Breast augmentation is not just a medical decision, but primarily a personal one. Improving appearance can increase the self-confidence of the person. Knowing as accurately as possible the modern technological and medical possibilities, the advantages, the risks and the implications of these possibilities, is the first and the most important step in the making of an objective decision in this respect.
Attention! Medical staff can provide objective information and recommendations, family members can tell you what they think you should do, but you will be the one to make the decision of breast augmentation. This brochure provides you with as much information as possible about this surgery and will give you the chance to make an informed decision.
Currently, there are more manufacturers of breast implants on the market, and each one sells several types of implants to adapt to the needs of each case. There are different types depending on size (length, width and projection), coating, content, and the purpose of the surgery (breast augmentation from one stage or several stages, reconstruction of the breasts, etc.).
- BREAST ANATOMY
- TYPES OF BREAST IMPLANTS
- BODY REACTION TO BREAST IMPLANTS
- BREAST IMPLANTS
- SURGICAL APPROACH AND OPTIONS FOR THE INTRODUCTION OF PROSTHESIS
- SURGICAL PROCEDURE
- PARTICULAR FACTORS
- RECOVERY PERIOD
The breast is made up of fat, glandular tissue, blood vessels, galactophore ducts (milk channels), sensory nerves. Some of the fat surrounds the breast uniformly, giving it a consistent consistency and contour, and another part gives it a volume. Pectoralis Major is the muscle on which the gland is placed and which is located immediately below it, helping to move the arm.
The size and shape of your breast is determined by the amount of breast tissue and fat . It is also affected by age, muscle development, postpartum period, genetic baggage and skin elasticity. Most of the time there is an asymmetry of the breasts, in terms of size, shape and positioning of the breasts.
TYPES OF BREAST IMPLANTS
Breast implants are of different types and shapes, with different coatings and contents. Together with your surgeon you will choose the best option for you to get the result you want.
This will allow you to choose the type and shape of the prosthesis you want. The shape of the implant can be: round, oval or anatomical. The surface of the implant may be smooth or textured.
In order to have a more natural result of the surgery, both at sight and touch, you can choose between:
- Saline implants (serum) or;
- Pre-filled silicone, soft or cohesive gel implants (a gel that mimics as much as possible the breast tissue).
- Mixed implants (double coated saline + silicone gel)
Physiological saline implants are used because the substance inside the implant is what forms over 70% of the human body. If the prosthesis flows, the saline solution is immediately absorbed by the body. On the other hand, saline prostheses are less pleasant to touch and do not perfectly mimic the consistency of breast tissue. The size of the prosthesis should be chosen depending on the shape and size of the bust and the quality of the skin.
Silicone implants are more preferred by surgeons and patients because they look and feel as good as a natural breast. The cohesive silicone gel implant has the advantage of having a higher consistency and the viscosity of the gel causes the gel to not get out of the implant in case of rupture.
If a normal silicone gel prosthesis breaks, some patients may experience a slight heat or change in the shape of the breast. Generally, in case of breakage of such a prosthesis, the leaking substance remains in the periprosthetic capsule.
BODY REACTION TO BREAST IMPLANTS
The natural response of the body is to reject or isolate any foreign body. The degree of rejection is partly dependent on the biocompatibility of the foreign body material. Currently, one of the most biocompatible materials used for breast implants is silicone. This material is used in many known medical implants such as pacemaker, digital articulation prostheses and condoms. The body will form a capsule around the prosthesis. The formed capsule is a normal reaction of the human body to any type of implant.
In some cases the capsule may contract causing the condition known as capsular contracture. It consists of having a very hard breast which leads to discomfort or pain. However, the textured surface of modern prostheses is made in such a way as to prevent the formation of this capsular contracture.
Researchers are still looking for new biocompatible materials with the body. Safety for silicone gel and silicone materials has been extensively researched by many renowned US institutions and not only in the United States.
There are breast implants of many shapes and sizes. There are round prostheses that have a smooth or textured surface; prostheses with anatomical shape and textured surface; adjustable postoperative prostheses with smooth or textured surface that have a dual quality of being expander and prosthesis. The special design of these prostheses gives the surgeon the opportunity to adjust the prosthesis volume after the initial surgery by a simple procedure a week after surgery.
No medical implant is considered to last indefinitely and should not be considered as a lifetime implant. However, some manufacturing companies offer a “Lifetime Replacement Policy” for all types of physiological saline implants. That is, they replace the breast prostheses in case of deflation or loss of saline through the valve.
SURGICAL APPROACH AND OPTIONS FOR THE INTRODUCTION OF PROSTHESIS
Typically, breast implants are introduced using one of the three traditional incisions: inframammary incision (under the breast), periareolar incision (on the nipple edge), or transaxial incision (the underarm). All these incisions allow the implant to be placed submuscularly (under the muscles) or subglandular (between the muscles and the mammary gland). Your surgeon can help you understand the best way to suit your preferences.
The inframammary incision is performed in the submammary ditch, the prosthesis is inserted through this incision, and the scar is well camouflaged by the fold. In case of the periareolar approach, the prosthesis will be inserted through the incision made around the nipple. The scar will be very well camouflaged in this area due to the difference in color. The transaxial incision is made underarm and the prosthesis will be inserted through this incision. There is also the transumbilical (through the belly) approach that is less commonly used. In the case of patients who have sagging breasts, mastopexy (breast lift) is performed before the prosthesis is inserted.
There are two main surgical options for placement of breast implants:
- SUBGLANDULAR (Prepectoral, Supramuscular)
- SUBMUSCULAR (Subpectoral)
Depending on the anatomical parameters (the shape and size of the chest, the amount of subcutaneous fat, the shape and size of the breast, the development of the pectoral muscles and the quality of the skin, and last but not least the surgeon’s preferences, one of the two methods is chosen. Regardless of the surgical method, a “pocket” will be created between the anatomical structures in which the breast implant is inserted. During the consultation, all these aspects will be discussed thoroughly with your surgeon.
There are many factors that may be of particular importance to you in terms of recovery and postoperative outcome. These should be well understood and discussed with your doctor. Some of these factors are:
Health state; …………………………..…Laboratory tests
- Breast structure …………………… Local preoperative examination
- Indication or contraindication; …… Other physical or mental disorders
- Bleeding tendencies; ………………… .. … Laboratory tests
- Predisposition to infections;
- Predisposition of development of capsular contraction.
The implantation procedure can be followed by hospitalization one night after surgery or a few hours depending on your surgeon and the chosen surgical method.
After the first 24 or 48 hours after surgery, you will feel a state of discomfort; Your breasts will be very hard and swollen. The recovery period varies from one patient to another, you will be able to resume daily activities after almost a week. But you’ll have to wait a month until you can resume physically demanding activities.
If problems occur, contact the surgeon urgently. This is important if high temperature feels the breasts or one breast is firm to the touch, painful, red or inflamed.
RISKS AND COMPLICATIONS
Except for anesthetic risks, there are risks and complications in breast augmentation surgery as with any other type of surgery. You will have to avoid such complications by talking to your doctor about the complications that may occur. This information may be provided by the physician, or by the prosthesis distributor. The information contains important factors regarding each type of surgical procedure for introducing breast implants and the potential associated risks.
Breast implant can not last forever. Surgery for the breast implant presents the same risks associated with anesthesia as any other surgical procedure.
MOST COMMON RISKS
- Deflation (implants with physiological saline): we encounter prostheses that deflated during the first months after implantation or prostheses that deflated after several years. It is not yet known when this phenomenon occurs. The implant may break due to a strong shock (hit), or it may break in time, and then the contents of the prosthesis are reabsorbed. Researchers are studying to deepen these causes of leakage. However, when the prosthesis begins to deflate, everything is happening very quickly, and our recommendation is that the implant is replaced. Because the physiological serum is present in the body, the saline solution that will drain from the prosthesis will be very quickly absorbed by the body within a few hours.
- Rupture (silicone gel implants): The implant may break due to a strong shock, or it may break in time, and then the prosthesis content begins to flow. While the silicone gel prostheses can break without causing pain, some patients have complained of burning or change of the prosthesis profile. In such situations you should consult your doctor immediately. You can check if the prosthesis is broken without surgery using mammography or ultrasound (ultrasound). If the rupture is produced, silicone usually remains in the capsule formed after insertion of the prosthesis, but in some cases there is a possibility that it has a small orifice and then the silicone can migrate into the body, to the mammary gland, muscle or to the fatty tissue around the breast, abdominal wall or arms. Fortunately, these cases are uncommon. The risks to such situations are unknown.
- Spread of the gel: It is well known that some silicone particles can also be spread through the prosthesis shield. Some of these tiny particles can remain in the capsule made prosthesis, or some may migrate into the body.
- It’s hard to get breast cancer if you have a breast implant:
There are no scientific or statistical data showing that there is a greater incidence of cancer in women who have breast implants.
The implant may interfere with finding breast cancer during mammography. It may obscure tissue induration, thus complicating the interpretation of results. The implant may also impede mammography. Because the breast is pressed during mammography, it is very likely that the rupture occurs, so it is important to inform the the imaging physician before the mammography ell that you have breast implants in order to avoid the break of the prosthesis. The doctor may use special techniques to minimize the possibility of implant rupture and achieve good results, and lately special mammography devices have been invented for this purpose.
Capsular contracture: The scar tissue or capsule that normally forms around the implant (periprosthetic capsule) may force or squeeze the implant. This is called the capsular contracture. From a few months to a few years, a small percentage of patients can see changes in the shape of the implant, hardness or breast pain due to the capsular contracture. There are no exact data on this phenomenon or how often it can occur. If these conditions are severe, surgery will be required to correct the capsule, move or change the implant. It is a fact that with the emergence of new types of implants (textured coating), the incidence of capsular contraction has seriously decreased.
- Calcium deposits in tissues around the implant: If these deposits occur, differential diagnosis with oncological risk lesions is established both by mammography and by all other diagnostic methods identified differently from the nodules that can cause cancer. Occasionally, it is necessary to remove small particles to examine and see if it is not cancer. Usually these can be done without removing the implant.
- Additional Surgery: Women should understand that when necessary, the implant should be removed for better diagnosis. Also, problems such as rupture, deflation, capsular contracture, infection and calcium deposits can lead to removing or changing the implant. Discuss the risks of additional surgeries with your surgeon
- Infection: The infection is a complication of any type of surgery. The frequency of infection with implant surgery is not known, but the patient may ask the doctor about their experience with this risk. Many of the infections resulting from surgery occur within a period of several days and even months after surgery. Infections with foreign bodies in the body (implants) are more difficult to treat than other types of infections. If the infection does not respond to antibiotics then the implant needs to be changed. Once the infection is treated, another implant can be put in place of the old one.
- Hematoma: Hematoma is a collection of blood inside the body (in this case around the implant or around the incision) and can cause pain; the probability of getting the hematoma is not yet known, but a woman who wants to have an implant should consult the surgeon about this risk. If a hematoma develops, it will appear immediately after surgery. A small hematoma is usually reabsorbed by the body, but large ones need to be surgically drained.
- Delay of healing: in rare cases, the implant forces the skin excessively. To solve this complication, surgery is usually required. This condition occurs in people with less elastic skin, or by choosing overly large implants.
- Changes in nipple or breast tenderness: Sensitivity may increase or decrease after surgery. These changes may be temporary or permanent and may affect the sexual response or the ability to breastfeed a baby.
- Breast lift: Sometimes (usually in the case of submuscular positioning), the implant can alter the initial shape of the breast, giving it an unnatural appearance. In these cases, surgery is needed for correction. Other problems that may arise are incorrect implant size or visible and unsightly scars.
- Autoimmune diseases: Studies conducted for comparing the frequency of autoimmune diseases between women with implants and women without implants have shown that women with implants are not at a higher risk of getting sick. These studies have been done only for the symptoms of known autoimmune diseases, except for the variety of symptoms we rarely encounter. Some of the symptoms of autoimmune diseases are:
- Hair loss;
- Unexplained loss of tonus;
- Breast leaks or lymph nodes;
- Colds (flu) more often
- Vomiting, dizziness;
- Memory problems;
- Muscle ruptures or skin irritation.
In the presence of these symptoms, the breast augmentation may not be indicated.
- Pregnancy and breast-feeding: There have been many questions if the implant will affect the body and you cannot have children or breastfeed. Some women with implants have reported problems about it. Only a few researches have been made in this area but none have shown that there are major issues. There is no scientific data on the risk of impaired fertility or if children of mothers with breast implants have health problems.
- Cancer: Major studies have been pursuing for a long time women with mammary implants, and they show that the number of breast cancers has not increased. On the other hand, medical centers along with breast implant-producing factories give as much information as possible about these types of implants. This information is made public and / or transmitted to physicians in order to inform the patient.
Aspiration – Extraction of a liquid from the body with a surgical vacuum cleaner;
Biocompatible – Be biologically compatible, not toxic or not immune to the body;
Capsular contracture – A firm grip of the tissue around the prosthesis;
Pocket – The place where the prosthesis is placed;
Fibrous tissue – Tissue formed largely from collagen fibers;
Glandular – Regarding a gland;
Haemorrhage – Internal or external blood loss;
Milk channels (galactofore) – Anatomical formations responsible for passing milk from the mammary gland to the outside;
Opaque – non-transparent, ray-impenetrable;
Surgery ‘outpatient’ – ambulatory surgery, after surgery patient is not to remain hospitalized in the clinic / hospital;
Large Pectoral (Pectoralis major) – a muscle located at the top of the chest that supports the breast and is involved in arm movements;
Physiological saline – 0.9% NaCl solution. Approximately 71% of the human body contains this solution;
Sensitive nerves – nerves that transmit different pulses from receptor sensors to the brain or spinal cord;
Sepsis – Infection, presence of several microorganisms with related toxins in blood or tissue;
Silicone – organic material, derived from sand (silica), which is generally well tolerated by the body and has the ability to be molded in various forms;
Thrombosis – the formation and development of blood clots in the vessels.