About breast aesthetics (mammoplasty)

The breast is extremely important in terms of expressing the sexual identity of the woman and reinforcing the sense of femininity. Because even in patients who have had one breast removed due to breast cancer and who have completely recovered from cancer in the follow-up, the sadness of losing their breast overshadows the happiness of getting rid of cancer.

Breast aesthetics (mammoplasty) includes enlargement of developmentally small or insufficient breasts (augmentation mammoplasty), reduction of excessively large breasts due to pregnancy and obesity (reduction mammoplasty), and lifting of deformed and sagging breasts (mastopexy) despite their normal volume.

Breast Augmentation ( augmentation mammoplasty):

Smallness of the breasts; It may develop either as a result of insufficient growth of the breast tissue or involution after breastfeeding.

In the current approach, the most effective way of breast augmentation is the use of ‘Silicone Breast Prosthesis’. Silicone breast prostheses are manufactured from silicone that is harder on the outside and softer on the inside and has a gel consistency.

These prostheses are extremely resistant to pressure and keep their shape even if the outer capsule is punctured.

Silicone is the least known allergenic substance for the body, so it is not expected to cause an allergic reaction. It has no known side effects on milk secretion and breast diseases (including cancer). It does not prevent routine mammography examination in women over 40 years of age. The only known problem in silicone breast prosthesis; It is the severe development of the fibrous capsule, which develops physiologically over a period of time and surrounds the prosthesis, in some cases. Although this is a rare problem, severe capsule reactions may require removal of the prosthesis. Silicone breast prostheses are produced in ‘drop’ and ’round’ forms. Round prostheses are preferred for breasts where the upper pole fullness is desired, and drop prostheses are preferred for breasts where an enlargement suitable for the natural form of the breast is desired. Silicone breast prosthesis can be placed in the armpit, nipple or under the breast groove according to the patient’s request.

Today, prosthesis is placed most frequently with the under-breast approach. One of the most frequently discussed topics is; Whether the prosthesis will be placed under the muscle or on the muscle. My approach here; If the person has some breast tissue and the person is not extremely weak, it is to place the prosthesis directly under the breast. In patients who have no breast tissue or are extremely weak, submuscular placement gives better results in order to cover the prosthesis with sufficient soft tissue and not be visible from the outside.

In my first meeting with my patients, I try to understand exactly what the patient wants. There are many different sizes of prostheses, so it is important for the patient to fully understand what the result will be when we put the prosthesis on the patient. The easiest and most understandable way to do this is to make a recipe for the patient through the bra he/she uses. Bras used by women are measured in two ways.

The value that emerges with the measurement of the circumference of the rib cage is the numerical values ​​that continue as 70-75-80-85…. With the application of breast prosthesis, this body size will not change and will remain constant since the circumference of the rib cage is not interfered with. However, the size of the breast tissue itself is determined by letters such as ABCD. A cup bra represents the smallest size and D cup bra represents the largest size.

Although there are intermediate forms of these sizes, the appropriate breast volume for our country is defined as B or B+. From this point of view, I ask my patients which size bra they would like to wear with full and without padding. Even for this purpose, it may be much healthier for the patient to visit a women’s clothing store and try on all sizes of bras and decide what they want.

Augmentation surgery with a silicone breast prosthesis takes an average of 45 minutes – 1 hour, according to predetermined conditions. The procedure is performed under general anesthesia and the patient leaves the operating room with a pre-measured special shaping bra. No drain is used in any way. The patient is hosted in the hospital for 1 night.

At the end of the first week after the operation, the patient can return to his daily life. It may take 3-6 months for newly made breasts to take shape and gain a certain form. Breasts, which are very upright and tense at first, need time to reach their ideal form due to gravity and tissue stretching. The shaping bra worn during the surgery has a very important function in this regard and it is recommended that the patient wear this bra for at least 3 months. After the surgery, edema and bruising in and around the chest can be seen, although rare. It is expected to return to normal within 2 weeks.

Recently, breast tissue enlargement practices have been performed by injecting fat into the breast tissue. Although fat injection into the breast tissue never has the same function as a breast prosthesis; Although there is sufficient breast size, it can be applied in cases such as low upper pole fullness, slight size difference between the breasts, and elimination of shape deformities. However, it should not be forgotten that there are negative effects such as the fact that a single session application is not sufficient most of the time, deformities may develop after the application and make the diagnostic approach difficult in terms of breast diseases in the future.

Breast Reduction (reduction mammoplasty)

Excessive size of the breasts (macromastia) is a pathology that can cause serious health problems besides causing aesthetic problems.

In young women, severe breast enlargement may occur structurally or due to fibrocystic breast disease. In this age group, aesthetic concerns are more prominent, and patients generally want to have more beautiful and acceptable size breasts. However, breast size in middle and older women causes many problems. Unable to cope with skin irritations and rashes under the breasts, shoulder and back pain, cervical herniation in the future, arm pain due to nerve compression and weakness in the arms, severe and treatment-resistant headaches can make life unbearable for women in this age group. It has been determined that breast size among all age groups causes severe depression symptoms and makes life meaningless from time to time.

Both physical complaints and aesthetic concerns continue in middle-aged women. Therefore, tummy tuck surgery is recommended for patients in this age group to correct the physical aesthetics as a whole. Since the main goal of breast reduction in older women is to reduce physical complaints and achieve a healthy body, aesthetic concerns remain in the background.

Breast reduction surgeries are the surgeries with the highest satisfaction rate among all aesthetic surgery patients. Because besides visual improvement, being freed from a great burden is enough for patients to be happy. I come across many patients who are extremely uncomfortable with excessively large breasts but cannot have surgery because they cannot get their spouses to accept it. Sometimes I witness men behaving in a way that lacks empathy and is selfish. Then I give an example for gentlemen who do not understand or do not want to understand the situation their wives are in; Tie two full grocery bags with a string and hang them around your neck. And try and see how many hours you will last!!!

In breast reduction surgeries, reduction is performed within the framework of certain dimensions and the targeted breast size is enough to fully fill the B cup bra. An important point to know is that permanent scars will occur in all breast reduction surgery. According to the technique used, either only a straight line extending from the nipple to the inframammary groove, or in addition to this line, a trace similar to the inverted T letter following the inframammary groove remains.

With good post-operative care, it is possible to reduce these scars a lot. Breast reduction surgery is an operation that takes about 2 -2.5 hours. The patient is removed from the surgery with a special shaping bra and a drain is placed in each breast. In breast reduction surgeries, drains act as an insurance due to the high risk of post-operative bleeding.

The patient is hosted in the hospital for 2 days. There is no obstacle for the patient to move on his own after the surgery and meet his needs. However, it takes 2 weeks for the patient to fully return to his daily life.

Breast Lift (mastopexy)

The effect of gravity on aging and deformation of tissues throughout human life is undeniable. Due to some personal characteristics, women may have normal breast volume but severely displaced breasts (ptosis). We call mastopexy the process of moving the nipple and breast tissue to the required position without changing the breast volume.

Although mastopexy is an operation performed to completely eliminate aesthetic concerns, in some cases, scars similar to breast reduction surgery may remain. The main determining factor here is how low the nipple is from the normal level and how much the tissues in the lower pole of the breast sag. If the nipple is 2-3 cm below where it should be and the ptosis in the lower pole is moderate; With a method called ‘periareolar mastopexy’, it is possible to lift the breast without leaving any scars. However, if there is obvious sagging in both the nipple and breast tissue; After the lift, a straight line trace down the nipple is inevitable.

However, mastopexy is a promising surgery in terms of the new breast shape obtained. The procedure is performed under general anesthesia. According to the technique, it ends in 1-2 hours. The patient is hosted in the hospital for 1 day. He can continue his daily life within 1 week.

In some cases, both breast tissue may have lost volume and sagging may have occurred. In such cases, the existing problem can be corrected by combining the breast augmentation and lifting procedure (augmentation mastopexy).

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