Breast augmentation surgery is performed to fix the problems where the breast volume is naturally insufficient. This may occur due to genetic or developmental reasons. In addition, weight loss and postpartum changes can result in volume loss and sagging of the breasts. In addition, prostheses used in breast augmentation can be a part of the treatment, such as correcting the obvious size difference (asymmetry) between the two breasts, which are less common, or in the treatment of congenital breast development disorders.
Today, breast augmentation surgeries performed with silicone prostheses are considered as the most effective and predictable approach in terms of patient selection, surgical technique, early and late results obtained, knowing the complications based on long-term follow-up and revealing the ways of coping. Breast augmentation surgery, performed with the help of silicone prostheses, is one of the most performed surgeries all over the world and the patients are most satisfied.
Breast Augmentation Surgery (Augmentation Mammaplasty)
For the purpose of breast augmentation, some other techniques and some drugs are frequently on the agenda. Augmentation via injections are becoming increasingly popular, some long-term synthetic fillers and fat injections are used in breast augmentation approaches. The amount of filler used in these is often insufficient, but may provide limited benefit. In addition, the risk of developing breast cancer with fat injections has not been fully demonstrated. It is not possible to benefit from herbal agents available for breast enlargement. However, some drugs containing hormones can give results in the breast, albeit partially. Uncontrolled use of these drugs can lead to many health problems, especially cancers. It would not be wrong to say that the most effective and safe way of breast augmentation is through silicone prostheses.
There are many types of silicone prostheses used in breast augmentation. It can be roughly defined as bags containing silicone gel or serum, which can vary in viscosity in terms of their consistency, inside a silicone sheat of approximately 1 mm thickness. There are different options in the shape of the prostheses. They are produced in a round or anatomic shape, that is, in an anatomical structure. In addition, the outer surface of the prosthesis may be smooth or rough, the risk of forming contracture (deformation by compressing in the space) of the rough surface is low. Although it is reported that silicone prostheses filled with serum are healthier, they are not preferred because of the volume loss problems that occur over time. In addition, as a result of the production of gel-filled prostheses with advanced technology, their consistency has been made closer to normal breast tissue and it has been ensured that they can remain in the body for a very long time without any problems. The new generation silicone prostheses contain a non-fluid and non-deformable silicone gel.
In the selection of the shape of the prosthesis, different choices can be made for each patient in order to eliminate individual problems. Success in breast augmentation surgery depends on how natural the breast looks after the surgery and how long the results will be, as well as meeting the patient’s expectations. While selecting the breast size requested by the patient, the structure of the breast and rib cage should be taken into consideration while choosing the pre-operative prosthesis.
Surgical techniques used in breast surgery
It is normal for all patients who want to have breast augmentation surgery to seek information from different sources. However, in some cases this can be a bit confusing. It can be considered reasonable that each physician provides information that highlights the type of operation or prosthesis they use, which they find superior. Each technique has its advantages and disadvantages. The technique to be used depends on the patient’s wishes and the patient’s anatomical structure and the preference of your doctor according to the condition of the breast. Surgical techniques in breast augmentation surgery vary depending on the place where the prosthesis will be placed and the entry site.
Breast prostheses are mainly placed inside the body at 4 levels. These are,
• Under the breast tissue (subglandular )
• Under the pectoral muscle membrane (subfascial)
• It can be placed under the chest muscle (submuscular or subpectoral)
• The upper part of the prosthesis is under the muscle and the lower half is under the breast tissue (dual plan).
The incisions used for the placement of the prosthesis are;
• Submammary incision made from the area where the breast meets the rib cage.
• Semicircular incision (periareolar) made along the lower half of the dark skin (areola) around the nipple
• Less commonly used incision made under the axilla
In general, the selection of the incision depends on the plane which is the prosthesis placed in. It is possible to place a prosthesis on the muscle, under the muscle or under the muscle membrane without disturbing the integrity of the breast tissue. Not only does not damage the breast tissue and therefore the milk ducts, but also reduces the risk of capsular contracture due to infection, it also helps to avoid problems with more milk production in these patients who already have insufficient breast tissue.
The scar is much less likely to be more visible than the incision under the breast, and the scars here are very difficult to notice because the skin is thin and both sides are different in color. However, the most important disadvantage of this incision is the possibility of bacteria living here to infect the prosthesis, albeit at a low level, due to the cutting of some milk glands and ducts, and increase the possibility of capsular contracture due to infection. In addition, it is possible to place a prosthesis under the breast tissue with this incision. Nipple semi-circumference incision does not cause permanent sensation on the nipple.
Although it is considered the ideal incision site for those who do not want any scars on their breasts, the most important disadvantage is that only serum-filled prostheses can be used and the entire prosthesis can be placed only under the muscle.
There are also some options in the shape of the prostheses used in breast augmentation. Among these, deciding on the most suitable prosthesis shape for the patient can create very important differences on the outcome of the procedure. Round and anatomical shaped prostheses, which is a better known difference, also have projection differences between them. Accordingly, both types of prostheses have low, medium, high, medium and high projection options. Naturally, it is possible to obtain a larger breast in a patient with a narrow rib cage, with a prosthesis with a narrow base and a high projection.
Determining the location of the prosthesis completely depends on the breast structure of the patient and the experience of the physician regarding the result. The communication of the physician with the patient is extremely important in this regard, since each of them has advantages and disadvantages.
Breast augmentation operations with silicone prosthesis are at the forefront of operations that provide high patient satisfaction because patients see the results as soon as possible and the operations are generally more effortless. The surgery generally takes about 1.5-2 hours. After the operation, the breast is bandaged in the form of a cone with plasters for 3 days. Then, the bra determined before the surgery is applied whole day for 3 weeks, and for the second 3 weeks only during the day. Stitches, if any, are removed within 15 days. Postoperative pain is easily controlled with pain killers. The patient can be discharged on the day of surgery. The patient is advised to stay away from heavy sports for 3 weeks.
Post-operative complications such as infection and blood accumulation around the prosthesis are rare and treatable. In such cases, some additional surgical procedures may be required, including removal of the prosthesis, but they are extremely rare.