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  2. 2. INTRODUCTION Breast augmentation using implants has become one of the most common procedures in Aesthetic Surgery. There are two main groups of women seeking breast augmentation for aesthetic reasons: ● women who are dissatisfied with the size of their breasts ● women who have had normal breast development but the breast size has decreased following pregnancy/or increasing age Breast implants could be used for correction of breast asymmetry.
  3. 3. ABOUT THE IMPLANTS The material usually used for breast implants is silicon, which due to its biocompatibility is most frequently used for medical implants. Besides it’s using for breast implants, silicon is used for many others medical purposes: cover for surgical suture material, protection layer for artificial heart valves, and silicon prostheses for patients with orthopedic diseases. For approximately 12 years there has been the suspicion that there is a connection between silicon implants and two specific diseases: breast cancer and autoimmune disease. Scientific data from more than 2,000,000 women with mammary implants were collected throughout the world. They attest that there is no evidence, which suggests that silicone would cause any type of cancer or autoimmune disease. The results are communicated by the University of Southern California "Official of Plastic and Reconstructive Surgery”, University of Calgary - Canada 'Official English Medicine, Mayo Clinic - U.S. and all attest that there is not an increased risk for breast cancer for women with silicon implants. Autoimmune disease is a general term to describe an immune system that responds to defensive substances that are part of the body. These problems occur spontaneously to the regular population. The theory concerning the fact that silicone could cause autoimmune disease is wrong, and this is demonstrated by numerous tests performed on groups of women with breast implants. Clinical studies have demonstrated that there is no connection between silicone implants and the tissue disorder. There are studies that continue to check these results on a large group of women, on a long term. Breast implants are either filled with silicone gel or filled intra-operative with saline solution. In recent years, gel implants have returned in use in the entire Europe and since 2007 it is decided that they can be used again in the United States as well according to FDA decision. Breast implants do not affect pregnancy, fetal development, breast feeding or health of breastfed children. The life expectancy of the implant is unpredictable
  4. 4. Type of implants There are two main types of implants: saline filled and silicone-gel- filled. The main disadvantage of saline-filled is deflation and rippling. In case of rupture liquid silicone gel filled implants could provoke local disorders that can lead to siliconoma formation and impregnation of the surrounding tissue. The silicone implants used today are filled with cohesive silicone, which even cut open can not leak. Regarding the form of the implants there are two types: ● anatomic ● round
  5. 5. COUNCELING There are important benefits of breast augmentation – enlargement and a balance in breast size, symmetrical form and contour of the breast and improvement of the self-image and self- esteem. The possible complications of breast augmentation are infection, bleeding, poor wound healing, asymmetry, rippling, capsular contracture etc. You should weight these risks against the benefits of the procedure. So you can make an informed decision about whether to proceed with surgery. Finally, after clearly understanding of the implications and outcomes of surgical procedure you will sign the informed consent. The augmented breast should look natural and proportional after surgery. Therefore, communication about what you desire and what is possible to do is extremely important. Breast shape is a common doctor and patient decision.
  6. 6. PREOPERATIVE RECOMMENDATIONS ● Before surgery, you should make an ecography or mammography; ● Do not eat and drink nothing after midnight before the surgery; ● It is forbidden to take an aspirin and any other medicines containing aspirin, with 2 weeks before the surgery; ● Usually, the surgery must be performed outside the menstrual period; ● You must prevent the surgeon and the anesthesiologist if you have medical problems (vascular tension, vascular problems, stroke, diabetes, lung problems, bleeding problems, epilepsy, neurological problems, allergies to various medications); ● The physician must be notified if you have a set of plates or eye lenses; ● If you smoke, plan to quit 2 weeks before the operation and do not start to smoke again for at least 2 weeks after the surgery; ● Avoid sunbathing in excess before surgery ● Do not follow a strict diet before surgery because it might delay the healing process; ● If you catch a cold or have any infection the surgery must be rescheduled.
  7. 7. PREOPERATIVE PLANNING Planning of desired form and implant selection There are several essential steps in planning the desired form of the breast and implant selection. First of all, we should not think about the volume, but about dimension The desired breast width and the tissue thickness allow us to determine the implant width. Round implants are selected in women who request them because they prefer greater volume in the upper pole. The anatomical implants are indicated when the patients desire more natural and proportional aspect of the breasts. The differences between width, height and projection allow choosing the most appropriate implants regarding anatomical particularities of the body. The anatomic implants with greater height then width and more inferior pole projection are most favorable for patients with taller, narrower torso. Implants with greater width than height are a good choice for augmentation when the patient has a shorter, wider torso. Full projection implants are indicated for patients with loose skin envelope with atrophic parenchyma. Pocket plane selection
  8. 8. The placement of implant may be: ● subglandular ● subfascial ● submuscular ● subpectoral ● dual plane The subglandular placement is below the breast tissue and above the muscular fascia. This placement works best in patients who have adequate soft tissue coverage with the thickness of more then 2 cm and degree of ptosis. It also may be favorable for patients which want to continue active exercise program. The subfascial placement is below pectoralis major fascia but the longer pole is relatively easy to dissect. This plan does not add much more tissue over the implant, because the thickness of the fascia is less than one millimeter. The advantage of this placement is that an upper pole fascia conceals the upper edge of implant. The total sub muscular placement is above the chest wall and below portions of pectoralis major and minor, serratus anterior, rectus abdominis and external oblique muscles. The pros are that the implants will not drop in time. On the other hand, pseudoptosis of the breast could occur later.
  9. 9. The subpectoral placement is above the chest wall and below the pectoralis major superiorly and in the subglandular or subfascial plane inferiorly. The dual plane is actually a variation of the subpectoral plane augmentation. This variation permits expansion and redraping the gland tissue over the implant, creating a pleasing breast appearance. SURGICAL PROCEDURE Breast augmentation is usually performed under general anesthesia and it takes between 1 and 2 hours Four incisions are used for breast augmentation: ● periareloar ● axillary ● inframammary ● transumbilical
  10. 10. We prefer as a first choice the inframammary and as a secondary choice the periareloar approach The advantages of the inframammary approach are: ● Simplicity ● Straightforward approach ● Better visualization of the breast pocket ● Easy incision and dissection f the pectoralis major insertion ● The scar is inconspicuous, placed right at the level of the new inframammary fold The surgeon tries to make an incision as small as possible and less visible. The implants filled with serum can be inserted through an incision of 2, 5-3 centimeters and the gel filled implants can be inserted through an incision of 5-5, 5 centimeters. During the past few years, we introduce the implants in the pocket above or beneath the pectoralis muscle depending on the initial appearance of breasts (tegument quality, the degree of mammary ptosis, thickness of the gland and adipose tissue). The advantages and disadvantages of such alternatives on the incision area and the positioning of the implants must be discussed in detail within the preoperative consultation. After the surgery drainage tubes are attached for 24 hours, in order to avoid the formation of hematoma, which encourages the occurrence of the capsular contracture.
  11. 11. POSTOPERATIVE HOSPITALIZATION A 1 to 3 days postoperative hospitalization is required and during this period antibiotics are administrated. You will probably experience some pain and initial discomfort following the operation for the first 24-48 hours, especially if the implants are placed under the pectoralis major muscle but you will be prescribed pain-control and antiinflamatory drogs. POSTOPERATIVE RECOVERY Stitches will be removed at 12 days after surgery, even by the family doctor. But usually the wound is closed with absorbable stitches. Therefore there is no need to remove it. The patient will wear for 2 or 3 months a suitable brassier well adapted to the new shape and volume of the breasts. It is usually recommended to avoid intense physical efforts for the first 2 or 3 weeks. As for the scars you must know that for the first 6 months they will blemish and swell but in about 9 months maximum one year after the surgery they will flatten and fade.
  12. 12. CONCLUSION The most important aspect of this surgical procedure is you personal wish and decision.You should take in consideration that today’s trend in breast augmentation is “natural look”. The benefit of this procedure from the emotional and psychological point of view is the boost of your self-confidence through achieving a new “look”. The main satisfaction for surgeon and patient is to see the augmented breast like one good looking naturally and being proportional.