Breast augmentation (Breast enlargement) using implants has become one of the most common procedures in Aesthetic Surgery. Breast augmentation comes from several aesthetic reasons:
- women who are dissatisfied with the size of their breasts;
- women whose have breasts’ size has decreased following pregnancy / or increasing age;
- women who have asymmetrical breasts
ABOUT THE IMPLANTS
The most common material used for breast implants is silicon, due to its biocompatibility. There has been the suspicion that silicon implants may connect to two specific diseases: breast cancer and autoimmune disease. Scientific data from more than 2, 000, 000 women with mammary implants were collected throughout the world. They attest that there is no evidence, which suggests that silicone would cause any type of cancer or autoimmune disease. The results are communicated by the University of Southern California “Official of Plastic and Reconstructive Surgery”, University of Calgary – Canada ‘Official English Medicine, Mayo Clinic – U. S. and all attest that there is not an increased risk for breast cancer for women with silicon implants. Autoimmune disease is a general term to describe an immune system that responds to defensive substances that are part of the body. These problems occur spontaneously to the regular population. The theory concerning the fact that silicone could cause autoimmune disease is wrong, and this is demonstrated by numerous tests performed on groups of women with breast implants. Clinical studies have demonstrated that there is no connection between silicone implants and the tissue disorder. There are studies that continue to check these results on a large group of women, on a long term. Breast implants are either filled with silicone gel or filled intra-operative with saline solution. In recent years, gel implants have returned in use in the entire Europe and since 2007 it is decided that they can be used again in the United States as well according to FDA decision. Breast implants do not affect pregnancy, fetal development, breast feeding or health of breastfed children. The life expectancy of the implant is unpredictable.
Type of implants
There are two main types of implants used for breast enlargement: saline filled and silicone-gel-filled. The main disadvantage of saline-filled is deflation and rippling. In case of rupture liquid silicone gel filled implants could provoke local disorders that can lead to siliconoma formation and impregnation of the surrounding tissue. The silicone implants used today are filled with cohesive silicone, which even cut open can not leak. Regarding the form of the implants there are two types:
- anatomic breast implants (indicated when a more natural and proportional aspect of the breasts is desired. The differences between width, height and projection allow choosing the most appropriate implants regarding anatomical particularities of the body);
- round breast implants (request when patients prefer greater volume in the upper pole).
There are important benefits of breast augmentation / breast enlargement: a balance in breast size, symmetrical form and contour of the breast, improvement of the self-image and self-esteem. The possible complications of breast augmentation are infection, bleeding, poor wound healing, asymmetry, rippling, capsular contracture etc. You should weight these risks against the benefits of the breast enhancement procedure. So you can make an informed decision about whether to proceed with breast enlargement surgery.
Finally, after clearly understanding of the implications and outcomes of surgical procedure you will sign the informed consent.
The augmented breast should look natural and proportional after breast augmentation surgery. Therefore, communication about what you desire and what is possible to do is extremely important. Breast shape is a common doctor-patient decision.
PREOPERATIVE RECOMMENDATIONS FOR BREAST AUGMENTATION
- Before breast enlargement surgery, you should make an echography or mammography;
- Do not eat and drink after midnight before breast enhancement surgery;
- It is forbidden to take any medicines containing aspirin, with 2 weeks before the surgery;
- Usually, for women, the surgical intervention must be performed outside menses;
- You must prevent the surgeon and the anesthesiologist if you have medical problems – vascular tension, vascular problems, stroke, diabetes, lung problems, bleeding problems, epilepsy, neurological problems, allergies to various medications;
- The physician must be notified if you have a set of plates or eye lenses;
- If you smoke, plan to quit 2 weeks before the operation and do not start to smoke again for at least 2 weeks after surgery;
- Avoid sunbathing in excess before breast augmentation surgery;
- Do not follow a strict diet before surgery because it might delay the healing process;
- If you catch a cold or have any infection, the breast enhancement surgery must be rescheduled.
PREOPERATIVE PLANNING FOR BREAST AUGMENTATION
- There are several essential steps in planning the desired form of the breast and implant selection;
- First of all, we should not think about the volume, but about dimension;
- The desired breast width and the tissue thickness allow us to determine the implant width;
- The anatomic implants with greater height then width and more inferior pole projection are most favorable for patients with taller, narrower torso;
- Implants with greater width than height are a good choice for augmentation when the patient has a shorter, wider torso. Full projection implants are indicated for patients with loose skin envelope with atrophic parenchyma;
- Pocket plane selection
The placement of the breast implant may be:
- dual plane
The subglandular breast implants placement is below the breast tissue and above the muscular fascia. This placement works best in patients who have adequate soft tissue coverage with the thickness of more then 2 cm and degree of ptosis. It also may be favorable for patients which want to continue active exercise program.
The subfascial breast implants placement is below pectoralis major fascia but the longer pole is relatively easy to dissect. This plan does not add much more tissue over the implant, because the thickness of the fascia is less than one millimeter. The advantage of this breast implants placement is that an upper pole fascia conceals the upper edge of implant.
The total sub muscular breast implants placement is above the chest wall and below portions of pectoralis major and minor, serratus anterior, rectus abdominis and external oblique muscles. The pros are that the implants will not drop in time. On the other hand, pseudoptosis of the breast could occur later.
The subpectoral breast implants placement is above the chest wall and below the pectoralis major superiorly and in the subglandular or subfascial plane inferiorly.
The dual plane is actually a variation of the sub pectoral plane augmentation.
This variation permits expansion and redraping the gland tissue over the implant, creating a pleasing breast appearance.
BREAST AUGMENTATION SURGICAL PROCEDURE
Breast augmentation is usually performed under general anesthesia and it takes between 1 and 2 hours.
Four incisions are used for breast augmentation:
We prefer as a first choice the inframammary approach and as a secondary choice the periareloar approach.
The advantages of the inframammary approach are:
- Straightforward approach
- Better visualization of the breast pocket
- Easy incision and dissection for the pectoralis major insertion
- The scar is inconspicuous, placed right at the level of the new inframammary fold
The surgeon tries to make an incision as small and less visible as possible. The implants filled with serum can be inserted through an incision of 2,5 – 3 centimeters and the gel filled implants can be inserted through an incision of 5 – 5,5 centimeters. During the past few years, we introduce the implants in the pocket above or beneath the pectoralis muscle depending on the initial appearance of breasts (tegument quality, the degree of mammary ptosis, thickness of the gland and adipose tissue). The advantages and disadvantages of such alternatives on the incision area and the positioning of the implants must be discussed in detail during the preoperative consultation with our cosmetic surgery specialists. After the breast augmentation surgery, drainage tubes are attached for 24 hours, in order to avoid the formation of hematoma, which encourages the occurrence of the capsular contracture.
BREAST ENLARGEMENT POSTOPERATIVE HOSPITALIZATION
A 1 to 3 days postoperative hospitalization is required and during this period antibiotics are given. You will probably experience some pain and initial discomfort following the operation for the first 24-48 hours, especially if the implants are placed under the pectoralis major muscle but you will be prescribed pain-control and anti-inflammatory drugs.
BREAST ENHANCEMENT POSTOPERATIVE RECOVERY
Stitches will be removed at 12 days after breast enlargement surgery, even by the family doctor. But usually the wound is closed with self-absorbable stitches. Therefore there is no need to remove it. The patient will wear for 2 or 3 months a suitable brassier well adapted to the new shape and volume of the breasts. It is usually recommended to avoid intense physical efforts for the first 2 or 3 weeks. As for the scars you must know that for the first 6 months they will blemish and swell but in about 9 months maximum one year after the surgery they will flatten and fade.
The most important aspect of breast augmentation surgical procedure is your personal wish and decision. You should take in consideration that today’s trend in breast augmentation is “natural look”. The benefit of breast enlargement procedure from the emotional and psychological point of view is the boost of your self-confidence through achieving a new “look”. The main satisfaction for surgeon and patient is to see the augmented breast like one good looking naturally and being proportional.
Breast augmentation with implants, clinical cases in plastic surgery clinics Romania , performed by the best surgeons in Romania :
This blog post is an educational resource only and does not replace a medical consultation with a doctor .
Please feel free to get in touch if you have any questions or comments. Your feedback welcome!