What is Breast Augmentation Surgery?

Breast volume has an important place in the measurements of shoulder width, chest circumference, waist and hip circumference. When the breast volume is small in these measurements, the body contour appearance is incomplete. The breasts may be structurally small for different reasons. One may be smaller than the other, asymmetrical, one may be congenitally absent. In order to equalize or increase the volume of both breasts, the most valid method today is silicone prostheses (implants). Breast augmentation surgeries with one's own tissues have been tried, but with limited results. For example, the breasts can be partially enlarged by taking fat tissue from the person. However, fat filling is not a completely permanent method. The main substance in breast implants is silicone on the outer surface of the implant. The filling material inside may be different. Each prosthesis has its own advantages and disadvantages. These should be discussed in detail before surgery and it should be decided together which one to use. 

What is a silicone breast implant?

Silicone-containing products are also used for other purposes in the cosmetic industry and in medicine. Breast prostheses are balloon-like structures shaped like a breast. There are round and drop-shaped ones called anatomical. The balloon part is made of silicone; the surface of the prosthesis is roughened to adapt to the tissues in the body. The materials filling the balloon may be different. Breast prostheses used today can be named as follows: a. The outer surface is silicone and inside the balloon there is a gel of silicone origin. These are produced ready for use in various sizes. They were approved by the FDA (Food and Drug Administration) in the USA in November 2006. b. Gel-filled (Gel-filled) : Saline-filled (Saline-filled) : During the operation, it is filled with saline, popularly known as saline, until the desired volume is obtained. Recently, it has been reported that ready-to-use ones have been manufactured. c. PVP : Similarly, the silicone balloon is filled with a chemical substance called PVP (polyvinyl pyrrolidone povidone). It is in gel consistency and ready to use. It has been withdrawn from the market by the manufacturer.d. Soybean Oil: These are ready-to-use prostheses filled with soybean oil inside the silicone balloon. The area of use is still new. There is not much information about remote results. 

What you need to know before surgery

If the patient is over 40 years of age, mammography and, if necessary, radiologic examinations called ultrasonography are performed before the operation. Each surgery has general or specific risks. Edema and pain in the breast area are common complaints after surgery. Some patients complain of increased or decreased sensitivity in the nipples or numbness around the incision after surgery. It has been suggested that some connective tissue diseases develop in the body against the prosthesis, which is a foreign body (connective tissue disease), that it becomes difficult to give milk to the baby, and that the prosthesis causes cancer. However, none of these have been scientifically proven. In breast augmentation surgery, since breast augmentation can be achieved with a foreign material for the body, there may be problems with the prosthesis. There may be hardening and narrowing due to the development of a membrane called capsule around the prosthesis. A thin membrane does not cause any problems, but in the case of a medium-thick membrane, a slight hardness in the breasts and prominence at the base of the breast may be noticed. In rare cases, the body may not accept this foreign material and may try to form a thick membrane (capsule) around the prosthesis, compressing and trapping it and sometimes trying to expel it from the body. In case of a thick capsule, the breasts may become hard and sometimes asymmetrical. In case of mild and moderate capsular contracture, external massage and additional surgeries can be performed if necessary to remove the capsule around the prosthesis. When severe capsular contracture occurs, there is no other option but to remove the prosthesis. Although the outer surface of silicone prostheses is very thin, it is very resistant to external impacts. Normal and moderate massages do not harm. The person can lie face down 2 months after surgery. Sometimes, leakage of the prosthesis content out of the balloon can be seen. If a gel-filled prosthesis is used, these substances leaking into the tissue spaces may cause mass formation. The effect of soybean oil is not yet known. If a saline-filled prosthesis is used, the saline filled into the prosthesis may leak out of the prosthesis and into the tissue spaces, in which case it will be rapidly absorbed by the tissues without causing any harm to the body. In fact, this substance, which can be administered intravenously and used for other therapeutic purposes, does not cause any harm. Rupture of the prosthesis is rare, it can occur with compression, falls from height and penetrating tool injuries, such as in car traffic accidents. Mammography and surgical examination to be performed later on in breasts with prosthesis does not pose a problem. The risk of developing cancer in a breast with silicone breast prosthesis does not increase, it is the same as normal breast tissue. When such a situation occurs, surgery and other forms of treatment for cancer in the breast with prosthesis are applied in accordance with the standards. Before deciding on breast augmentation surgery, you should clearly tell your doctor about your defect that bothers you and your expectations from the surgery, discuss the prosthesis to be selected, the incision through which the prosthesis will be placed, the type of anesthesia, the early and late results of the surgery. 

Surgery

The operation is performed under general anesthesia in the operating room under hospital conditions. It takes 1-2 hours. A 4-5 cm scar is made to place the prosthesis. The placement of this scar can be one of the following:
Submammary fold (Submammarian)
Lower part of the nipple head (Circumareolar)
Armpit (axillary).
Recently, prosthesis can be placed endoscopically by entering around the umbilicus. However, this method is not yet widely accepted. Regardless of the entry site, a scar will remain. These scars are evident at the beginning and become indistinct over time. Depending on the breast structure of the patient, the prosthesis can be placed behind the breast tissue or behind the pectoral muscle (pectoral). Each procedure has advantages and disadvantages, and this detail should be evaluated before surgery. 

 After surgery

Postoperative period is usually comfortable. Pain is minimal. If the prosthesis is placed behind the pectoral muscle, arm movements may be restricted for a few days. A bra or bandage is applied to the breast after surgery. If there are non-melting stitches, they can be removed on the 10th-12th day. There is no need to remove stitches in dissolving stitches. There may be swelling in the early period, numbness in the nipple and purplish discoloration on the skin. These disappear spontaneously in a short time. The patient can return to work in 3-4 days. After 3 weeks, the prosthesis settles in place and the breast functions normally. The patient is advised to avoid heavy sports (jumping and running) for 2 months. Breast augmentation surgery with prosthesis is an operation that gives good and permanent results in general, improves the mental health and psychosocial structure of the person and makes them more attached to life. 

Today, textured round prostheses filled with silicone gel are most commonly used. The choice and placement of the prosthesis may vary according to the patient, the condition of the breast and the surgeon's preference.