Breast Augmentation

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Breast Augmentation

Breast Augmentation (Breast Implant– Silicone Mammoplasty) is the procedure that involves the enlargement of a small-sized breast by placing a silicone implant into the pouch formed under the breast tissue. If the breast is small but has a significantly sagging nipple and breast skin, a breast augmentation surgery is performed in combination with breast lift operation (mastopexy). It is a surgery that directly affects the person’s quality of life, and has an extremely positive influence on her psychosocial status.

In the United States, 289,000 breast augmentation operations were performed with silicone implant just in 2009, and the procedure has been the most commonly performed plastic surgery in the country. Although different drugs or procedures are offered for breast augmentation, silicone implants are still the gold standard in breast augmentation.

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Age for Breast Augmentation Surgery

Age for Breast Augmentation Surgery

Ages over 18, until when the development of the breast tissue is completed, are recommended for breast augmentation. However, if the condition of “asymmetrical breasts”, in which the developments of the breasts are different from each other, creates a serious psychological problem for the person, the undeveloped breast can be equalized with the other breast by use of breast implant at earlier ages.

Before Breast Augmentation Surgery

A breast examination should be performed before the surgery; and in suspected cases or in people over the age of 40; the breasts should be assessed based on breast ultrasound and mammography results. Thus, the overlooked breast diseases can be detected before surgery. By this way, a reference assessment is made for also the postoperative period.

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Breast Implant

Size of Breast Implant

When determining the size of the breast implant that will be used to enlarge a breast, the person’s chest wall and breast structures, height, weight and body measurements are taken into consideration. The patient determines, in consultation with her doctor, the size and shape of the implant to be used, on condition that these do not push the physiological limits. And during the surgery, the plastic surgeon first places the test implant for making a final assessment before placing the determined implant. Sometimes, implants one size larger or smaller than the determined one are tried, and then the implant giving the best result is used.

When a breast implant in normal standards is placed duly, it cannot be noticed when looked from outside. Most of the operated breasts shown in the media are breasts that push the normal limits or breasts that have gained an artificial appearance in consequence of wrong applications.

Structure of Breast Implant

The outer sheaths of breast implants are made of silicone. Their surfaces can be textured or smooth.  Implants with textured surface are less likely to cause a capsule formation around the implant.

Physiological saline solution (salt water) or silicone gel that can be in various fluidities are contained in the sheath of the implant.

Implants inflated with saltwater had been commonly used in the United States, before the approval of silicone gel-filled implants by the FDA. This types of implants are placed under the breast through very small incisions, before they are inflated. They have the advantage of allowing for equalizing the small asymmetries between the two breasts (one breast can be inflated more than the other). However, in this type of implants, the liquid inside the sheath is more likely to leak out and cause deflation. Sometimes, swash of the fluid inside the implant can be heard, and it may also cause deformities on the breast skin when placed just under the breast.

Recently, more viscous silicone gels called “cohesive gels” gained currency. Even if the sheath of the implant is punctured, the gel inside does not flow out. With this implant, it is possible to give a better shape to the breast, and ensure it to maintain that shape for a long time, by means of its structure. And in terms of consistency, it is closer to the consistency of the breast tissue. By using implants of various sizes and structures, successful results can be achieved in asymmetrical breasts.

Shape of Breast Implant

Breast implants are classified in two main groups as round and anatomic (drop-shaped) implants Anatomical type implants mimic better the shape of a normal breast; the nipple and the part under the breast are fuller. It is preferred especially in cases where the breast tissue is very small. Such implants are produced in various width, length and height combinations. Determination of the right combination is based on the experience of the plastic surgeon.

Breast Augmentation Surgery

It is done under general anesthesia in an operating room.  The surgery time ranges from 1 to 2 hours, depending on the techniques used.

Breast Augmentation Surgery Technique

Preparing the pouches under the breasts in a right and symmetrical way, performing a very well bleeding control, keeping the breast tissue undamaged, and placing the implant in the right position are of critical importance in Breast Augmentation Surgery. I think the incision be preferred should be the one, through which the above mentioned points can be ensured better. The experience and preference of the plastic surgeon play an important role in this regard. On the other hand, the place where the surgery scar is more acceptable is open to discussion.

Breast Augmentation – Entry Point under the Breast

The operation is done through incisions of 3-4 cm made on the nipple, the inframammary fold, or the armpits. Each incision has certain advantages and disadvantages. Placement of implants inflated with physiological saline solution by accessing through the belly hole is not preferred much because it is not sufficiently controllable and predictable.

If heals poorly, the incision scar in the armpit is more difficult to hide, and it is likely to be seen under all short-sleeved dresses.  It is technically more difficult to make a pouch under the breast through an axillary incision and then control the bleeding. It requires special tools and experience. Location of implants excessively above and outside is the most commonly encountered problem.

For accessing under the breast through a half-moon shaped incision made around the brownish area that surrounds the nipple, this should have a diameter of at least 3 cm. When entering through this incision, the under-breast area is accessed by cutting the breast tissue or by-passing it. The bacteria settled in the milk ducts are more likely to infect the implant and lead to a partial loss of sensation in the nipples. If the incision heals poorly, it becomes more prominent when viewed from the front.

When entering through the incision made on the inframammary folds, where the breast and rib cage meet, it is easier to prepare an inframammary pouch. It is possible to see the blood vessels clearly and control the bleeding. Likewise, preparing a pouch under the chest muscle is more controllable and easier. The nipple or the breast tissue is not directly contacted. When the incision scar is positioned just under the inframammary fold, it is hidden very well; however, it draws attention if remains over or under this fold. Especially when wearing a bikini, such a scar cannot be concealed; whereas it is possible to conceal a scar around the nipple. On the other hand, when viewed from the front, it is in a position that draws less attention, compared to a scar around the nipple.

Placement Area of the Implant

The pouch prepared for the implant under the breast can be positioned just under the breast tissue (subglandular) or under the chest muscle (pectoral muscle) below the breast tissue (subpectoral).

There are many factors for the determination of the most appropriate plan for the patient. These factors include the existing volume of the patient’s breast tissue, the quality and thickness of the breast skin and subcutaneous tissue, the structure of the rib cage, the status of using the chest muscles, and the plastic surgeon’s experience and preferences.

Placing the implant just under the breast is easier and painless. The breast is shaped more easily. However, in cases where there is not adequate amount of breast tissue and subcutaneous tissue for concealing the breast implant, the edges of the implant become prominent and can be noticed when looked from outside, and this gives an artificial appearance to the breast. When touched, it can be noticed more easily. Again, the complication called the capsule formation around the implant is more commonly encountered.

Generally, the technique called “dual-plan” is the most preferable procedure, in which the implant is placed in such a way as that its upper part remains under the muscle while its lower part remains under the breast. Thus, the edges of the implant are hidden under the muscle in the upper décolleté, whereas the implant is located just under the breast tissue; and as a result, a better shape is given to the breast.

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Breast Augmentation

After Breast Augmentation Surgery

The patient can get up and eat a few hours after the Breast Augmentation Surgery. Spending the night in hospital is useful in terms of the position of the bed, pain control and the close monitoring of the potential complications.

Athlete bra without strap or special bra is useful in edema and pain control.

3-5 days after the surgery, the patient can take shower and begin to work.

In the first week after breast augmentation surgery, the breast is larger and tighter than normal. The breast gains its exact size and gets softer in within several days.

If the implant is placed under the muscle, the patient should abstain from actions that over-strain the chest muscles such as lifting heavy things and driving, for a period of a week.  It is recommended to protect the breasts from the sun for a period of 4-6 weeks. Especially the incision scar should be protected from the sun with 50-factor sunscreen or a tape. Otherwise, its color gets darker.

The sports that require actively using the arms, such as swimming, tennis, and weight lifting, can be started 6-8 weeks after surgery.

After the Breast Augmentation Surgery, the patient should visit the doctor for follow-up controls, at intervals determined by the doctor (1, 3, 6 months etc.).

Tapes or ointments can be used, which enable the incision scar to heal without any problem. The incision scar will gain its final appearance and turn into skin color within a year on average. The patient should wait with patience.

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Breast Augmentation Surgery

Complications of Breast Augmentation

The most common complication after Breast Augmentation Surgery is blood build-up (hematoma) in the pouch, where the breast implant is placed. This cause sudden growth and severe pain in the breast. The patient is re-operated to drain the accumulated blood, and take the bleeding under control. Blood-thinning drugs such as Aspirin should not be used for at least 10 days before and after the surgery, because of the possibility of bleeding. The patient should avoid muscle straining by straining on the toilet and lifting heavy things etc.

In case of infection development in the surgical area, the implant may need to be removed. The implant can be reinserted a certain time after the infection is gone.

Wound healing problems may be encountered in the sutured area.

In the late period, pain and deformity may develop in the breast due to a membrane (capsule) formation around the implant. It can be surgically corrected, depending on its degree.

Implants can be deflated only when they are pierced with a sharp-edged tool. Or after many years, the external membrane of the implant may tear due to its attenuation, and its integrity may be disrupted. In such a case, the implant should be replaced.

Breast Augmentation, Lifetime of Silicon Breast Implant

Although theoretically it is alleged that silicone breast implant can be used as a lifetime device in the body, there is a possibility of deformation development after a certain period of time, due to the abrasion in the external membrane of the implant. This period varies depending on the structure and quality of the external membrane. An average period of 15 years can be said in this regard. Since generally there is sagging in the breasts at the end of this period, both the sags are eliminated and the implants are replaced.

Breast Augmentation, Pregnancy and Breastfeeding

Breast implants do not pose an obstacle to pregnancy and breastfeeding.

Breast Augmentation, Implant and Bra

You can begin to use underwired bra 3 months after the surgery.

Breast Augmentation, Routine Breast Exams

Regular controls with ultrasonography and mammography are subjected to the same rules, which are also applicable to people who have not undergone implant placement surgery. During radiography, you should declare that you have an implant. Upon your declaration, the breast will be positioned accordingly.

How Can I Know That The Implant Is Torn?

Volume decrease and deformity in the breast draw attention. There may be a palpable stiffness, mass, and pain. The diagnosis is made certain with imaging methods such as breast US, mammography, and MRI. In such a case, the implant needs to be replaced with a new one as soon as possible.

To get information about Breast Augmentation and silicone, please fill out the contact form.

Prof. Dr. Cengiz Açıkel, Aesthetic Plastic Surgery Specialist, Breast Augmentation, Breast Implant, Silicon, Mammoplasty

Frequently Asked Questions About Breast Augmentation

Is Breast Silicone Noticed when Looked from Outside?
How many days after Breast Augmentation Surgery Can I return to My Daily Life?
How many days after Breast Augmentation Surgery Can I Wear Bra?
Age for Breast Augmentation Surgery
Before Breast Augmentation Surgery
Size of Breast Implant
Structure of Breast Implant
Shape of Breast Implant
Breast Augmentation Surgery Tecniques
Entry Point in Breast Augmentation Surgery
The Area Where Silicone Breast Implant is Placed in Breast Augmentation Surgery
After Breast Augmentation Surgery
Complications of Breast Augmentation Surgery
Lifetime of Breast Implant
How Long After Breast-feeding Can a Woman Have a Breast Augmentation Surgery?
Routine Breast Exams in Breast Augmentation
How Can I Know That My Breast Implant Is Torn?