BREAST AUGMENTATION WITH IMPLANTS

By the term hypoplastic breast we refer to residual breast volume, in relation to the body morphology. It could refer to a pre-existing by birth hypoplasia, but also to occur later, after a great weight loss, as well as a pregnancy accompanied with breastfeeding. As an entity, it can either be on its own or be accompanied with a fall of the breast, as well.

Purpose of the operation
The goal of the surgery is to increase the volume of the breast by means of silicone prostheses placed behind the gland or behind the major chest muscle. All prostheses consist of an envelope with fluid inside. This envelope in all cases is made of silicone elastomer and may have a smooth or irregular texture. The liquid may be a silicone gel or even saline, in other words water. These implants have been used for over 40 years in Plastic Surgery.

What should be done preoperatively
After the Plastic Surgeon has received a complete history, he must fully inform the patient of the procedure and take some photos of the area where the surgery will take place. The technical details such as the surgical incision, the type of prosthesis to be used, whether it is placed above or below the muscle, depend on the breast anatomy and the desire of the patient. After an extensive briefing and discussion, we end up with the surgical technique that is appropriate for each individual case. A mammogram and / or a breast ultrasound, depending on the age of the patient, is necessary before the surgery.

Then, the below instructions must be followed:

  1. Classic preoperative control.
  2. 12 hours before the surgery do not drink and do not eat.
  3. On the morning of surgery, we do not receive any medication, unless the anesthesiologist agrees.
  4. Smoking and alcohol should be discontinued at least 3 weeks before surgery.
  5. Meeting with the anesthesiologist before surgery. The anesthesiologist reports past anesthesia experiences, whether positive or negative, and informs the patient about any health problems or medication.
  6. We do not take aspirin, anti-inflammatory drugs or herbal supplements 10 days before surgery, because they all increase the chance of bleeding during and after surgery.
  7. 3 days before the surgery and every day we wash our body with a pharmaceutical soap.

Type of anesthesia
Typically, general anesthesia is selected.

Hospitalization
It can be one day clinic.

Operative technique
The surgical technique is simple. The incisions can be made:

  1. In the inframammary fold
  2. On the inferior border of the nipple
  3. In the axillary area
  4. From the umbilicus

The plastic surgeon prepares the "pocket" under the breast where the prosthesis will be implanted.
A drainage tube is usually left in each breast in order to prevent fluid collection after the surgery around the prosthesis. This tube is usually removed on the same day or the day after the surgery.
At the end of the surgery, self-adhesive bands and a bandage are applied, creating an improvised bra that is replaced with a normal bra in 48 hours after the surgery.

The duration of the surgery is approximately 1,5-2 hours depending on the case.

Combining surgeries: During a breast augmentation, a breast lift may be needed.

Post-operative instructions

  1. After surgery, the patient may have chest pains for 3-4 days if the prosthesis is placed under the muscle. These pains are treated adequately with pain relievers from the mouth. In the best of cases you will feel a tendency to the chest for some days.
  2. Swelling occurs in the first days and gradually resolves without problems.
  3. Apply a small gauze to the wound for about 2 weeks.
  4. Compression bra for 6 weeks.
  5. The incision is red for the first 3 months and gradually becomes white with the final result becoming visible in 1 to 3 years.
  6. The incision should not be exposed to the sun for the first 3 months.
  7. Progressive recovery of fitness in the chest area is allowed after the 8th week.
  8. The incision will not disappear completely. For the best course of the incision, massage with a cream every day and silicone leaves is recommended at the cut, until the desired aesthetic result is achieved.
  9. The complications of general anesthesia will be reported by the anesthetist in pre-operative control. It should be noted, however, that anesthesia techniques over the last 20 years have made tremendous progress and the risks are statistically insignificant.
  10. Abstinence from work is recommended 4 days.
  11. The final result begins to be estimated at 3 months, as this time is needed to soften the breast and take its ultimate form.

Complications

  1. Hematomas: It is possible that they appear from minor bruising up to a collection of blood inside the breast. To prevent hematoma, the plastic surgeon performs very good haemostasis during surgery, but also places a drainage on each breast. The patient on the other hand, needs to be less active with the hands.
  2. Inflammation: The risk is minimized when the plastic surgeon administers antibiotics during the surgery and immediately postoperatively
  3. Bad healing: It can be avoided if the plastic surgeon does not close the wound with high tension on the skin. Each individual heals differently.
  4. Pulmonary embolism: Complication of each surgical procedure prevented with anticoagulants immediately after the operation and with immediate mobilization of the patient.
  5. Hypoesthesia: Mainly in the area of the nipple, if happens. It resumes gradually after 6 - 18 months. It is more probable with implants bigger than 400cc.

Lifetime of silicone prostheses
A silicone prosthesis, either gel or saline, has a specific life time. Manufacturers of prostheses calculate it around 10 years. This does not mean that the prostheses cannot be changed earlier or later. It is a fact that one cannot guarantee that they will never be changed. A woman with silicone prostheses should know that there is a risk at some point to undergo a change of the implants. If, of course, there is no problem, the implants can stay on the breast as long as the woman wants it.

Long-term complications of implants.

  1. Creating folds of the implant.
    This is more common in saline prostheses, but can also occur in those with silicone gel. In this case the woman sees and grasps the folds of the prosthesis, mainly down and out of the chest. To avoid this, the physician makes enough space for the implants intraoperatively. It can also be seen in very thin patients. If this happens, however, there are surgical solutions to resolve this problem. These are decided on a case-by-case basis because each case is different.
  2. Creating a capsule around the implant.
    Creating a capsule around the implant is inevitable. It is a normal body process in order to isolate a foreign body. In some cases, however, this capsule may become more prominent and thicker and compress the implant, causing pain and distortion. There are 4 stages of this situation. The probability of creating a problem capsule cannot actually be measured, because it depends on many factors, such as the type of prosthesis, the surgical technique and the individuality. If the capsule causes symptoms, such as pain and aesthetic distortion, it should be corrected surgically.
  3. Damage of the implant.
    Such a phenomenon may occur after an intense injury to the chest area, rarely due to an error in the prosthesis construction or more often after years due to the age of the prosthesis. In cases of silicone gel prostheses, silicone usually remains in the capsule and does not diffuse into the surrounding tissues. Of course, all this is prevented by the well-established and systematic control of the breast, to which all women should undergo.

FAQ’S

Can I breastfeed after a breast prosthesis surgery?
Breast augmentation does not seem to have any effect on breastfeeding.

Breast implants increase the likelihood of breast cancer?
The relationship between breast prostheses and cancer has been analyzed by many. A recent article associates a type of breast prosthesis with a very rare type of lymphatic cancer. This percentage of women who are infected is too small compared to the general population carrying breast prostheses. It is information that every woman is entitled to know before deciding to enter the procedure. Naturally, every woman has a chance to get breast cancer, so frequent and systematic controls should be done regularly and uninterruptedly.

Can I have the radiological check of the breast?
Before each mammogram or ultrasound, you need to inform the radiologist that you have breast implants, because there are special techniques applied in these cases to make a complete examination.

Consequently, you should not overestimate the dangers of a breast augmentation surgery, but just realize that it is a relatively simple surgery that can have complications.
This text may give rise to new questions. We are at your disposal for any other information.