Breast augmentation - enlarging of breast

Introduction

Enlarging of breast or augmentation is a surgical procedure the aim of which is to increase a volume of small breasts or to restore the ampleness of the breasts due to the changes after pregnancy, this procedure is also used to solve a small dropping of breasts. A correction of big dropping of breasts, co-called ptosis, cannot be solved by this method. By this operation can also correct different sizes of breasts, so-called asymmetry. Implants are also used to correct the shape of breasts and possible deformities after operations of breasts or to reconstruct breasts after the breasts are removed due to oncological reasons. The operation is not limited by age. It is not suitable to perform it if you are planning to start a family in near future. Breasts are enlarged by means of silicon implants from Mentor company – a top product of the highest quality, that contain silicon gel. This brochure will provide you with basic information concerning enlarging of breasts, what examination you have to undergo before the actual operation, what is the procedure of the operation, what are your possibilities and what expectations can be fulfilled, what is the course and subsequent monitoring after this operation, what are the possible risks and complications of this operation etc.

Pre-operation examination

Medical history

Before the operation you should inform your doctor about the following facts:

• Occurrence of bleeding
• Symptoms of connective tissue diseases (rheumatic diseases, diseases of joints), skin diseases etc.
• Other serious diseases (diabetes, tumorous conditions, diseases of heart and lungs, kidneys etc.)
• Allergy
• Medicine taken
• Complications after preceding operations in general anaesthesia
• Occurrence of breast cancer at direct relatives

Laboratory examination

Before the operation, which is performed in general anaesthesia, it is necessary to undergo an overall examination by your general practitioner or family doctor or internist, including laboratory examinations. You will obtain an order form for this examination from your plastic surgeon and the results of these examinations should not be older than two weeks before the term of the operation.

Examination of breasts

Before the augmentation of breasts it is recommended to have the breasts examined by a specialist in one of mammary clinics, in oncological or gynaecological department. This examination includes either mammography or sonography of breasts. Breast can only be enlarged if the result of this examination is good.

Instructions before the operation

Only an absolutely healthy patient can be operated. In case of an illness or cancellation of the operation due to any reasons, let your doctor know in advance.

During the consultation with the plastic surgeon before the operation all your questions will be answered, you will be shown photographs of patients before and after the operation, you will see the individual types of implants we use and you will obtain order forms for the individual above specified examinations that you have to undergo before the operation. You will pay for the operation in cash on the day of the operation after your arrival to the hospital or according to an agreement with the surgeon. To book a term it is necessary to pay an advance the amount of which will be agreed.

In case you will agree with your surgeon to insert implants from armpits, it is advisable to come to the hospital shaved. You will come to the hospital at the arranged time and day, which will be agreed with your surgeon. Take drugs that you take at home regularly for the time of 2-3 days, thinks of personal hygiene, ID cards, result of pre-operative examination, slipper, pyjamas or night dress and also an elastic bra without fixations, the size of cups depending on the size of breasts you will agree on with the surgeon. During the first days after the operation the bra serves as bandage and it can be stained with blood. If you wear contact lenses, come to the hospital without them. It is also not suitable to come to the hospital in clothes that must be pulled over the head. After the operation, it would be painful to put these clothes on and to take them off.

It is a cosmetic operation paid by the patient to which the health insurance company does not contribute and it is not possible to provide sick leave for it.

Six hours before the time of the planned operation you must not eat and drink. On the day of the operation you should not smoke and minimum one week before the operation it is necessary to stop using drugs containing acetylsalicylic acid (Acylpyrin, Aspyrin, Aspro, Acylcoffin, Alnagon, Defebrin, Harbureta, Mironal, Neuralgen and others). It is not very suitable to perform the operation during menstruation. You will agree with your gynaecologist whether it is suitable to stop using contraception before the operation.

Implants

We use implants from Mentor company - top products of the highest quality that have been certified in accordance with the Act No 22/1997 Coll. and Certificate of Compliance was issued for them and they also obtained the CE mark for the EC countries. These implants comprise of a jacket from hardened silicon and they are filled with cohesive silicon gel. Implants filled with silicon gel are manufactured in two variants, with a round and teary profile. The application of the implants with a teary profile is only limited to some types of breasts and they cannot be implanted from armpits.

All the types are manufactured in many sizes. You will agree on the size of the implants with your surgeon within the scope of pre-operative consultation. The size is limited by the shape and size of the chest and flexibility of your skin. The surgeon undertakes to check before the operation that the implants are not faulty. The average lifetime of implants is specified by the manufacturer to be around 15 years, the costs of a possible replacement of old implants for new ones in future, the operation and stay in hospital will have to be paid by you.

Operation

The operation is usually performed on the same day when you come to hospital, it takes approximately one hour and it is performed in general anaesthesia. You usually stay in hospital for two days when the day of your arrival and the day of your departure are counted as one day. On the day of your departure it is necessary to arrange a lift home in the morning. If necessary, it is possible to call a taxi for the patients from Brno.

What is the procedure of the operation: The selected implant is inserted between the mammary gland and the pectoral muscle or deeper between the pectoral muscle and ribs.

Placing the implant under the mammary gland and above the pectoral muscle is less painful. In this way it is possible to correct a slight dropping of breasts and to tighten the breasts but a disadvantage is the fact that there is less of your own tissue above the implant compared to the placement under the pectoral muscle and it is clear that the implant is sometimes more visible under the skin and it can be felt more easily. With regard to the fact that it is only held by skin, after some time it can drop more. Examination of breasts is more difficult than when it is placed under the muscle and higher percentage of hardening of the pocket around implants has been described (see the paragraph with risks and complications).

When the implant is placed between the pectoral muscle and ribs, it is a bit more painful after the operation and convalescence is longer but you almost cannot feel the implant, it is easier to examine the breasts and dropping of the implant after some time is smaller as it is held by the pectoral muscle. The percentage of hardening of the pocket around implants is much smaller but an implant placed under the muscle will not tighten slightly dropped breasts and in some cases it can move together with the movement of the pectoral muscle. Implants placed in this way are about 2 cm further from each other than when placed under the gland.

Possible skin incisions: the implants can be placed under the mammary gland from an incision in the line under the breasts or from a short semicircle incision at the bottom edge of the areola. Under the muscle the implant can be placed from the line under the breasts, from an incision at the edge of the areola and from an incision in the armpit. If the areola is small, it is not possible to operate the implants through there. In case of enlarging breasts through the access from the armpits and occurrence of any post-operative complication requiring replacement of the implant, it is more difficult to replace this implant from the armpits again. Sometimes it is necessary to replace the implant from an incision around the areola or from the line under the breasts, which results in another scar. Implants with teary profile (anatomic) can only be inserted from the line under the breasts.

Due to preventive reasons, after the operation you will get several doses of antibiotics, you will get painkillers as it is quite painful after the operation and breasts will be drained with sucking drains discharging blood. These drains are taken out on the second day after the operation and on this day you can leave hospital.

At the moment there is no alternative method of comparable quality by means of which it would be possible to enlarge breasts.

Postoperative instructions

You will be released from the hospital on the second day after the operation.

1st week

This first week it is necessary to wear an elastic bra without fixations during the day and at night and you must not lift arms above the head. If the implant was placed through the armpits, a special belt above the breasts is suitable.

It is not good to wash and shower the operation wounds for at least 3 to 4 days. In this first week after the operation it is necessary to rest in bed. For the first several days you should have a person who will look after you or helped you to look after children. Wounds are stitched with internal absorbable stitches so no stitches will be taken out at checks. Minimum one week after the operation it is not allowed to drive a car.

2nd and following weeks

In the second week after the operation it is recommended to wear a bra during the day, not at night, and starting from the third or fourth week it is advisable not to wear a bra at all for several months. This does not apply for implants placed above the muscle, a bra must be worn during the day. For approximately 1-2 months after the operation the implants have a tendency to move upwards, so due to this reason when wearing a bra straps must be loose so that the bra did not push the breast upwards. For several weeks after the operation the breasts are swollen. You must take into account that after several weeks the swelling subsides and the size of the breasts gets a bit smaller. From the second week after the operation it is possible to start common everyday activities, go for walks but not to do any difficult work, cleaning etc. It is not recommended to do more difficult work, to carry heavy things and luggage, to do exercise or to have a sporty holiday at the sea, on skis etc. for two months after the operation. For the first month after the operation it is necessary to have sex with your partner with maximum carefulness.

After two months it is possible to start slowly to work out, exercise, do sport, do more difficult work etc. However, the time is individual. Two weeks after the operation you can already sunbathe, go to solarium but for at least half a year you must not expose the scars to the sun or radiation in solarium, they have to be protected by sticking a plaster or putting cream with high UV factor on them. Fresh scars draw in pigment and then they remain dark for a long time. After the operation the scars fade gradually and they start disappearing in about half a year to a year, but they never disappear absolutely.

Checks

According to the agreement with your surgeon, the first check will be approximately one week after the operation.
Next check at your doctor is usually as agreed in two more weeks after the first check, then in a month, in two months, in half a year and then regularly every year for the whole life. In some case, after consultation with the doctor, gentle massage of breasts is necessary several months after the operation.

During the second or third check at your surgeon and then regularly every three years for the whole life it is suitable to repeat the specialised examination of breasts by sonography or mammography. Examination by sonography is more suitable. In case you do not observe these regular checks, you take over a risk of possible complications.

Possible risks and complications

Risks connected with narcosis – general anaesthesia

General anaesthesia is ensured by a consultant, anaesthesiologist. Immediately before the planned operation you will be visited by your anaesthesiologist who will discuss the most suitable method of anaesthesia, its advantages as well as the possible complications. General anaesthesia due to a planned operation is absolutely unsuitable for pregnant women. Nowadays general anaesthesia is performed in such a gentle way that any possible complications or risks connected with it are absolutely minimum, especially as regards healthy people who are undergoing a planned operation.

Complications connected with the operation

Every operation is burdened with a certain small percentage of post-operative complications that the patient must take into consideration.

• These include for example complications concerning the healing of the operation wounds, infection of the operation wounds and its surroundings and surroundings of the implant. Due to this reason you will use several doses of antibiotics as prevention. Some cases have been documented when due to the infection the implants had to be taken out.
• Another possible operation complication is bleeding. Due to this reason you will undergo a laboratory test of bleeding and coagulability within the scope of the laboratory examination before the operation and it is very important to be resting for the 1st week after the operation.
• There are also some cases when the patient has a tendency to so-called celoid or hypertrophied scars. Probability of such scars is very small but it is not possible to say for sure before the operation that celoid scars will not occur. Their elimination is very difficult.
• With regard to the fact that the operation is performed with arms extended sideways, after the operation there is sometimes pain shooting to forearms and hands. It is connected with position of nerves leading from armpits to upper extremities. These difficulties are temporary and in most cases they disappear totally in several days or weeks.
• A dreaded complication of any operation in anaesthesia is so-called lung embolism – blockage of a lung blood vessel with a blood clot. The prevention includes elastic bandages of lower proximities, walking as early after the operation as possible (the following morning), sometimes it is suitable to stop using contraception or to use drugs against blood coagulation as prevention.

Overall impacts of silicon and silicon implants on the organism

• The data available at the moment show that implants do not cause cancer or other malignant diseases.
• The overall scientific, clinic and epidemiologic researches prove that silicon breast implants do not cause auto-immunity diseases or disorders of connective tissue, such as rheumatic arthritis, scleroderma and others. At the moment there are no scientific data concerning so-called "new disease" caused by the application of silicon implants. Also there are no reactions such as silicon allergy or intoxication.
• Silicon implants do not have negative impacts on pregnancy, breastfeeding and health of breastfed children.
• No specific antibodies to silicon have been found.

At the moment silicon is a basic material with a wide range of application in everyday life. No better alternative material is available. In all field of medicine and surgery silicon implants and silicon medical equipment are basic means not only for cosmetic purposes but often to save life (heart valves, joints etc.).

Possible risks and complications connected with the application of silicon breast implants

Forming of a capsule and its contracture (contraction and hardening)

Forming of a capsule (pocket) from the ligamentous tissue around the breast implant after the operation is a normal physiological reaction to the implantation of a foreign body. Forming of this pocket occurs at all patients to a different extent. The pocket can be from thin ones up to highly incrassate, tightly embracing the implant. It can happen that the fibrotic pocket can contract. Probability of this phenomenon is about 5 %, this phenomenon is then accompanied with unpleasant pain, stiffness of the breast, the breast can have a different shape than the other one. It can require another surgical operation during which the pocket – the bed of the implant – is released surgically. By means of this the phenomenon is eliminated. The specialist literature described cases of repeated contraction of the pocket around the implant and cases when the stiffness of the breast can reoccur and it requires the implant to be taken out.

Tearing of the implant

Breast implants do not have to last all life. Their approximate lifetime specified by the manufacturer is about 10 to 15 years. If an implant tore or is damaged, it has to be replaced. Tearing of an implant in the course of the life is very often connected with an injury or inadequate pressure on breasts. Due to this reasons it is necessary to have the enlarged breasts checked regularly once a year all life.

Prolapsing of the implant

Due to excessive tension of skin in the area of operation wound or somewhere else, the skin can be gradually getting thinner, become necrotic or burst and the implant can prolapse. This risk is higher in case the implant was placed in damaged areas, e.g. under scarred skin, burnt skin or in the area that was exposed to radiation within radium therapy or if too big implant was chosen. In case the implant prolapses, it must be taken out.

Liquid accumulation

Specialist literature published excessive post-operative and later liquid formation around the implant shown as enlarged breasts. Most frequently it is a result of non-observance of resting after the operation, injury or very intensive exercise.

Occurrence of haematoma

It is accumulation of blood around the implant after the operation. The most frequent cause is not resting after the operation.

Dissatisfaction with the cosmetic result

Wrong size of the implant, inappropriate location of the scar etc. can cause dissatisfaction of the patient with the operation result. Due to this reason before the operation it is necessary to have a very detailed consultation of the patient with her surgeon when the patient explains exactly her idea and the surgeon will explain his possibilities.

Wrinkling of implants

There has been described visible or tangible wrinkling of the jacket of the implant. This is seen as waves tangible under the skin. More frequently this happens to thin patients with thin skin and a very small mammary gland, more often when the implant is placed under the gland than under the muscle. It is always possible to feel the implant in the area of the line under the breasts.

Asymmetry

After some time the implanted breast can drop a bit, like a natural breast. There have been cases when certain asymmetry occurs when one side drops more than the other. This asymmetry can also occur short after the operation, again as a result of not observing post-operative instructions and resting in be as well as due to other reason. As a result of movement of the pectoral muscle immediately after the operation the implant can change its position.

Changes of nipple sensation

Specialist literature published complications concerning changes of nipple sensations, both as regards increased sensitisation and also decreased sensitisation. In most cases these changes go back to normal in the course of approximately one year.

Inclination to thrombosis of veins

Near the implant there can be temporary occurrence of clogged small veins resembling thin cords placed under the skin, mostly running in the armpits or under the skin of abdominal wall. These will disappear themselves I the course of several months.

The implant shades approximately 20 % of the mammary gland tissue when mammography is performed. Due to this reason this examination often has to be combined or replaced with sonography.

The patients who had their breasts enlarged by means of implants must not undergo diathermy (e.g. warming of liver within the scope of spa treatment). This could result in extreme heating of the implant, internal burns and possible burst of the implant.

Conclusion

Surgery is not an exact science and thus it is not possible to guarantee 100 % result. The world statistics show that cosmetic operations have approximately 5-10 % of complications. In most cases these complications can be solved.

If you have any questions or comments, contact us please by e-mail, telephone or on-line contact form.
If we can, we will be glad to answer you.

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