation period was terminated, not only shrinkage but also sagging was added. Patients in this group often require not only a prosthesis augmentation, but also a simultaneous breast lift operation.

Preoperative evaluation

Two points are particularly important in preoperative evaluation. In fact, this is the reason why not every patient has the same result. Often, breast augmentation patients come into a meeting knowing or seeing other patients have undergone this operation or famous figures. However, differences in skin structure, chest width, height, size and location of the nipples, and perhaps most importantly, preoperative breast tissue thickness and prevalence, make it impossible to achieve the same result in each patient. These points are taken into consideration in the preoperative evaluation and it is decided what the best choice will be for each patient.

In the preoperative evaluation, the following points are discussed with the patient.

-Which type of prosthesis will be used?

-Where will the prosthesis be placed?

-Where will the prosthesis be inserted from?

-Will there be a need for breast lift?

Before the operation, in addition to these;

-The use of any medicine,

-Whether they have allergies,

-Whether breast biopsy was performed for any reason before,

-The presence of breast cancer in the family and

-More mammogram results,

Are discussed and evaluated with the patient.

Risk of breast cancer

To date, no scientific data have been found that breast prosthesis used for breast augmentation increases the risk of breast cancer. At this point, the only issue with the use of breast prostheses is the difficulty that protheses cause in mammography evaluation. In recent years, the more placement of prostheses under the muscles – in other words, the reduction of physical contact of the breast tissue with the prosthesis has reduced this difficulty in mammography evaluation.

Weight loss and pregnancy

Breast prostheses, whether placed under the muscle or on the muscle, do not have a positive or negative effect on the delivery of pregnancy or breastfeeding. However, the diets that cause weight loss and pregnancy will inevitably lead to a change in size and shape. Since the gland-to-fat ratio of the breast tissue is genetically determined in each patient, it is not possible to estimate the weight changes in breast size and shape, including the period of gestation. Therefore, it is necessary to be aware of this situation when making the decisions of both the patients who will start weight loss programs and the patients planning to have children.

Operation

Breast augmentation with breast prosthesis is approximately 2 hours of operation. This surgery is usually performed under general anesthesia. The patients remain in the hospital on the day of surgery and are discharged on the day after the surgery by taking the drains. After surgery, especially in patients with prostheses under the muscle is expected to be pain due to arm movements for 4-5 days. During this time, patients are prescribed antibiotics and painkillers.

What patients should know about the operation:

– What kind of incision is made,

– Where the prothesis will be placed,

– What kind of incision is made,

– What kind of prosthesis will be used

Incision

The incision points used to place the prosthesis in the breast augmentation operation;

Nipples –Periareolar

Breast Bottom Line – Infra Mammarian Sulcus

Armpit area-Axillary

Nipple

It is a semicircular section made on the outer borders of the brown area around the nipple. Since this incision is made at the border of the normal skin color with the brown zone, the scarring has the advantage of being minimally noticeable. We use this incision especially in patients in the second group. This is because we often use the same area for prosthesis placement when the nipple area is raised, since frequent uplift surgery is also required in these patients. Again in the second group, the brown area of the nipple was irregular after pregnancy, increased in diameter and frequently gained an asymmetrical appearance. Turning this area into a more regular circle and reducing the arola -brown nipple area- already requires an incision.

Breast bottom line

It is an incision place often used in patients in the first group. This area is also preferred in patients in the second group, where the nipple does not need to be lifted and the nipple area, which is called areola, does not change after previous pregnancies or weight gain. This region has two advantages. The first is that the contact with the breast tissue is minimal while reaching the area where the prosthesis will be placed, this is almost no harm to breast anatomy and physiology. Second, the incision uses an already existing anatomically foldable line. It is assumed that the scar will occur to a minimum degree as it will not be exposed to any tension, such as a nipple incision after prosthesis placement. In the first group of patients, the nipple brown area is quite small, consistent with the insufficiency in the development of the breast. A semicircular nipple incision in this group of patients makes the placement of the prosthesis very difficult. Therefore, the breast bottom line incision is a mandatory choice.

Armpit incision

This region, which looks attractive due to its distance to the breast and its concealed placement under the armpit, requires the use of special endoscopic instruments. It is not our preferred method for two reasons. First, the prostheses to be placed with this method should be filled with saline after placement under the breast. Secondly, the risk of bleeding during or after surgery is even higher even in the most experienced hands than in other methods. Since the pocket where the prosthesis is to be placed is opened from a very small and remote area, it is very difficult to cut a pocket at the right size and placement.

Breast augmentation surgery is an appropriate pocket preparation procedure for the prosthesis. Preparing a pocket at the right size and placement is more important than where the incision is. In the long term, the scar on each incision area is acceptable, besides some exceptions.

Prosthesis

The most important change of breast augmentation surgery since the first application is related to prostheses rather than surgery. Surgical principles, ie where and how to open the prosthesis pocket, have not changed much. However, the developments regarding the production of prostheses, which may create a more natural breast appearance and sensation, are still continuing. Prostheses which are produced in the United States of America gets tested and supervised in the most serious way. For this reason, we are using FDA-approved products from America today. Particularly in the first group of patients, our choice is the drop shaped prostheses filled with silicone gel, which provides the most natural breast appearance. After the use of prostheses in the operation, we provide stickers to our patients with the basic information of these prostheses and carry the production number.

Placement of prosthesis

Except in special cases, the preference for prosthesis placement in both groups is under the chest muscles. In this method, also known as subpectoral, the upper part of the prosthesis is under the pectoral muscle in the anterior chest wall, and the lower part of the prosthesis is below the breast tissue. The most important reason for this preference is that the prosthesis has minimal physical contact with the breast tissue and the prosthesis is surrounded by the muscle layer, so that it is prevented from being noticed from the outside.

Particularly in the first group of patients, the operation is not only breast augmentation, but also to create the shape of the breast.  Raindrop shaped prostheses placed under the muscle give the breast the most natural appearance. Since the patients in the first group have very few breast tissues before surgery, the task of hiding the prosthesis is given to the muscle tissue. In the second group of patients, breast tissue is mostly sagged, and the upper part of the prosthesis placed on the muscle is a common problem. In these patients, the prosthesis is placed under the muscle and provided with adequate cover and muscle tissue.

After the operation

Arm movements are expected to be painful for 4-5 days in the early period after breast augmentation with a prosthesis placed under the muscle. At the end of this period, the limitation of movements gradually decreases. In the early period, risks such as bleeding or infection are very small. The patient is usually seen by the doctor on the 5th day and the supportive bra is started to be used. The necessity and duration of bra use is different in each patient. It is recommended not to do sports activities for about 1 month. The breast takes its shape at the end of this time.

 


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