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BREAST AUGMENTATION



Breast augmentation is a very important surgical procedure when it comes to improving a female patient’s outlook. The breast has always been a symbol of femininity for women. As a result, women who have smaller breasts may feel that their femininity is reduced. In particular, young women whose breasts have not developed yet tend to feel quite inferior, in particular where their relations with the opposite sex are concerned.

Breast augmentation is one of the most popular cosmetic operations, not only in Greece but throughout the world. If we were to impose an order on cosmetic operations in terms of their popularity, it would most likely take first or second place.

WHEN TO PURSUE BREAST AUGMENTATION

Usually, when female patients seek out a plastic surgeon to undergo breast augmentation, they tend to fall into the following categories:

•    Women who naturally have small breasts.
•    Women whose breasts used to be of normal size, but lost their volume and ‘hollowed out’ following a pregnancy.
•    Women whose breasts have ‘hollowed out’ after extensive weight loss.
•    Women whose breasts are lacking the mammary gland, or part of the mammary gland due to an operation.

BREAST AUGMENTATION TECHNIQUES

In recent years, several different methods have been put forth for breast augmentation, such as:

•    Augmentation using fat
•    Augmentation using hyaluronic acid, but;
•    Augmentation using implants is the standard method employed worldwide. This method has been in use for quite  a few decades and is extensively tested.




IMPLANT TYPES

Implants are comprised of an outer layer, composed of solid silicone, which contains a filling material. They are split into categories, based on:

1.    Content, which includes the following categories:
•    Silicone implants, wherein the content is liquid silicone.
•    Saline implants, which contain a salt water solution.

Silicone implants tend to be used more frequently than saline implants, as their texture is more natural.




2.    The implant’s surface type, which includes the following categories:

•    Rough surfaces, and
•    Smooth surfaces.

Rough-surfaced implants have, as the name suggests, a coarser surface, while smooth-surfaced implants have a more even surface. The debate over the issue of surface type mostly centres around the possibility of causing inflammation. Many claim that rough-surfaced implants are less likely to cause inflammation, whereas others insist that smooth-surfaced implants, which are considered an overall improvement over older models, are only just as likely to cause inflammation as rough-surfaced implants.

3.    The implant’s shape, which includes the following categories:

•    Round implants
•    Anatomical (teardrop) implants

Round implants have a consistent volume, while anatomical implants are shaped like a teardrop; they have more volume in their lower section. There is no consensus on which of the two is preferable, but the choice of shape may differ depending on each patient’s particulars.

4.    The projection of the implant. This is determined by the doctor, depending on the diameter of the ribcage, the skin’s elasticity, and the desired shape of the breast.

5.    The size of the implant. This is determined by the patient’s wishes, but also by the composition of the breasts and ribcage. For each patient, there are certain limits when it comes to the size of the implants that be employed. These limits are defined by the diameter of the ribcage and the skin’s elasticity.

Implants are very durable. They can withstand great pressure without breaking. They are even capable of surviving a traffic accident, where they are certain to receive heavy blows. In general, implants are constructed to last throughout the patient’s lifespan. However, occasionally an implant may appear that, after some time, manifests a rupture in its walls. Even in such cases, the type of silicone they contain (cohesive silicone) is such that it does not look out into the body, but remains within the implant. This is made possible by the fact that silicone gel has a gelatinous form which is soft yet not fluid.

It is certain that there is no truth in the various bizarre and even humorous rumours which appear from time to time, e.g. that implants burst during airplane journeys, and others.

CHOOSING IMPLANT SIZE

Most people seeking a plastic surgeon are afraid they might augment their breasts to the point where they become overlarge. Certainly, moderation should always be practiced, but if the patient is able to communicate clearly with their surgeon, there is no likelihood of an over-the-top augmentation taking place.

Methods of Selecting Implant Size

There are various methods of selecting implant size, which can on the whole be freely combined.
The first of these methods is to communicate your wishes to the plastic surgeon. For example, you may illustrate your point by stating your desired bra size. Most patients request a larger bra size than the one they currently have.

The second method is to examine relevant photographs which may be provided either by your or the surgeon, and explain your preferences based on them.

The third method requires the surgeon to measure the diameter of your ribcage and the dimensions of your breast, as well as the elasticity of your skin. Based on this information, the surgeon should be able to determine which implants i best for you.

Tools known as breast sizers are also available; these, if the surgeon is able to provide them, can be placed on your chest in order to give you some idea of the chest’s appearance after the augmentation. In order for these sizers to be placed, it would be best to wear a non-enhancive bra.

Recently, software has been developed which can allow patients to see via a computer what their chest will look like after the operation, when a certain size of implant is used. However, such a service is usually charged extra.

If the aforementioned methods are combined, it is certain that the patient will be led to pick an appropriate type of implant, provided their wishes have been fully communicated during a thorough discussion with the surgeon.
When a surgeon takes the wrongful attitude that “It is my job to place an implant which I believe to be appropriate for you, so don’t worry about it,” it can often lead to unacceptable results. Make sure to personally choose your desired breast size, and not be influenced by others. You should not be influenced by the opinion of your surgeon, your partner, or anyone but yourself.

Also, endeavour to select the breast size you want without fearing that you may be going over the top. Many patients who exhibit this fear, or are afraid that the people close to them will become aware that they have undergone such an operation, conceal their true wishes from their plastic surgeon. However, this usually leads to under-correction, wherein an implant smaller than what the patient really wishes for is placed. These patients may well end up undertaking the procedure again later on, in order to obtain the breast size they truly want.
Do not worry about the change becoming noticed by your friends and family, since in any case, none of your friends and family are likely to be as observant as you fear. Seek to obtain the breast size you truly wish for; not a larger one, or a smaller one.


ACCESS ROUTE

In order for the implants to be placed into the breast, an incision must be made. Each patient must decide for themselves where that incision must be made, as it will be sure to leave a scar. The scar will eventually heal to the point where it does not present any particular annoyance, but it is still up to the patient to decide where they would prefer it to be placed.

There are three choices when it comes to the access route through which the implant be placed:

1.    The under-breast. This incision is made at the point where the breast meets the ribcage on its lower end. As a choice, it offers the advantages of good visibility during the operation, easy concealment under a bra, swimsuit or bikini, and the fact that the incision is placed upon a natural groove of the breast.

2.    The nipple. In this case, the incision is made in the lower boundary between the areola (the darker periphery of the nipple) and the skin. As a choice, it offers the advantages of good visibility during the operation, very good healing, and its placement in a location that is easily concealed by a bra, swimsuit or bikini.

3.    The armpit. The advantage of this is that the incision is not made on the breast itself. However, the incision will not be concealed if the patient raises their arms high; also, it is a longer access route, offering less visibility than the other two.





IMPLANT PLACEMENT LEVEL FOR BREAST  AUGMENTATION

The implant is deposited in the breast between certain tissues. The term ‘placement level’ refers to which tissues the implant is placed between.

The two main choices are placement over the pectoralis major muscle, and placement under the pectoralis major muscle.

1.    PLACEMENT OVER THE MUSCLE: In this case, the implant is placed under the mammary gland and over the pectoralis major muscle. This means that the front of the implant will be in contact with the front of the muscle.
This placement can be made regardless of access route, through any of the three incisions. The advantages of this placement level are:

•    A shorter duration for the surgical procedure
•    Less likelihood of causing hematoma
•    Less pain after the operation.

2. PLACEMENT UNDER THE MUSCLE: In this case, the implant is placed deeper, i.e. the front of the implant will be in contact with the back surface of the pectoralis major muscle, while the back of the implant will be in contact with the pectoral wall. Of course, the pectoralis major muscle cannot cover more than upper 2/3 of the implant, while the lower 1/3 is in contact with the mammary gland. This level of placement can also be made regardless of the access route, i.e. where the incision is made.

This placement level offers the following advantages:

•    The implant is not visible through the upper pole (the upper part of the breast)
•    Reduced possibility of inflammation
•    Reduced likelihood of sagging
•    Clearer images of the breast in a mastography
•    Reduced possibility of wrinkles appearing on the implant



These are two basic choices of placement level. There are other choices, however, which are less commonly employed, or are applied to a particular type of problem. These include:

•    Subfascial access
•    Dual plane placement.

The dual plane method is essentially a placement under the pectoralis major muscle, with some slight differences. It is mainly used to deal with cases wherein a small degree of sagging is present in the breast.




AFTER THE OPERATION

The patient is required to remain at the clinic for a few hours after the operation. Most patients undergo the operation in the early hours, so that by evening they are free to return home. In some cases, an overnight stay may be required.

Once they have returned home, the patient can resume their daily activities within the house without any particular problems. Of course, they should avoid stressing the breast area with activities that requires excessive mobility or heavy weight lifting.

The degree of annoyance differs greatly from patient to patient, and as such it is difficult to offer precise advice. However, even in the event that there is some annoyance, the use of appropriate painkillers tends to suffice to deal with it.

The period of time before the patient can return to work depends on factors such as the type of work, the patient’s constitution, the type of operation and various others. Most patients who are employed at an office should be able to return to work after 3-5 days. More physically intensive work requires a longer recuperation period.

During the first few days after the operation, some edema or swelling will be present around the breasts, and their shape will be fairly altered. After some time has passed, however, the edema will recede and the breasts will begin to acquire their final shape. After a month the breasts will already have a fairly pleasing shape, but the final result will become visible after approximately 6 months.

Swimming in the sea or at a pool should only be allowed after one month has passed.
A female patient who has undergone breast augmentation should be able to breastfeed without problems.

The augmented breast does not sag easily;
the implants acts as internal support, causing the breast to sag less than it would have if it did not contain an implant.






RESULTS OF BREAST AUGMENTATION

When the operation is performed correctly, the result will appear completely natural, such that no one should be able to notice that the breast has been surgically augmented.

Results that make it evident that the breasts have undergone augmentation tend to be produced by an incorrect procedure. Many patients are terrified by their encounters with such results, and are led to believe that breast augmentation is always apparent.

There are people amongst us who have undergone the procedure with very satisfying results; it would be impossible to determine that their breasts have been augmented, as the result appears completely natural. Moderation should, of course, be applied when selecting the desired size, as overlarge breasts will certainly appear unnatural. After all, the vast majority of people who approach a plastic surgeon tend to request a regular breast size.

Female patients who have had their breasts augmented via this method tend to report that they feel more feminine after the operation, and that they wish they had undertaken it sooner. The improvement in their outlook and temperament is evident, which is particularly satisfying for themselves, their surgeon and the people around them. Many patients stress that their love life in particular has been vastly improved.