breast-surgery

Breast Augmentation Aesthetics (With Silicone Prosthesis)

Prosthetic breast augmentation is one of the most frequently performed operations in plastic surgery. We can collect patients in need of breast augmentation by using a prosthesis in two main groups:

1. Patients have congenitally insufficient breast development or asymmetric breast structure.
2. Patients with asymmetry in breast tissue after pregnancy/breastfeeding or severe weight loss.

Patient Selection in Breast Augmentation

The patients in the first group mentioned above are usually young and have no children.  Breast sizes of patients in this group are proportionally small with body structures. This situation, which is noticed more when wearing clothes or bikini, swimsuit forces the patients to wear a supportive bra.  Again, it is a frequent occurrence for this group of patients to have asymmetrical breast size and shape. In some patients, there may be mild deformity in the breast wall in addition to the breast size problem. In this sense, the most common condition is the increase of protruding forward of the chest, and therefore the nipples are placed more outward on both sides. In every way, these problems can be solved by prosthetic surgery. The patients in the second group are older and have children frequently. It indicates that breast size increases significantly during most pregnancies and breastfeeding periods. Patients with insufficient breast size before pregnancy are usually happy with their breast size and shape during pregnancy. However, after the end of pregnancy/breastfeeding period, not only shrinkage but also slackness and sagging were added to their breast problems. Patients in this group are often in need of not only prosthetic enlargement but also simultaneous breast lift operation.

How many types of silicones are used in breast augmentation?

Two points are particularly important during preoperative evaluation. Each patient should be evaluated with their anatomical and physiological features. Factors varying from person to person determine the planning of aesthetic breast surgery and the direction in which patient expectation should be. There are two types of silicone prostheses in use. Both are under the guarantee of Mentor, the most trusted brand in the world. These are round and drop model silicones.

Topics discussed in preoperative evaluation:

– What type of prosthesis will be used?

Drops or round?

– Where will be the Prosthesis area ?

Subpectoral or under the mammary gland?

 – Where will the prosthesis be placed?

Is the incision will be performed upper the nipple, under the nipple, or under the armpits?

– Will it be required the breast lift together?

 – In addition to these, preoperative interview with the patients asked;

– Whether they use any medication,

 – Whether they have allergies,

 – Whether breast biopsy was performed for any reason before,

– Whether breast cancer in the family and whether the previous mammography results are evaluated.

In addition to the above points, the patient’s skin structure, chest width, length of neck, size and location of nipples, and perhaps most importantly, pre-operative breast tissue thickness and diffusiveness, make each operation special for the patient.

The most accurate operation planning is made for each patient as a result of the collective evaluation of all these points.

Breast Cancer and Disease Risk in Breast Augmentation Aesthetics

To date, there are no scientific data indicating that breast prosthesis used for breast augmentation increases the risk of any disease including breast cancer. At this point, the only issue related to the use of breast prostheses is the difficulty of mammography evaluation of breasts with a prosthesis. As a solution to this, in recent years, the placement of prostheses subpectoral, in other words, the reduction of the physical contact of the breast tissue with the prosthesis has reduced this difficulty in mammography evaluation.

Does Breast Augmentation Prevent Pregnancy and Breastfeeding?

Breast prostheses, whether placed subpectorally or on the muscle do not have a positive or negative effect on the pregnancy or on breastfeeding. However, pregnancy will inevitably lead to a change in the size and shape of the breast. Since the ratio of fat/gland (ie breast mammary gland / fat ratio) of breast tissue is genetically determined for each patient, it is not an issue that can be predicted the reflecting of the breast size and shape, including the gestation period. Therefore, patients planning to have children should be aware of this situation when making their decisions. 6 months after stopping breastfeeding the breast tissue is completely free from the effects of pregnancy and breastfeeding. The planning of the breast implants operation can begin accordingly.

Weight loss and breast tissue

Losses in the breast tissue occur in people who do diets that cause a great weight loss. While the volume of the breast becomes smaller, sagging may occur. Again, as in the case of pregnancy, since the ratio of fat/gland (ie breast mammary gland / fat ratio) of breast tissue is genetically determined for each patient, a reflection of breast attenuation in breast size and shape is not an issue that can be predicted. In this case, aesthetic breast prosthesis surgery is not planned for the person who continues to lose weight actively. When the patient reduce weight to the desired level and her weight remains constant, then the aesthetic breast surgery is planned by considering the above factors. If the placement of the silicone prosthesis is necessary, it is performed with the uplift operation.

How long does the breast augmentation take?

Breast augmentation aesthetics with breast prosthesis is approximately a 2 hour operation. Patients remain in the hospital on the day of surgery and are discharged from the hospital on the day after surgery by taking off the drains if they have been placed. For 4-5 days after surgery, our patient should limit arm movements and not carry heavy loads. During this period, patients are prescribed antibiotics and analgesics. Our patients come to medical control on the 5th day of the surgery and start to use a support bra for 1 month. It is recommended not to do sporting activities for about 1 month. The final shape of the breast would form about the end of this period.

The incision in the breast augmentation aesthetics

The incision points used to place the prosthesis in breast augmentation; * Nipple tip area: Periareolar * Breast bottom line: Inframammarian sulcus * Armpit area: Axillary

Breast tip incision in breast augmentation

It is a semicircular incision made on the outer borders of the brown area around the nipple. Since this incision is made at the border of the normal skin area with the brown zone, the scarring has the advantage of being minimally visible.  Surgeon Doctor İlker Manavbaşı uses this incision especially in patients in the second group. The reason for this is that uplift surgery is also frequently needed for these patients and when the nipple is lifting up the same area is used to place the prosthesis. Again in the second group of patients, the brown area of the nipple is most likely irregular, increased in diameter and frequently asymmetrical after pregnancy. Turning this area into a more regular circle and reducing the areola (brown nipples) requires making an incision in this area in any case.

Breast bottom lineIt is an incision zone that is 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 called areola does not change after previous pregnancies or weight gain. This area has two advantages. The first is the minimal contact with the breast tissue when reaching the site where the prosthesis will be placed and this incision is almost no harm to breast anatomy and physiology.  Secondly, the incision area is located in an already existing anatomical fold.  It is assumed that scarring will not be exposed to any tension after placement of the prosthesis as a nipple incision. In the first group of patients, the nipple brown area is often very small, consistent with the deficiency in breast development. A semicircular nipple incision in this group makes the placement of the prosthesis very difficult. In such cases, an inframammary incision is already mandatory preference.

Armpit IncisionThis area, 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 a preferred method for two reasons. First, the prostheses to be placed with this method should be filled with serum, ie saline-filled after placement under the breast. The second reason is that the risk of bleeding is higher than the other methods during or after surgery even in the most experienced hands. Since the pocket where the prosthesis is to be placed is opened from a very small and remote area, it is very difficult to open a pocket in the right size and place.

Breast augmentationsurgery is the procedure of a preparation of a convenient pocket for the prosthesis. Preparing a pocket of the right size and placement is more important than where the incision is. In the long term, the scar on each incision site is considered acceptable, beside for exceptions.

The most important change that has been performed since the first applications ofProsthetic Breast augmentation aestheticsis related to which prostheses are used 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 cause a forming less reactive to the body or more natural breast appearance and sensation still continue. The process of inspection and testing of prostheses produced by prosthetic manufacturers before they are released is most seriously applied in the United States. For this reason, today we use the Mentor brand which is one of the best products that have received FDA approval in the USA. Particularly in the first group of patients, our choice is the drop shaped prosthesis filled with a silicone gel which provides the most natural breast appearance. After the use of prostheses in the operation, we provide our patients the basic information of these prostheses and give the stickers that carry the production number.

Location of prosthesis placementExcept in special cases, we prefer the subpectoral placement of prostheses in both groups. 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 is below the breast tissue. In this method, also known as subpectoral, the ¾ upper part of the prosthesis is under the pectoral muscle located in the anterior chest wall and the lower ¼ part is below the breast tissue. The most important reason for this preference is to prevent the prosthesis from being noticed externally because it is surrounded by muscle layer. Particularly in the first group of patients, the operation is not only breast augmentation but also to create the breast shape, that is why the drop shaped prosthesis under the muscle placement of the breast gives 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 patients in the second group, breast tissue mostly sags, so observable upper part of the prosthesis placed on the muscle is quite a common problem. In these patients, the prosthesis is placed under the muscle and sufficient cover is provided by the muscle tissue. Healthy and beautiful days.