Breast

surgery

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Breast augmentation

Breast augmentation is a surgical intervention aimed at:

  • Increase of volume of small breast
  • Renewal of breast fullness for example after pregnancy or weight loss
  • Adjustment of hanging breast
  • Correction of breast asymmetries

Breast augmentation can be performed in several ways. The most common is silicone breast implants which are also used for shape corrections and removal of potential breast deformities. Breast augmentation may also be performed by other materials and by own fat according to recently developed methods.

The surgery is not age limited but it is not recommended to undergo it if you plan pregnancy. Adjustment of heavily hanging breast cannot be performed by this method and needs breast modelling.

The surgery is performed on the day of admission to the clinic, takes about 1 hour and is performed in overall anaesthesia. Before the surgery you must undergo the usual preoperative examinations. For preventive reasons you will receive a couple of doses of antibiotics and an injection for prevention of thrombo embolism. You will be hospitalised for two days and transported home in the morning of the third day.

Breast augmentation is performed by all of the below described methods. The best variant of the implant placement, selection of its type, shape and size will be discussed with you by the surgeon in the context of the preoperative consultation. In this context you can try several implant sizes in your bra.

For maximum accuracy and correctness of selection of the size and type of the implant we also use the BODY LOGIC SYSTEM, first introduced at the international congress of plastic surgery in Berlin in 2007.

We also offer our patient the option of final selection of the implant in the course of the surgery itself when the surgeon finds by special test implants (sizers) the optimum type and size. The size range is agreed with the patient in advance. This service is not offered by many body clinics of our kind and we offer it thanks to a large stock of breast implants available to us.

Breast augmentation: breast implants

Our BODY Clinic uses luxury breast implants MENTOR®. These implants represent a top product by the largest world producer for plastic surgery – the American company Mentor. These implants belong to the best quality implants with long tradition globally. MENTOR® breast implants also belong to the few approved by the American FDA (Food and Drug Administration), as they were able to meet the highest demand for quality and safety required by FDA.

Gel breast implants of MENTOR® brand include original cohesive MemoryGel®, which is absolutely safe and does not leak. MemoryGel® is designed for the implants to keep optimum shape and still remain naturally soft. You can choose from a wide range of round and anatomically shaped implants tailored to your desires and requirements.

For correct settlement of the implant and successful operation the surface texture of the implant is important. MENTOR® breast implants can boast of the unique SILTEX® surface allowing for ideal connection of the implant to the surrounding tissue. Thanks to that the MENTOR® implants record the lowest documented occurrence of post-operative complications.

The Mentor company keeps a large set of data on the implant behaviour in the clients´ bodies. Thanks to that the MENTOR® implants are proven safe for women.

Types of breast implants

MENTOR® breast implants are available in round and anatomic shapes in all sizes and several height profiles. The size of your future implant is limited by the size and shape of your chest, flexibility of your breast skin and muscle.

  • Anatomic implants (i.e. drop-shaped implants) can only used for certain breast shapes and cannot be inserted from the armpit. Their advantages include a slightly more natural breast shape, especially when the implant is placed under the breast gland or in cases you need addition of missing breast tissue, especially in the bottom part of the breast. The disadvantages include higher risk of the implant flipping.
  • Round implants are suitable for most breast shapes. They are ideal when you need addition of missing breast tissue, especially in the upper part. These implants are softer and there is no risk of the implant flipping.

Mean life of the currently made implants by most manufacturers is at least 20 years or longer. But no current implants are for the whole life. Mean life of older implant types is 10-15 years. These are recommended to be replaced preventively before their EOL for if they break liquid silicone oil begins to leak from them. This risk is not present in the new implants.

Breast augmentation: methods of implant placement

The basic method of implant placement is over the muscle (between the breast gland and muscle) or deeper under the muscle (between the muscle and the ribs).

Placement under the breast gland

This placement over the breast muscle is recommended to patients with bigger moderately sagging breast. The post-operative progress is less painful and the recovery is shorter. This way moderately sagged breast can be improved and tensioned. The disadvantages include the fact that there is less of your own tissue over the implant than if the implant is placed under the chest musculature which means that the implant may sometimes be seen or felt under the skin. As the implant is only held by the skin the breast can drop after a time and so a bra is recommended. The breast is then more difficult to be examined than in the case of the implant placement under the muscle and there are more reported cases of hardening of the pocket around the implant (the capsule) (see Potential risks and complications).

 

Placement under the breast muscle

PIn the case of slim patients with small firm breast it is recommended to place the implant under the breast muscle. The post-operative progress is a little more painful and the recovery is longer but the implant is hard to feel, the breast can easily be examined afterwards, the implant hardly sinks after a time for it is held by the breast musculature. The transfer between the chest and the breast skin is smooth and the upper edge of the implant cannot be seen. The percentage of capsule hardening is nearly zero. Implant under the muscle will not tension moderately sagging breast and may move while exercising or body building. Thus placed implants cannot be put closely together and there will always be a little gap between them.

In addition to these two basic variants there is also the possibility of a compromise placement of the implant partly under and partly over the muscle and/or under the thin ligament layer over the breast muscle. This is called fascia.

These two newer variants combine advantages of the two basic methods and are increasingly popular.

Scars

The options of skin incisions for insertion of the implant are:

The under-breast line for placement under the breast gland or a short semi-circular incision on the bottom of the papilla.

The under-breast line, the bottom of the papilla incision or the armpit incision for placement under the breast muscle. If the papilla is small the implant cannot be inserted that way. In the case of post-operative complications requiring replacement of the implant inserted from the armpit this replacement can be complicated and sometimes requires another incision around the papilla or the under-breast line, which means another scar afterwards.

Breast augmentation: other methods

Breast augmentation by hyaluronic acid based preparation /Macrolane etc./

Hyaluronic acid is commonly used for lip augmentation and wrinkle smoothening.

he preparation is applied under local anaesthesia by injection to the breast tissue. This intervention does not require hospitalisation and the patient can go home immediately after the intervention. The disadvantages of this method include the price (often higher than the price of breast augmentation by implant) and short-term effect. The substance is absorbed from the breast in 1 – 1.5 years and the intervention must be repeated. The last disadvantage is minimum effect of breast enlargement by 0.5 – 1 size. A 200 ml silicone implant enlarges the breast by 1 size. Hyaluronic acid is applied in the quantity of around 100 ml. However, this method is currently being abandoned and we do not offer it at all.

Own fat injection – lipo grafting

First your own fat is sucked carefully under low under-pressure through a thin cannula. The fat is then purified to take away undesirable components and then the fat cells are injected three-dimensionally across the breast tissue. The fat tissue contains a lot of the stem cells necessary for healing processes and survival of the transferred fat tissue. The disadvantages include the fact that a small proportion of the fat dies in the course of the first year and gets absorbed. The breast augmentation by this method is limited and sometimes requires several applications. Subsequent breast examination may be made more difficult by lipo-grafting. 

Injection of own fat enriched by stem cells

This method is similar to the previous one. Only the fat is specially adapted with the aim to increase concentration of the stem (germ) cells contained in the fat. Higher concentrations of these cells in the transferred fat tissue are assumed to assure smooth completion of the interconnection, improve healing and reduce absorption for a more long-term effect.

This method is not absolutely safe yet. Studies are in progress now to find whether the transferred concentrated stem cells are able to cause tumour growth. Also improved survival of the transferred fat tissue has not been proven yet. The method is very expensive. It is sometimes incorrectly called auto-augmentation, generally meaning “augmentation by own tissue". Therefore breast fill with own fat of the patient is also auto-augmentation. Some sites offer breast augmentation by stem cells and yet they only perform lipo-grafting. They simply make use of the natural stem cell content in the fat tissue.

Augmentation and simultaneous modelling

In certain cases breast augmentation can be combined with simultaneous modelling (uplifting and shaping). This is recommended for moderately sagged breast where implants are not sufficient for firming. This combination can also be used for sagged beast when you want to augment them at the same time.

The combination of these two surgeries is not recommended for large augmentation (large implant) or if the breast is much sagged. We will advise you about the possibility of the simultaneous interventions in the course of the consultation.

Breast augmentation: recovery

You need not be afraid of post-operative pain, you will receive analgesics. The breast will be drained of excessive blood from the operative wound. The drains will be removed on release from the clinic.

On release you will receive the implant card (passport), containing accurate data on the implants used. Keep this document carefully for potential future implant replacement. You will also receive a guarantee certificate (link to Medimplant certificate) by Mentor about lifelong guarantee for the implants.

The intervention usually requires two-day hospitalisation and you will be released on day three in the morning. You need to arrange transport and accompaniment for the release day. We can call a taxi for clients from Brno. Parking is possible in the underground parking of the clinic. In the case of interest you can spend more days after the surgery in our Body pension, which is mainly recommended to clients travelling long distance or abroad after the operation or to family members or partners of the client during hospitalisation.

For the first couple of weeks after breast augmentation by implants you need to wear elastic medical bra day and night. A special above-breast belt is recommended in the case of the implant insertion from the armpit. Sometimes you may need both. This post-operative underwear will be prepared for you at the reception.

You can shower the operative wound in 3 days after the drain removal. Then it is recommended to wash the wounds with a disinfecting shampoo for 2-3 weeks, dry with a clean towel and apply disinfection. After the disinfectant drying apply a thin strip of permeable paper adhesive plaster over the wounds. You will receive all that at the reception on release. You will need to rest n bed for a week after the surgery. You should have a helper for the first couple of days, including child care. The wounds are sutured with absorbable suture which dissolve spontaneously after a couple of months. You should not drive for one or two weeks after the operation.

In the case of implants over the muscle you will need to wear a bra long-term.

For several weeks after the surgery your breast will be swollen and stiff. You must know that after several weeks the swelling will recede and the breast size will decrease a little. Then the breast will also slowly being to soften again. Since the second post-operative week you can slowly start with light daily activities like walking but avoid hard physical work still like household cleaning etc. Hard work like heavy object or luggage carrying, exercise, sporting holiday at the sea, in the mountains (skiing) etc. is not recommended for one or two months after the operation. For the first month after the operation any sexual intercourse should be performed with maximum carefulness.

After two months you can resume body building, exercising, sports etc. However, this period is individual. One month after the operation you can sunbathe, use solarium, but for at least six months do not expose the scars to direct sunlight or solarium sun and protect them with adhesive plaster or a cream with high UV factor. Fresh scars attract pigment and remain dark for a long time afterwards. Scars get pale and disappear for about six moths to a year after the operation but never disappear completely. You can buy several products for wound and scar treatment at our reception. The scar appearance can be improved 2-3 months after the surgery by laser treatment (see link to laser).

The first post-operative visit at the clinic is usually scheduled by agreement with surgeon tow weeks after the surgery. The next visit takes place two months after the first post-operative visit and another one is scheduled 1 year after the operation. If all is found OK at this visit you will receive a recommended schedule of long-term monitoring of the implants and the breast. The visits at our clinic for this purpose are free for the rest of your life. We recommend regular annual specialised sonographic examination of the breast at a specialised site for the rest of your life.

Breast augmentation: possible risks

Like all operations, breast augmentation entails certain risks. These are general operation-related risks connected with the total anaesthesia (bleeding - hematoma, infection, pulmonary embolism, poor healing, operation wound splitting, development of colloid scars etc.) plus intervention-specific risks.

Potential risks related to application of breast implant:

Development and contraction of capsule (hardening)

Post-operative capsule formation by ligament tissue around the breast prosthesis is a normal physiological response of the organism to a foreign object implantation. This capsule develops in all patients but to a different extent from thin (degree I-II) to very distending tightly embracing the implant (degree III-IV). The capsule may contract and harden. The probability of this phenomenon is reported to be around 2-5% and its occurrence is most frequent in the course of the first post-operative year. The capsule symptoms include unpleasant pain, breast stiffness and shape deformation. This complication may require surgical revision when the capsule (implant bed) must be surgically removed and the space enlarged). Cases of capsule contraction around the implant are reported. There are also cases of recurrent capsule requiring implant replacement or complete removal.

Implant rupture

The currently used breast implants may not last for the rest of your life. Their mean life specified by their manufacturers ranges around 20 years or more. The implant wears and its surface is abraded and weakens. Then it may rupture after years. The cohesive gel does not leak from the ruptured implants but the beast can slowly change shape and be painful. Damaged or ruptured implant should be replaced. Implant rupture in the course of its life is usually connected with injury or excessive pressure on the breast. For this reason lifelong examinations of the augmented breast are necessary.

Implant prolapse

The currently used breast implants may not last for the rest of your life. Their mean life specified by their manufacturers ranges around 20 years or more. The implant wears and its surface is abraded and weakens. Then it may rupture after years. The cohesive gel does not leak from the ruptured implants but the beast can slowly change shape and be painful. Damaged or ruptured implant should be replaced. Implant rupture in the course of its life is usually connected with injury or excessive pressure on the breast. For this reason lifelong examinations of the augmented breast are necessary.

Implant prolapse

Excessive skin tension in the operative wound area or elsewhere may cause skin thinning, development of necrosis and rupture with subsequent implant prolapse. This risk increases if the implant was placed in damaged areas, such as under scared skin, under burn or under an area treated with radiotherapy in the past. The most frequent causes include too large implant, post-operative bleeding or infection. In the case of prolapse the implant must be temporarily removed.

Fluid around implant - serom

Post-operative or later exudates around the implant manifested by breast swelling and pain is mostly caused by failure to observe the post-operative rest period, injury, too intense exercise, infection in another part of the body (oral cavity, kidneys, flu, tonsillitis, gynaecological infection etc.) transferred by blood to the breast. Smaller exudates are absorbed spontaneously, larger exudates must be drained.

Hematoma around implant

Blood accumulation after surgery may form a hematoma. The most frequent causes include failure to observe the rest period after the operation or blood coagulation disorder. Smaller hematomas are absorbed spontaneously, larger ones must be drained.

Infections represent a rare complication after breast augmentation. You receive preventive antibiotics after the operation. However, there are reported cases of post-operative infection causing problems which may require temporary removal of the implant in extreme cases. Sometimes infection of another part of the body may be manifested around the implant months or years after the operation. The symptoms include pain, breast reddening, swelling and enlargement. This infection may be recurrent in some cases.

As the surgery is performed with stretched arms pain shooting to the forearm and hand may appear after the operation. This is connected with strain of nerves passing from the armpit to the upper extremities. This trouble is temporary and usually completely disappears in a couple of days or weeks.

Dissatisfaction with cosmetic result

Incorrect implant size or type, inappropriate placement of the scar etc. may cause dissatisfaction of the patient with the result of the surgery. For that reason a detailed consultation with the surgeon before the operation is necessary. The patient must accurately explain her requirements and expectations and the surgeon must inform her about the options. Generally large implants cause problems more frequently than smaller ones.

Implant shrinking - undulation

Cases of visible or tangible shrinkage of the implant surface manifested by visible and tangible undulations under the skin are reported. This phenomenon mostly occurs in slim patients with thin skin, weak subcutaneous fat tissue and very small breast gland, after application of large implants or after application over the muscle. The implant may always be felt on the under-breast line and on the side.

Asymmetry

Nearly all women have a small breast asymmetry manifested by shape or size difference, papilla height, rib arching etc. This asymmetry is mostly hard to hide completely and the papilla height difference cannot be repaired by the implant at all. The implanted breast may sag after a time like natural breast. The process is quicker in the case of large implants or implants placed over the muscle. There are also cases of asymmetrical sag on either side. This asymmetry may develop soon after the surgery again as a consequence of failure to observe instructions or for other cases. As a consequence of the breast movement soon after the operation the implant may change position. This risk is higher in the case of drop-shaped implants.

Papilla sensitivity change

Complications concerning changed papilla or breast skin sensitivity are reported, both in the sense of increased and in the sense of decreased sensitivity. These changes usually return to normal after several months or one year but may also be permanent.

Thrombotisation – vein clogging

Temporary clogged subcutaneous veins may occur near the implant reminding of thin ropes under the skin, often in the armpits or under the belly skin below the breast. They disappear spontaneously after a couple of weeks.

Overall effects of silicone and silicone implants on the organism

Available data show that silicone implants do not cause cancer or other malignant diseases.

Summary scientific, clinical and epidemiologic research data show that silicone breast implants do not cause auto-immune diseases or connective tissue disorders such as rheumatic arthritis, sclerodermis etc.

At present there are not available scientific data about the “new illness” coming from use of silicone implants. There are no reports of silicone allergies or intoxication.

Currently used silicone implants do not negatively affect pregnancy, breastfeeding or health of breastfed babies, not even in the case of their rupture.

No specific silicone antibodies have been found.

Silicone is a basic material with a wide range of applications in everyday life. There is no better alternative material for breast augmentation. Silicone implants and medical devices represent the basic equipment in all areas of medicine and surgery not only for cosmetic purposes but also as life-saving means (heart valves, joints etc.).

Other notices

The implant shields about 20% of the breast gland in mammographic screening. For that reason this examination must be combined or replaced with sonographic or MRI examination. Mammography may cause rupture of older implant.

Clients with breast implant must report this fact before diathermal treatment (for example liver warming in the context of spa procedures). Extreme heating may cause overheating of the implant, inner burns or rupture.

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Breast augmentation

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