Today, breast augmentation is most commonly performed by placing silicone implants under the breast tissue or the muscle under the breast tissue. It is aimed to create a more voluminous and upright breast for women who have structurally small breasts and whose breast volume has decreased due to post-pregnancy and weight loss. Apart from the implant, fat transplantation and the process of gaining volume to the breast by using synthetic filling materials are relatively new methods and are applied more limitedly.
• After breast augmentation surgery, your breasts appear more upright and voluminous.
• Your body gains a more balanced appearance. • Your physical self-confidence increases.Breast augmentation should be applied in conjunction with breast lift surgery on sagging breasts above a certain limit. In such cases, it will not be enough to place a implant under the breast tissue, but it will also be necessary to move the nipple to a higher place.
Breast augmentation surgery is not a scarless operation. In fact, some scars occur in most of the plastic surgery procedures. However, these scars are placed in less noticeable areas and surgery is performed through as small incisions as possible, so that the scars are short. Breast augmentation surgery is performed with incisions made from three areas: under the breast, around the nipple and under the armpit.
Each of the incision areas made for the placement of the implant provides some advantages and disadvantages.
With this incision, the inframammary fold or a scar that remains half a centimeter above it is formed. The prosthesis is placed in this area. In surgeries performed in this area, the area where the implant will be placed is better seen and blood vessels are stopped more clearly. Since the implant is very close to the place where the implant is placed, it is less likely to damage it with the fingers while placing the implant. Many implant companies recommend incisions made in this area for implant safety. If the person does not have a wound healing disorder (excessive wound healing), the scar left after this surgery will be about 4-5 cm long, linear, close to the skin color, remaining in the fold under the breast. In my experience, people who have surgery with this method are not bothered by this scar.
Placing a implant with this incision is also a frequently used method. Since this incision is made between the colored area around the nipple and the skin, a scar that is almost unnoticeable remains after healing. However, incisions made in this area may cause a decrease in nipple sensation, albeit at a very small rate. Again, in order to place a implant from the nipple, the colored area around the nipple must be of a certain width. If the diameter of the colored skin around the nipple is larger than 4 cm, the person is suitable for such an incision.
The incision made under the armpit has become more known with the slogan “breast augmentation without leaving a trace on the breast”, which you have seen frequently advertised in the newspapers recently. In fact, this is a technique that has been described for the placement of intraoperative saline (isotonic NACL) implants. I talked about these types of implants in the article. These prostheses are placed in the breast as a deflated sheath and inflated like a balloon inside. However, since it is full of water, it does not feel as natural as silicone gel implants when touched from the outside, and they may lose some of the water volume in time. When placing a gel-filled voluminous implant through this incision, the wall of the implant may be damaged because it is attempted to be placed from a far point in the area where the implant will be placed. It is more difficult to shape under the breast in implant placement surgeries made through underarm incision and irregularities may occur. In my applications, this technique has not found a place due to its risks.
Breast implants are balloon-like structures designed in special shapes to add volume to the breast. The outer surface of the implant is made of silicone. The inner part of the implant is filled with physiological saline (saline) or silicone gel.
Implant filled with salt water give the feeling of a balloon filled with water when touched. Again, in this type of implant, there may be volume reduction due to water leakage from the system. This type of implant is less preferred than gel-filled implants.
Implants filled with silicone gel have a consistency closer to the breast tissue. Prosthetic companies have strengthened the outer wall of the implant with new formulations and a second layer of diphenyl silicone coating, and they state that they almost completely prevent silicone leakage. The gel in the implant is in the form of a gel close to solid compared to the old implants and has less fluidity. When cohesive 3 implants are cut in half, the gel does not flow out.
Implants are produced in different shapes and sizes according to their shape. Round and anatomical implants, as can be understood from their names, are produced in the form of round or breast, that is, anatomically.
Anatomical implants are drop-shaped, that is, the volume of the lower part of the implant is greater than the upper part. They are produced with the aim of making the breast look more natural. The volume of the upper part of the breast is less than the lower part of the breast. This form can be created more easily when the volume at the bottom of the implant is large. This approach is generally correct.
If you place an anatomical and round implant at the same point, the anatomical implant will look more natural. However, if you place the round implant lower than the anatomical implant, you will increase the volume under the breast again and you will still get a natural result. Round implant provide décolleté fullness better. An important complication of anatomical implant is their postoperative rotation in the breast and the formation of an undesirable appearance.
Both have reasons for preferring different types of breasts over the preoperative form of the breast. This is a decision that will be made after the examination, together with your doctor, which implant will make your surgery more successful.
Implants are also classified according to their base widths or heights in terms of shape. There are low-profile, mid-profile, mid-high and high-profile implants with the same base size.
Implant dimensions, base width and height are determined according to the patient’s expectation, breast structure and skin condition.
Smooth or rough implants are produced according to their surface. Implants with a rough surface are produced with the aim of creating less capsular contracture, that is, scar tissue around the implant, in the long term. In some studies conducted in recent years, there are findings that cast doubt on the accuracy of this. In some studies, it has been shown that there is no difference in the formation of capsular contracture between rough or smooth implants, especially under the muscle. Rough implant’s folding (rippling) problem is observed more
As in all surgeries performed with general anesthesia before the operation, there are important points to be considered.
If the person smokes, smoking should be stopped at least 2-4 weeks before. The nicotine in cigarettes causes less blood to flow to the tissue by shrinking the blood vessels, which both slows down wound healing and increases the possibility of infection as a result of less oxygen and nutrients going.
Drugs that delay bleeding clotting time, such as aspirin, NSAIDs, excluding painkillers-paracetamol, and vitamin E should be discontinued at least 1 week before.
Alcohol should not be consumed within 1 week before surgery. Garlic, ginko biloba, ginseng (found in herbal supplements) should not be taken. These types of supplements also prolong bleeding time.
It is recommended to consume protein-dense (meat, milk, egg and fish) a few days before the surgery.
The surgery is performed under general anesthesia. It takes 1.5-2 hours on average. Preoperative drawings of the surgical plan are made in the patient’s room. This process takes about 15 minutes.
Many different techniques and incisions in which the implant will be placed have been described for breast implant surgery. I mentioned the incisions used to place the implant in the article. Another important point is where the implant will be placed.
Although breast implant is found in many less common technical literature, it is generally placed in 3 areas. These areas are under the breast, fascia (under the membrane) or submuscular. The implant is placed on the muscle and muscle membrane just below the breast tissue or gland.
Since the implant is placed under the mammary gland, it opens the mammary gland and skin better. In order for the implant to be placed in this plan, the breast tissue must be of a certain thickness. This thickness should be 2 cm at the upper border of the breast, otherwise it will be palpable and clearly noticeable at the upper border of the implant.
It is a newer method compared to the other two methods. The implant is placed in the area created under the pectoral muscle (chest muscle) membrane. This method can be applied to patients with less breast tissue who cannot place a implant under the breast. It is less painful than submuscular application. As the surgical technique, the preparation of the area is more difficult, and the operation time is 30-45 minutes longer. I have been using this technique for about 5 years. We still do not have as much information about long-term results as submuscular breast implant applications.
The implant is placed under the muscle under the breast tissue. Since the muscle will cover the implant, the visibility of the implant will be reduced. Since the muscle is a tissue that bleeds very well and covers the implant, the probability of long-term problems with the implant is reduced (such as capsule contracture).
When the implant is placed under the muscle, if the muscle is not sufficiently released, the implant can move upwards with the movement of the muscle, and the implant can also move with the movement of the muscle. In this case, the under-breast does not open enough. The conical appearance, where the under breast is more voluminous than the upper one, and the nipples pointing slightly upwards, does not occur.
To overcome these problems, a technique called DUAL PLAN (dual plane-muscle and mammary gland) has been developed in the medical literature. In this technique, muscle. It is released from the skin and the bone to which it is attached, displaces slightly upwards and is only in the upper part of the prosthesis. In the lower part of the implant is the mammary gland. Thus, the implant does not move upwards and opens under the breast well. This placement of the implant has the advantages of both submuscular and submammary placement.
It is necessary to use a compression garments designed for post-operative breast surgeries for 4 weeks.
In breast augmentation surgery, different types of implants can be used according to the patient’s breast volume, skin amount, sagging or not, and the location of the nipple. It is an operation in which a meticulous preliminary evaluation before the operation is very important.
