Breast AugmentatIon aESTHETIC OPERATION
Breast tissue may be insufficient in size due to genetic properties or decreased breast tissue (involutional atrophy) after breastfeeding. In some cases, breast enlargement may be requested by a person, who finds an almost ideally sized breast small. In all these cases and with the breast augmentation operations, the main aim is to increase the self-confidence of the person to prevent her social reluctance. Most women wear supportive bras, thinking that their breasts are small, feel bad when they wear swimwear or bikini or think that they cannot fit the clothes they wear. The most commonly used method in breast augmentation is the placement of a silicone prosthesis. Very rarely, in patients with enough fat deposits in the body, breast augmentation is possible with the fat tissue to be taken from the person. One of the major disadvantages of this technique is that some of this fat melt over time and repeated fat injections may be required. Prostheses, surrounded by a silicone sheath and with saline or silicone gel inside, are used in breast augmentation. Silicones can be drop (anatomical) or round-shaped. Depending on the shape of the breast and the adequacy and quality of the breast tissue, these prostheses can be placed just below the breast tissue or under the pectoral muscle in the anterior chest wall. If the person’s breast tissue is not sufficient to cover the prosthesis, subcutaneous placement will be a better option, as otherwise the prosthesis will be felt when the breast is touched. When the silicone is placed under the muscle, there is more pain after the operation when compared with the operations of placement under the breast tissue and the risk of bleeding also increases. Perhaps what is the most critical about this operation is to determine the degree of breast augmentation by mutual decision of the patient and the doctor. While the request of the patient is essential, the physician should consider how realistic this request is and if it will suit really well with the body structure.
The ideal breast size should be evaluated together with the patient’s shoulder width, height and body characteristics. The breasts of the same size may appear beautiful in one of the persons with different body profile but repulsive in the other. If necessary, the demo prostheses should be placed in the bra in front of a mirror and the patient should determine the prosthesis of the desired size and shape. The choice of the jointly decided prosthesis is quite a critical step in meeting the patient’s postoperative expectations. Prostheses can be placed through incisions around the nipple, under the armpit or along the breast crease. The most commonly used incision is along the breast crease and an average 4,5 cm incision will be enough. The use of drain may be required after the operation and the average hospital stay is 1 day. It will be useful to use a sports bra after the operation, as it provides a good support until the person adapts to the prosthetic tissue. After the operation, a short weakness, dizziness, and nausea can be seen. There may be oedema in the breast tissue and a feeling of pressure but from the 3rd day onwards, the swelling decreases gradually.
Bleeding, hematoma (accumulation of blood in the tissue), infection, wound site dehiscence, seroma (accumulation of serum-like fluid in the operated area) can be seen in the early period. In the late period, asymmetry, capsule contraction, poor scar, a decrease in nipple sensation (depending on the technique) are possible complications.
** In prostheses, the situation, which is known as prosthetic burst colloquially, is more common in serum-containing implants. In the case of silicone implants with newly produced cohesive silicone gels, this ratio is expressed as 1-2% in different studies.
** There is no evidence that breast cancer increases after using silicone prostheses produced by trusted brands. Breast cancer risk in women who have breast prosthesis is the same rate as that of women, who do not use prostheses, and it is a known fact that breast cancer develops in 1 out of 7 women.
** The prostheses used in breast augmentation operations do not prevent breastfeeding. In addition, although it is thought that the total amount of milk will decrease, as a part of the mammary glands, which are opening to the tip of the breast, are cut during the placement of the prosthesis from around the nipple, milk production amount will be sufficient thanks to compensation from the remaining breast tissue.
** For the first 3-4 weeks after the silicone is placed, the arm movements and force and pressure applications on the breast should be avoided. Heavy exercises usually should not be done for 2-3 months and the sports bra should be used for 1,5 months.
** Capsule contraction occurs when the prosthesis is perceived as a foreign object by the body and is surrounded by a capsule. If the capsule formation does not limit itself, it causes prosthesis displacement, pulling and folds in the breast. In these cases, it is necessary to intervene via different methods depending on the severity of the contraction. With the use of today’s prostheses with the ragged surface, the risk of both silicone replacement and capsule contraction is reduced.
** There may be uncomfortably small stings and burning sensations for months after the breast augmentation operation but these often do not indicate a bad condition.