The breast is one of the erogenous organs that symbolizes femininity. Every woman wants to have aesthetically beautiful looking breasts. However, as a result of unilateral or bilateral growth retardation of the breasts or weight loss following pregnancy, the volume of the breasts may be smaller than normal. In such cases, it is possible to create a fuller, larger, aesthetically more beautiful breast with attempts to enlarge and plump the breast. The rate of enlargement is determined by taking into account the desire of the person, the condition of the existing breast and the dimensions of the rib cage. When prosthesis placement surgery is applied to breasts that have lost their fullness, loosened and severely sagged, the loosened breast tissue may again droop over the prosthesis. In such breasts, breast lift surgery should be performed in addition to the prosthesis placement surgery.
The surgery is performed under general anesthesia in a full-fledged hospital and takes 1-2 hours depending on the preferred technique. The patient can leave the hospital after 1 day. The chest area remains bandaged for about 1 week. There are no seams on the leather surface as hidden stitching is applied.
BREAST PROSTHESIS
The material used for breast augmentation is silicone prostheses. Silicone is not a harmful substance for the body. Silicone is an inert substance, that is, after it is placed in the body, it does not enter into a chemical reaction with the organism, its molecular structure does not change. It is a scientific fact that there is no relationship between silicone and breast cancer.
Prostheses are divided into 2 groups according to the material they contain:
1- Prostheses containing saline: They contain saline in a capsule made of silicone. If prostheses containing saline are punctured, burst or leak for any reason (traffic accident, penetrating sharps, gunshot wounds, etc.), the leaking serum can be absorbed by the body and does not have a harmful effect on the body.
2- Silicone-containing prostheses: There are 2 types of these types of prostheses according to the consistency of the silicone they contain:
I- Those containing liquid silicone: Liquid silicone has a soft consistency and flowing properties. Since the softness of the liquid silicone is close to the softness of the breast, when the breast is palpated from the outside, the presence of the prosthesis containing liquid silicone is less felt or not felt at all compared to other types of prostheses. If the prostheses containing liquid silicone are punctured, burst or leak for any reason, the leaking silicone will disperse from the area it is in to the environment. Tissues need to be cleaned with a surgical intervention.
II- Those containing cohesive silicones: They are thicker and solid than liquid silicone, therefore they do not have fluid properties. Since the consistency is darker and a little harder than liquid silicone, the presence of the prosthesis can be felt when the breast is palpated from the outside.
Prostheses are divided into 2 groups according to their shape:
1-Round prostheses: They are in the form of hemispheres. After placement, they create a fuller appearance in the upper half of the breast.
2-Anatomical prostheses: They are in the form of drops. Their shape is more compatible with the natural shape of the breast. After placement, they create a fuller appearance in the lower half of the breast.
LOCATIONS OF PROSTHESES
The breast is made up of adipose tissue and mammary glands. Below the breast, between the breast and the rib cage, is the pectoral muscle. Prostheses can be placed either between the breast and the chest muscle, that is, on the muscle, or between the chest muscle and the rib cage, that is, under the chest muscle.
1- Placement on the pectoral muscle
A rapid recovery is achieved. A natural appearance cannot be created as prostheses placed under the muscle, in people with low breast fullness, the prosthesis can be felt when examined by hand.
Prosthesis placed on the muscle
2- Placement under the pectoral muscle
The edges of the prosthesis are more difficult to notice when viewed from the outside or to be felt when palpated. Therefore, a more natural appearance is gained. Capsular contracture (see possible problems section) is less likely. Since the position of the chest muscle changes, slight pain may be felt in the first few days with shoulder and arm movements that cause the contraction of the chest muscle.
Prosthesis placed under the muscle
ENTRY PLACES FOR PROSTHESIS PLACEMENT
Prostheses can be placed in the chest area by entering from 3 different places:
1- Nipple circumference
The surgical incision is approximately 4 cm around the dark colored area around the nipple. in the form of a semicircle in length. When an incision is made around the nipple, the area where the prosthesis will be placed is reached by cutting the mammary glands, cutting the mammary glands to reach the area where the prosthesis will be placed, may adversely affect breastfeeding after a possible birth, the nerve that provides the sense of the nipple may be affected, in this case temporary or permanent numbness may occur in the nipple. The surgical incision heals, leaving a faint scar around the nipple.
2- Under-breast fold line
4-5 cm over the inframammary fold line, or over the line that will form this fold. long incision is made. The surgical incision heals by leaving a faint scar on the inframammary fold line. When the prosthesis is inserted by entering from the under-breast fold line, the mammary glands are not damaged, there is no breastfeeding problem after a possible birth, and the nerve that provides the sensation of the nipple is less likely to be affected. For this reason, nipple numbness is not common. The risk of infection is very low, especially when the prosthesis is placed under the muscle in this way.
3- Underarm
1-1.5 cm above the fold lines of the skin under the armpit. A long incision is made and a tunnel extending under the breast is prepared and the prosthesis is placed through this tunnel. Prostheses are usually placed under the pectoral muscle in this way. In this way, the prosthesis considerably reduces the risk of infection, especially when placed under the muscle. Since the surgical incision is under the armpit, there is no scar in the breast area. The surgical scar under the armpit disappears over time as it remains within the fold lines. The intervention made in this way has no effect on the mammary glands. Breastfeeding problems do not arise after a possible birth. It is a technique that does not disrupt the original structure of the breast. The possibility of affecting the nerve that provides the sensation of the nipple is very low. For this reason, nipple numbness is not common.
POSSIBLE PROBLEMS
Such problems may be caused by the surgical technique and type of prosthesis applied. They are extremely rare and do not threaten the health of the person.
Problems caused by the prosthesis
– Perforation and explosion of the prosthesis: Perforation and explosion of the prosthesis is not a situation that occurs under normal conditions. However, prostheses may puncture and explode as a result of gunshot wounds, penetrating or related injuries.
– Wear and tear of the prosthesis over the years: It is possible for the prosthesis to wear out over the years. There may also be a leak due to this. In this case, the prosthesis should be replaced.
Conditions that require a second surgery
– In cases described in the section Problems arising from prostheses, the prosthesis may need to be replaced or removed without repositioning.
– Infection: It is not uncommon for an infection to occur. It is almost never found.
– Capsular contracture: When a foreign body is placed inside the body, the organism forms a capsule that surrounds the foreign body in order to protect itself. The formation of this capsule is a normal and natural state. However, the organism of some people reacts more than normal to foreign bodies, the capsule shrinks and begins to compress the object inside. When a capsular contracture develops around the implanted breast prosthesis, it compresses the prosthesis, this causes chest pain and hardening of the breast, and the prosthesis takes a distinct appearance under the skin when viewed from the outside. In mild cases, the complaints are also mild and this situation can be improved with massage. If advanced capsular contracture has developed, part or all of the capsule formed by surgery is removed. However, if the capsular contracture recurs, then the prosthesis must be removed in order not to be reinserted.
– Slipping and displacement of prostheses: Prostheses may rarely move sideways or upwards over time. This can create an asymmetrical appearance. A second surgery is required to correct this condition.
– Revision of surgical scars: In some people, surgical scars may remain prominent. Revisions can be applied to reduce these traces.
Personal factors affecting the outcome of the surgery
– The current size of the breasts: It is an important factor affecting the outcome of the surgery.
– Diameter of the base of the breast: It is an important factor affecting the outcome of the surgery.
– Thickness, looseness and fullness of the breast tissue: It is an important factor affecting the outcome of the surgery. Thin, weak and loose breast tissue can affect the result.
– Sagging of the breast: Slight sagging of the breast can be corrected when the prosthesis is placed. Lifting surgery should also be applied to sagging breasts with extremely loose and weak tissue.
– Shape of the chest wall: Congenital deformities in the chest wall adversely affect the appearance.
– Asymmetric breasts: Some people may have differences in shape and size between both breasts. This is a factor that makes it difficult to give a symmetrical appearance.
– Elasticity of the skin: It is an important factor affecting the outcome of the surgery. The results are more impressive in people with normal skin elasticity.
– Deformities in breast development
PRE-SURGERY PREPARATION
Ø Some drugs may interact with anesthesia or their side effects may occur with surgery. Be sure to inform your doctor about all the medicines you use. In particular, aspirin-derived and cortisone-containing drugs should be discontinued one week before the operation.
Ø Smoking negatively affects wound healing. For this reason, it is recommended to leave it as early as possible before the operation and not to use it after the operation.
Ø Inform your doctor if you have any discomfort before the operation. Be careful that your surgery does not come to the days of your period.
Ø If your operation will be performed by entering under the armpit, apply epilation to your armpit 4-5 days before the operation.
Ø Come to the hospital with comfortable clothes on the day of surgery. Do not make up. Leave your jewelry at home (wedding rings, necklaces, etc.).
Ø Take a warm shower at night before the operation.
Ø If the operation is before noon, nothing should be eaten or drunk after 24 hours. If it is in the afternoon, a light breakfast can be eaten considering the 6-hour fasting period.
Ø It is necessary to be admitted to the hospital 2 hours before the operation, for the necessary examinations (laboratory and imaging) and for evaluation by your anesthesiologist.
Ø You will need a companion during your stay in the hospital.
POST-OPERATIVE CARE
Ø Post-operative pain is a normal complaint. It can be controlled with painkillers. If you have pain, you can take the prescribed pain reliever. If you do not have pain, you do not need to use painkillers.
Ø Pain occurs due to the change in the position of your chest muscle when the prosthesis is placed under the muscle. Avoiding heavy shoulder and arm movements will relieve your pain.
Ø After the operation, it is recommended to use a slightly tight bra that wraps your breasts in such a way that there is no slack.
Ø Post-operative 3.-4. You can take a warm shower from day one. Before taking a shower, consult your doctor for the condition of the bandages on the wound.
Ø 15 days after the operation, lie on your chest for periods that will not disturb you, and start practicing the exercises described by your doctor.
Ø After the operation, you can do light sports such as walking, avoid intense physical activities for 3-4 weeks.
Ø You can return to work 2-3 days after the operation, if it does not require an intense and tiring work (such as desk, office work).
