Breast aesthetics and breast augmentation

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Which operation is suitable for whom in Aesthetic Breast Operations?

Breast size is one of the biggest problems in our country. Unfortunately, almost no one is satisfied. As a nation, we find it either ‘too big’ or ‘too small’. The reduction of the big breast is inevitable and a major surgery. It can even be argued that this surgery is an aesthetic operation. However, many methods are mentioned in the visual and written media for the growth of small breasts.

Although creams seem to be the easiest way in this regard, there is a majority of people who say they can’t get results, even if they say they get results. In addition, there is a possibility that these creams may cause breast cancer due to their content. That’s why we don’t recommend you even try it.

Another option is oil injection. In this method, which is applied under general anesthesia, just like in liposuction surgery, fat is taken from the areas of the body with local excess fat (abdomen, hips, etc.) and injected into the breasts. Since in this procedure, the injected fat may be lost over time, it is necessary not to think of this procedure as a single operation. In addition, it is not a suitable technique for very small breasts or those who are very weak and do not have much adipose tissue.

“Creams are dangerous, fat injection is ineffective! Which is the most reliable way for breast aesthetics?”

Breast implant is actually the most guaranteed and reliable technique among these options. Basically, these implants consist of liquid silicone in a silicone capsule. Types of this liquid silicone with different levels of fluidity are produced, and implants with soft or harder consistency are available in the market. In addition, there are serum-filled implants, which are not commonly used in our country, and these are generally used in implants placed over the armpit or navel, apart from their normal use. Again, different types were produced on the wall surrounding this liquid part. Changes in the structure of this surface are made to prevent the implant from moving and to prolong the formation time of the capsule that will form around the implant. In the market, smooth, rough, polyurethane coated etc. implants are available. Basically, the long-term expected capsule formation after these operations is the only negative aspect of this operation. When the capsule is formed, the shape of the breast and the formation of shrinkage require a second operation to intervene in this capsule and renew the implant.

Types of silicone breast prosthesis placement options

Implants are produced in different heights and different base diameters. As the base diameter or height of an implant increases, its volume increases (cc).
Another difference is the shape of the implant. Today, round and anatomical (drop) implants are available. Although there are rumors such as ‘drop is better’ among the people, the type of implant to be used depends on the body structure of that person and the region where the implant will be placed.

Implants can be placed in basically 2 places on the chest wall. Placing under the breast tissue is preferred in patients who have enough breast tissue to hide the implant.

The alternative to this operation is the technique of placing under the pectoral muscle membrane, and it is not significantly different from placing it under the breast tissue. It is currently only used by some surgeons to be different.

Another technique is to place the implant under the pectoralis major muscle behind the breast. Although it is generally preferred in cases where the breast tissue is very small, it is also a preferred technique because the capsule is formed later in long-term results.

dual plan On the other hand, the so-called technique is a variant of submuscular application and good results are obtained when applied in appropriate cases. Postoperative pain problem is the biggest disadvantage of submuscular application. Pain may last for 3-4 weeks.

Do you know the actual size of your breast?

Although it is not used much in Turkey, bra sizes consist of two separate units as chest circumference and cap, and we make the plans in these operations with these criteria. To summarize this measurement system simply, the chest circumference measured from under the breast constitutes the numerical part. Then, the breast circumference measured from the nipple is united as AA if it is 10 cm larger than the inframammary measurement, as A if it is 12.5 cm larger, and as B if it is 15 cm, with 2.5 cm intervals. Usually, a maximum of 3 sizes of growth can be achieved with implant surgeries. If more is desired, first an application for skin expansion and then an implant application is required.

“The only authority to decide whether a breast is large or small is the person himself.”

Although smaller and firm breasts (like the Venus statue) were appreciated in the past, larger sizes began to be preferred in the 2000s. A breast where the nipple placement is at or slightly above the lower border of the breast will have a pleasant appearance if it has the appropriate volume with the person’s body.

Among all these techniques and measures, which one should I choose?

After discussing with the patient what size breast will be created by making measurements before the operation, the amount of breast tissue of the patient is taken into consideration, and it is decided with which technique the implant will be made (under the breast tissue or under the muscle).

It is decided where the incision will be made for the placement of the implant. The most frequently applied ones in this regard are the lower edge of the colored area of ​​the nipple or the lower border of the breast. Apart from this, implant placement processes are also performed by entering through the armpit and belly button, but there are some risks in these techniques as they are placed from a long distance.

And on the day of the operation…

Drawings are made in accordance with the operation plan. The operation takes an average of 1-2 hours under general anesthesia. In the operation, the use of the tubular system, which is called a drain and collects the blood leaking from the area where the implant is placed, varies according to the surgeon. I support its use because the blood accumulated in this area after the operation is shown as the number one source of the problem of capsule contracture seen in the long term. After the dressing is done with 2-3 day intervals, the dressings are terminated at the end of the 1st week and the patients can meet their daily needs (shower, etc.).

It is recommended to use a special bra for an average of 6 weeks after the operation. It is important that patients do not lie face down during this time.
After the operation, complications such as blood accumulation (hematoma) and infection can be seen. The use of drains is important in terms of preventing hematoma formation. Infection is a very problematic picture because in cases where it does not respond to antibiotic treatment, it may be necessary to remove the implant, clean the area where the implant is placed, and reinsert the implant with another surgery.

So is there any risk?

Important problems in the long term after the operation are the explosion of the implant and the situation we call capsular contracture. In cases where the implant bursts, the liquid silicone starts to escape into the capsule formed by the body and the shape of the breast is distorted. It is a rare situation where the implant needs to be replaced.

Capsule contracture usually occurs more than 10 years after the implant application (with the appropriate technique, following the appropriate surgical rules). In this situation, which occurs when the body acts as a foreign body on the implant and surrounds it with a tight tissue, the capsule is surgically removed or deformed and a new implant is placed.

Studies conducted in recent years have shown that the rumors about the risk of breast cancer caused by implants are inconsistent with the realization. The hesitations about the implant making the diagnosis of breast cancer difficult are no longer a problem thanks to new and advanced imaging techniques.

Why didn’t I do it before!

Although we talk about its complications, breast implant application is the most ideal option for people with small breast complaints today. For a woman, breast smallness is undoubtedly a condition that damages her self-confidence and puts pressure on her psychologically. The first word I heard from my patients who learned that this situation could be solved with such a short and low-risk operation and had surgery was always ‘Why didn’t I have it done before’.

Kind regards
Op.Dr. Tahsin Görgülü

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