Breast

Sinonimi: Breast augmentation, Augmentation mammoplasty

This is a surgical procedure that has for an objective to increase the circumference and volume of the breasts through use of implants. Breast augmentation in this manner is usually used on persons with significantly underdeveloped (underdeveloped gland and fatty tissue) or unequal breasts, after child birth when the breasts get smaller and saggy (moderate loss of voluptuousness and droopiness), and after breast surgeries in which a part of the breast tissue was resected.

Any female person who is unsatisfied with the size and/or shape of their breasts is a potential candidate, as well as persons with asymmetrical and breasts in disproportion with their stature.

Women after breastfeeding, when breasts lose their volume and the skin becomes too lax, can use this procedure to resolve the issues with droopiness and loss of volume.

Before making a decision on any surgical procedure, it is important to know that all surgeries come with a potential risk of complications. Fundamental principle in esthetic surgery is that persons undergoing procedures are HEALTHY. Other than that, it is necessary to be well informed about your procedure and every aspect of it.

This surgical procedure is generally considered a low risk surgery.

There a re two potential risks involved: embolism (fat or thrombus) as a consequence of the surgery and an immunological reaction of the organism to a foreign object (silicone).

Breast augmentation as a surgical procedure isn’t considered an extensive surgery so the risk of embolism as a complication is relatively small. Essentially, none greater than a tonsillectomy, appendectomy, hernias etc. Also, it needs to be mentioned that early activation and verticalisation after the procedure are of utmost importance in preventing this complication.

As far as immune reactions of the body to the implants as a foreign object go, there are two possible groups of problems: a local immunological reaction and a systemic immune response. In case of a local reaction, either the entire breast turns hard to the touch (capsular contraction), or there is forming of small lumps in the vicinity of the breast (silicone leakage). These complications are rare, and you can learn more about them in sections on Post op complications and Our experience.

This selection is based on the position of the implant relative to the pectoralis major muscle, in effect – is the implant placed under or over the muscle.

Under the breast tissue

With this procedure the implant is placed over the pectoralis major muscle, just under the skin and the mammary gland. In order for the implant to be placed in the supramuscular position any of the approaches for the incision can be used..

Under the muscle fascia (subfascial)

With this approach the implant is placed between the muscle and the muscle sheeth (fascia). The favored placement of the incision is in the fold beneath the breast.

With this procedure the implant is placed under the pectoralis major muscle, just over the ribs. In order for the implant to be placed in the submuscular position two of the incision placement approaches can be used: the fold beneath the breast and the axillary (arm) pit.

There are three approaches for placing the implant:

Incision (a cut in the skin) in the fold beneath the lower pole of the breast is the most common approach and the approach with most history for placing the implants. The fold is situated under the lower pole of the breast, where it meets with the rib cage. The incision is 3 to 5 cm long, depending on the size of the implants. Implants can be placed both under and over the muscle this way.

A semicircula incision around the areola is made, usually on the lower half. Length of the incision is 3 to 5 cm long, and is dependant on the size of the implants and the size of the areola. Implants are placed over the muscle using this approach.

Incision in the arm pit is an approach of less frequent use (it was popular for a brief time in the late 80s and early 90s). Length of the incision and the scar is 3 to 5 cm long, depending on the size of the implants. Implants are placed both over and under the muscle using this way.

Through an approach of choice, usually the fold beneath the breast, the breast tissue is accessed. Followed by creating room for the implant at desired level ( supramuscular, subfascial, submuscular) and placing the chosen implant itself. After placement is finished, tissue and skin is closed up using the finest sutures to keep the scar minimally visible.

General anesthesia.

Almost immediately after surgery, the early activation of the patient commences (getting on your own feet), 2 to 8h after the surgery. First dressing of the wound is done in the first post op day, and after it a special bandages are applied which are removed at first follow up.

Sutures are remoced successively, outer microsurgical on the 7th, inner sutures on the 14th day.

After the final sutures are removed, scar can be treated with a scar reducing cream.

Hematoma , bleeding, infection, implant prolapse, capsular contraction (reaction to a foreign object)…

The final form of the breasts can be expected in 3 to 6 months after surgery, depending od the position of the implants, over (3m) or under (6m) the muscle. Of course, the preliminary results are obvious immediately after the surgery, and they will continuously progress to full form from week to week.

Health check ups are mandatory after having implants, in the form of regular follow ups, lab checks, and ultrasonic diagnostics, mammogram can be done if needed.

Basic division refers to which surgical procedures we use to augment and remodel the breasts. In that manner, we could be talking about simple placing of the implants (augmentation), or a procedure where in addition to placing the implants, we do a lift, tightening and remodeling/reshaping of the breasts (augmentation and lifting).

Division relative to the problem:

Simple placing of implants (augmentation)

This surgical procedure is used in all cases of small, underdeveloped, moderately saggy, moderately asymmetrical breasts and with rib cage deformities conjoined with small, underdeveloped breasts.

Placing of implants, lifting and tightening the breasts (augmentation and lifting)

Augmentation and remodeling of the breasts by placing implants combined with breast lift and changing the position of the nipples is a surgical procedure that resolves the issue of saggy breasts without enough glandular and fatty tissue. Breasts that used to be well balanced with the stature, of appropriate size, sometimes during life (change of body weight, gravity, loss of skin elasticity) tend to droop,losing form, size and firmness. Augmentation and remodeling of such breasts is achieved by placing implants in combination with lifting..

Placing implants with asymmetrical breasts

There is a certain umber of asymmetrical breasts, when one breast is bigger than the other ( combinations go from one of normal size, other completely undeveloped or significantly underdeveloped to one being significantly overdeveloped or lax and droopy and the other being minimally underdeveloped).

Placing implants after a mastectomy

Breast cancer is unfortunately one of the most common forms of cancer in Serbia. Over the last two decades, rate of curing has fortunately been constantly climbing, but the cure of choice is usually a complete mastectomy. Reconstruction of a removed breast can be done in the same surgery when it’s removed, called a primary reconstruction, or after a period of time, called a secondary reconstruction.

Contribution of having breast implants to the looks of the figure as a whole, most patients describe as excellent or highly satisfactory.

Discomfort of having a scar is usually deemed acceptable by the patients, and in cases of a more pronounced scar (which is a rare occurance) they still consider that the surgery was justified, despite the scar.

During our 27 years of experience, there were no serious complications.

Complications which endanger the life and health of the patient, such as thromboembolism, or fat embolism were never observed.

Post op bleedings were never incurred.

Leaking of clear – yellowish fluid (seroma) at the wound was observed in five patients, and all of them resolved spontaneously during recovery.

Deflation (leaking) of implants was never observed.

In only one case there was a drop of silicone gel observed on the surface of the implant. The implant was removed and replaced by another one promptly, during the surgery itself. Patient has not had any complications in post op.

Infections were never observed.

A slower rate of healing around the incision line occurred with 3 patients, with no need of a surgical intervention.

There were no observed cases of implant rupture and capsular contraction (hardening, stiffness).

Hypertrophic scar was observed in two patients, with surgical correction (excision of the scar and resuturing) done on one patient, the other patient deemed the scar non-problematic, and was completely satisfied with the size and form of her breasts.

There were no cases of keloidal scars .

Procedure takes an hour and a half on average.

7 to 10 days usually.

Usually one day.

Any time of the year is appropriate, you just need to be healthy at the time of the surgery and try not to have the surgery when you have a cycle.

When the implant is placed over the muscle there is minimal amount of pain during the first post op day. The pain is usually resolved with no medication.

When the implant is placed under the muscle there is a moderate amount of pain during the first 3 post op days. The pain is usually managed with medication on the first post op day.

It takes, on average, 3 to 4 weeks to a full recovery. The process is somewhat shorter and easier with supramuscular implants.

Full touch sensation usually returns in 6 to 12 months. It needs to be mentioned that there are differences in establishing natural sensations depending on the place of the implant (supramuscular or submuscular) and the placement of the incision ( in the fold under the breasts, around the areola or in the arm pit). With supramuscular placement of the implants, especially with incision around the areola, full sensation recovery takes longer, 6 to 12 months, with most of the patients reporting increased sensitivity, and with submuscular placement of the implants with the incision in the fold, occurance of increased sensitivity is rare.

When placing the implants directly under the glands, the function of the glands can be disrupted but is not always the case.

With any other approach, function of glands and breastfeeding is completely preserved.

Synonyms: Reduction mammoplasty

This is a surgical procedure that has for an objective to reduce the size of the breasts by removing excess skin, fatty and glandular tissue. It’s used to acquire smaller, firmer, more proportionate to the figure breasts, and in order to reduce the stress on the spine and the pain caused by disproportionately large breasts.

This surgical procedure is exclusively associated wit female patients who are dissatisfied by the size, shape and position of their breasts, or for reasons of disproportion to stature, or because of the pain and stress to the back.

Before deciding on any surgery, you must be aware that all of them come with potential risk of complications. The basic principle of plastic surgery is that persons undergoing surgery are HEALTHY. Other than that, it is necessary that you are well informed about the procedure you are having and all aspects of it.

This is considered a low risk procedure.

A semilunar incision is placed around the areola. The inside of the breast is accessed through that incision and excess fat, glandular tissue and at the end skin, is removed. The nipple is repositioned upwards in order to achieve a new,more perky position of the whole breast. Draines are placed at the end.

General anesthesia.

Early activation of the patient (getting on your own feet) begins almost immediately after surgery, 4 to 8hrs after. Draines are removed on day 3. Post op period takes about 3 weeks, most intensely in the first 2 to 5 days.

Sutures are removed successively through days 7 to 14.

After removing the final sutures, the scar can be treated with a scar reducing cream.

It is necessary to wear special or adjusted bras that maintain the new position of the breasts. They are to be worn for 1 to 3 months.

Very rare, they can be in form of a hematoma, infection, seroma, skin necrosis, hypertrophic scar.

New, final form of your breasts, and your figure accordingly, can be expected in 3 to 6 months after the surgery. Ofcourse, the basic result is seen immediately after the procedure, which improves to full form from week to week.

Health check-ups after the surgery are done on a regular yearly basis: clinical examination, lab results and ultrasonic diagnostics. Mammogram is usually done in cases where there is a reason to, i.e. family history of breast cancer.

We consider this as one of the more creative reconstructive procedures in plastic surgery. There is a large number of different techniques and solutions. Good knowledge of many techniques and choosing the appropriate one for a certain patient are of utmost importance.

With moderate (up to 500 grams per breast) reductions we never had any complications.

With more extensive procedures (from 500 grams to 1 kilogram per breast) we had a single occurrence of hematoma.

With extreme reductions (2 kilograms per breast), we had one case of partial areolar skin necrosis, which was successfully solved by reconstruction. The patient was completely satisfied.

With large and extreme reductions, the most common complication (about 10%) is leakage of clear- yellowish liquid from the wound (seroma) or through a drain. It always resolves spontaneously, with no need for any further treating, except for regular dressing of the wound.

The procedure takes from 2 to 4 hours.

Usually it takes 2 to 3 weeks off-work.

You stay at the hospital for 2 to 3 days.

Any time of the year is good, all you need to be is healthy and try to avoid having the surgery when you have your period.

There is a mild presence of pain for a day or two. A feeling of tension and the need to bend the body forward is present for a few days.

It takes on average 3 to 4 weeks to make the return to full mobility.

Return to normal touch sensitivity takes usually about 6 months. It has to be accented that this is individual. Lowered sensation is the most common occurence, with touch sensation being somewhat unpleasant.

Most often it is imppossible to breastfeed after this procedure, therefore it is recommended that the procedure is to be done only when you are finished with child birth.

Synoyms: Breast lift, Mastopexy

This is a surgical procedure that has for an objective to lift sagging and low hanging breasts. Procedure is based on removing excess skin, reshaping/remodeling the breast and lifting the nipple.

Breasts that used to be well formed, elastic (firm) at a younger age, tend to sag and droop over time., changing their original shape, loosing firmness, so becoming a source of discontent and arising the wish to be returned to their original state.

Any female person that is unsatisfied with the low hanging position and droopiness of their breasts can be a potential candidate for this procedure.

Before deciding on any surgery, you must be aware that all of them come with potential risk of complications. The basic principle of plastic surgery is that persons undergoing surgery are HEALTHY. Other than that, it is necessary that you are well informed about the procedure you are having and all aspects of it.

Different types of breast lifts directly come out of the problem, in fact the degree of droopiness and laxiness of the breasts. The incision is placed around the areola, then vertically downwards and/or in the fold beneath the breast. Excess skin is removed, with no glandular or fatty tissue removal. The nipple gets raised and the breast gets lifted and reshaped by removing the excess skin.

General anesthesia.

Early activation of the patient (getting on your own feet) begins almost immediately after surgery, 4 to 8hrs after. There may be some swelling.

The sutures are removed successively through days 7 to 14.

After removing the final sutures, the scar can be treated with a scar reducing cream.

It is necessary to wear special or adjusted bras that maintain the new position of the breasts. They are to be worn for 1 to 3 months.

Very rare, they can be in form of a hematoma, infection, seroma, hypertrophic scar.

New, final form of your breasts, and your figure accordingly, can be expected in 3 to 6 months after the surgery. Ofcourse, the basic result is seen immediately after the procedure, which improves to full form from week to week.

Health check-ups after the surgery are done on a regular yearly basis: clinical examination, lab results and ultrasonic diagnostics. Mammogram is usually done in cases where there is a reason to, i.e. family history of breast cancer.

We would like to point out that in case of moderate breast sagginess, in addition to breast lifts through traditional methods, the aswell procedure of choice can be a breast lift and augmentation with the use of subfascial implants. We often suggest this as a first choice because of the smaller scar needed.

We must mention the fact, derived from our experiences, that there is sometimes a small level of unsatisfiedness of the patient with the existance of a scar, whether it’s a normal or hypertrophic scar. Obviously, the presence of a scar on one’s breast is something that is difficult to get accustomed to.

We haven’t had any case of significant complications in our practice.

There were a few cases of hypertrophic scars.

The procedure takes anywhere from to one and a half to 3 hours.

Usual period off work is 2 to 3 weeks.

You stay at the hospital for 1 to 2 days.

Any time of the year is suitable, all you need is to be healthy and try to avoid having the surgery when you have a period.

Incidence of pain is very rare in this type of surgery.

It takes on average 2 to 3 weeks to make the return to full mobility.

Return to normal touch sensitivity takes usually about 3 months. It has to be accented that this is individual. Lowered sensation is the most common occurance.

It’s absolutely possible to breastfeed after this procedure.