For what purpose is breast augmentation surgery performed?
Breast augmentation (“augmentation mammoplasty”) surgery is the most frequently performed aesthetic operation in the world (ISAPS Global Survey 2020). This surgery is performed in individuals who have developmentally small breasts, who have lost some of the breast tissue for any reason (burns, traumas, surgeries etc..), who have difficulty choosing clothes and who have self-confidence problems. This surgery is done in order to obtain a more voluminous, larger, fuller and better breast shape.
As you can find at the end of the chapter, I have analyzed this subject in detail by examining dozens of articles. However, my main aim is to talk about my concept instead of giving general information or explaining a technique.
How is breast augmentation done?
I do breast augmentation using silicone implants. Apart from this; saline implants, fat injections and injected fillers can also be used for breast augmentation. I do not prefer fillers due to the high complication rates. In fat injection, the situation is a little different. When fat injection is used in combination with silicone implants, it increases the quality of the result in suitable patients. However, fat injection alone is often insufficient to bring both breasts to the desired volume.
What are the differences between the silicone implants?
Silicone implants for breast augmentation vary in size, shape and surface properties. It can be classified as round or teardrop (anatomical) according to its shape; and as smooth or textured according to its surface properties. Sizes of silicone implants can start from 125 cc and go up to 800 cc. I do not prefer to use very large (>450 cc) implants due to the irreversible damage it creates on the skin and artificiality.
How do I choose the features and size of the implant to be used?
There are many criteria to consider when choosing the implant. The physical examination, anatomical features of the person, breast structure, fullness of the breast quadrants, skin quality and thickness, occupation and sports habits of the person, the plan to be used, aesthetic measurements of the breast, the patient’s wishes and desires, the technique and the experience of the doctor are very important. The physical examination and measurements we make usually give us an idea about the implant we will put in, but the most important point is that the doctor and the patient must meet at a common point. The patient should trust his doctor and his doctor’s experience.
Where exactly are silicone implants placed?
The silicone implant can be placed under the breast tissue (“subglandular”), under the pectoral muscle fascia (“subfascial”) or under the pectoral muscle (“submuscular”). There is also a dual plan option. You can think of the dual plan as a combination of subglandular and submuscular planes. The dual plan is a plan that I love to use because it has the advantages of both plans, provides good protection, looks more natural and has less complications. In addition, in my own practice, the results of the subglandular or subfascial plane are also quite satisfactory in suitable candidates (volume loss after breast-feeding, adequate skin coverage, etc..).
From which area are silicone implants placed? Are the scars visible and permanent?
Breast implants can be placed from inframammarian fold (the fold under the breast), from the brown ring around the nipple, from axilla or from the umbilical area. I use the inframammary fold to place the implants, considering the dominance of the surgery, the success of the results, the naturalness and the fact that the scars are well hidden in the inframammarian fold. The scar of this incision, which is about 3,5-4 cm long, is well hidden and its visibility decreases over time.
Is breast augmentation surgery a difficult operation? Will you have a lot of pain after the surgery? What awaits you after the surgery?
Breast augmentation surgery is one of the relatively easy operations of the aesthetical surgery. The results are very successful in suitable people and in appropriate indications. It takes around 1.5 hours on average. I recommend my patients to stay in the hospital on the day of surgery. Pain is an expected situation due to the tension and pressure sensation on the skin and/or muscle, caused by the placed silicone implants. However, this pain is not a pain that will ruin your life or make you regret having surgery. The pain responds well to appropriate painkillers. In the early post-operative period, movements such as raising the arms are a bit challenging for you, but there is no obstacle to returning to your daily activities or work 1 week after the surgery. At least 4-6 weeks should be waited for active exercises. Minimal bruises on the chest wall can also be expected. These bruises, if happens, start to lighten (purple-green-yellow) from the 3rd day and disappear towards the end of the 1st week.
Is breast augmentation with silicone implant sufficient in breast aesthetics? There is also sagging/ptosis in my breast tissue. Will the sagging/ptosis of my breast be corrected when you put the implant? What are the other procedures combined with breast augmentation surgery?
Appropriate patient selection is very important in breast augmentation surgery with silicone implants. This surgery is performed in patients whose nipple is in a normal or near-normal position and volume increase is desired. Implant application alone will be insufficient in sagging/ptotic breasts and breasts with insufficient skin quality and excess tissue. In these people, breast lift surgery called “mastopexy” should be added to the breast augmentation surgery. The nipple should be replaced where it should be, excess and sagging tissues should be removed (See Breast Lift Section).
In addition, fat injection can be applied in combination with silicone implants for breast augmentation. In appropriate patients, fat injection (lipofilling) is added to the upper&inner parts of the breast and the prominence of the décolleté area is increased (See Fat Injection (Lipofilling) Applications Section).
Do silicone implants rupture? Is it safe? Can I use these silicones for life?
Silicone implants have undergone many evolutions throughout history and many studies have been done on these implants. Silicone implant brands that have been used around the world for years are safe. Qualified implants do not lose their integrity, rupture, or leak unless they are exposed to a very serious penetrating trauma. Like every product, implants have a shelf life, and the manufacturer recommends replacing the implants every 10 years. However, placed silicones implants can be used for many years if there is no problem, and there are many patients who use the placed implant for life.
Years after breast augmentation surgery, some sagging/ptosis of the breast tissue is inevitable due to aging and gravity. At this point, breast lift (mastopexy) surgery can be performed, and your existing silicone implants can be replaced with new ones during this operation (about 10 years after breast augmentation surgery).
Does breast cancer risk increase after breast augmentation surgery with silicone implants?
Silicone implants do not increase the risk of breast cancer. However, as in every individual, routine follow-up and imaging are of great importance. “Breast Implant Associated-Anaplastic Large Cell Lymphoma” (BIA-ALCL), which has been emphasized in recent years, is a very rare problem encountered after some implant placements.
Is there any breastfeeding problem after breast augmentation surgery?
Many studies have been conducted on breastfeeding after breast augmentation. If we look the studies on this subject, breastfeeding rates have been reported as 82% after breast augmentation surgery. The breastfeeding rate of patients who did not have breast augmentation surgery was calculated as 89%. In cases where no intervention is made on the mammary glands, a breastfeeding problem is not expected. As a result, the risk of breast-feeding problem and loss of nipple sensation after surgery is very low in patients for whom the appropriate method and appropriate plan are selected.
What is capsular contracture?
The body produces a capsule structure that surrounds the implant as a result of the placement of the silicone implant. This is an expected situation, that is, it is normal. Rarely, this capsule structure produced by the body contracts around the silicone implant, thus causing breast deformity and pain. If capsular contracture has occurred, revision surgery may be required. Capsular contracture in breast augmentation surgeries is very rare with the right technique and the selection of appropriate silicone implants.
Will both breasts be 100% symmetrical after breast augmentation surgery?
The answer is “no”. Because both breasts are not 100% symmetrical before the surgery. In addition, the rib cage and chest wall may also be asymmetrical. Chest wall asymmetries that existed before the surgery will not improve after breast augmentation surgery. Before the operation, the difference between two breasts should be carefully evaluated. If necessary, implant placement of different sizes on both sides can be considered. The advantages and disadvantages of this situation should be discussed in detail. When comparing both sides, it should be noted that existing minor asymmetries are quite normal and natural unless there is a noticeable difference.
Summary
Breast augmentation surgery is the most frequently performed aesthetic surgery in the world, with many studies on it. With this surgery, very good results are obtained in a very short time and the satisfaction level of this surgery is quite high. Pain, which is encountered after the operation and gradually decreases within 1 week, is usually the biggest problem. The history to be taken before the operation, the physical examination to be performed, the imaging methods, the understanding of mutual demands and wishes, the evaluation of whether the expectations are realistic, and the meeting at a common point are the most important stages of breast augmentation surgery. It should be noted that the technique to be applied, the healing process and the results depend on many variables. You can browse the related articles in the References section. Best regards.
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