Breast are a symbol of femininity throughout all the history of human race development. Specific aesthetic preferences are prone to changes within time, but well-shaped breast of a sufficient fullness will always be a sign of beauty.

In medical terms, breast augmentation or, so called, augmentation mammoplasty, consists of surgical volume enlargement with breast implants. Together with rhinoplasty and liposculpture, this is one of the most frequently conducted surgical procedures in cosmetic surgery. With technology development during recent years, implant quality and durability has risen to high standards which, together with using new surgical techniques and surgeon’s experience, ensure high level of satisfaction.

CANDIDAES FOR THE PROCEDURE

Patients may want to enlarge their breast for different reasons, e.g. because of the feeling that their breast have always been too small; due to congenital or acquired breast asymmetry; due to volume loss after breast-feeding or due to a greater weight loss; due to abnormal breast development (e.g. tuberous breast), as well as in cases of breast reconstruction after previous surgical procedure.

A woman who considers breast augmentation, needs to be psychologically prepared for her body shape change and she also needs to be healthy and in good physical condition. During the first conversation with a plastic surgeon, she needs to explain her wishes and expectations regarding the procedure and she needs to ask all the questions that she contemplates about. After considering possible options, physical examination and anatomic measurements, plastic surgeon will be able to talk about the possible alternative for the patient, regarding the size and shape of the implants, incision site and other details of this surgical procedure. If necessary, initial examination can include breast mammography or an ultrasound examination in order to exclude any possible pathological lesions.

Benefits from breast augmentation, after shape and size improvement, are related to a woman’s better perception of herself having well-balanced proportions and prominent body contour. In cases of breast asymmetry and reconstruction surgery due to breast disease, where the emotional and psychological factor is even more important, it has been proved that this procedure greatly helps preserve and emphasize woman’s personal satisfaction.

Augmentation or possible reconstructions of the breast are recommended to patients above the age of 18, when complete tissue growth has already been achieved and when a patient is completely ready to cooperate during the procedure and to conduct postoperative health care. If the procedure due to specific reasons should be performed earlier, parental or legal guardians’ consent is necessary.

BREAST STRUCTURE

In anatomical terms, breasts are modified glands that serve for milk production during breast-feeding. Both with women and men, breasts tissue is developed from the same structures, but considering women, the tissue develops more significantly under the influence of female sexual hormone oestrogen during puberty.

Each breast is covered with skin and each has one nipple surrounded by areola. Under the skin, a group of milk glands surrounded by adipose tissue extracts milk produced during the lactation period through the milk ducts towards the nipple. Other constituents of breast tissue are connective tissue and Cooper’s ligaments which help with the maintenance of structural integrity and breast shape, while connecting skin with subcutaneous tissue. Under the breast, there is a connective membrane which surrounds pectoralis muscle.

Size and colour of the nipple, areole and breast size significantly differ from woman to woman and are under the influence of genes, age and pregnancy.
Milk gland can be prone to different pathologies, including benign lesions like fibroadenoma and cysts, inflammatory processes and malignant tumors due to which is important that women are instructed how to do breast self-examination and to go to periodic ultrasound and mammography controls, depending on their age and family history of breast diseases.

IMPLANTS

A large selection of implants is offeredon the market and in Polyclinic Arcadia brands of scientific maximum proven quality from surgical practice are being used.

Breast implants of the most recent generation usually consist of an envelope made of multilayer elastomer filled with high-strength cohesive silicone gel. This combination makes them safer and more resistant to breaking and penetration of silicone into the surrounding tissues, while at the same time they look more natural in appearance and consistency. Implants filled with physiological saline are less frequently used.

Different factors influence implant type:

Filling: an implant can be filled with sterile saline solution (physiological saline) or silicone gel.

Silicone gel usually gives more natural sense of touch and it is related to lower breakage of the envelope after the implantation. Silicone gel can have different levels of cohesion or thickness which changes dynamics of the implant.

Implants filled with physiological saline are used less frequently; they are of different consistency and they are harder to touch than the silicone ones and sometimes there are indications for using this type of implants.

Third type of implants is an expansive type with complex filling. In cases when skin envelope of the breast is too tight for placing the implant of a preferred size (as in the case of emphasized breast asymmetry or breast reconstruction after the previous surgery- mastectomy), an implant that already contains a certain amount high-strength cohesive silicone gel is being placed. Also, an additional container which can gradually expand by adding physiological saline after the procedure is placed too and it remains until breast symmetry and appropriate volume, which satisfy the woman, have been achieved.

Type of an envelope: it can be smooth or textured. Textured implants have very small micropores on the outer surface that which differ slightly depending on the brand name. Such implants, especially those with smaller micropores, show a lower rate of capsular contracture after the procedure (creating a firm tunica albuginea which impairs the appearance of the breasts).

Shape:implants cane be round or anatomical.

Round implants can be freely rotated in the pocket that is created during the surgery, without the change of a breast shape and sometimes they can give a more noticeable increase in volume, especially in the upper half of the breast. Round implants: Natrelle ® Round implants, Mentor ®

Anatomical implants, or so-called tear-drop implants, are larger in the lower part and usually give a more natural appearance to increased breast, giving the fullness to a lower half of the breast. Concerning their specific shape, implementation requires making surgical pocket adjusted to an implant shape in order to prevent rotation. Anatomical implants: Natrelle ® Anatomical implants, Mentor ®

Each manufactured implant arrives to the market with a special serial number and a certificate (an implant “passport”) which enables monitoring the patient over time, so that the patients who were submitted to breast augmentation should keep that card in case of necessity. One copy is always kept in our records in Polyclinic Arcadia.

Safety This topic has been discussed many times and some researches have been conducted in order to prove the long-term safety of breast implants. Previous researches have shown that there is not connection between the implants and breast cancer development or immune diseases.

Selection of implants: the final selection of implants shall be carried out according to anatomical measurements, your preferences and surgeon’s recommendations. Special cases of asymmetry and congenital conditions are thoroughly discussed with each patient. Different alternatives and recommendations are determined exclusively on an individual basis.

We are aware of the importance and sensitivity of breast augmentation surgery regarding our patients and we give our best to achieve the best possible results in any case.

PREPARATION FOR THE PROCEDURE

Depending on the patient’s age and previous health condition, in our polyclinic different tests can be done and that includes: hemogram (blood analysis), coagulation tests, metabolic and urine tests, electrocardiogram and if necessary breast ultrasound examination and internist inspection. In case of a young patient without clinical disease history, only minimal tests are performed.

Medication therapy which affects blood clotting, has to be corrected in agreement with the doctor. It is recommended to stop smoking 10 days before the surgery, so the tissue can heal better. If you take any medicines, or if you are allergic to some material or food, it is obligatory to inform the surgeon and medical staff about that immediately after your arrival to our polyclinic.

ADMISSION TO POLYCLINIC

Admission to Polyclinic Arcadia is appointed by phone in advance. Admission is possible earlier on the day of surgery, or the day before the surgery. After situating you into your room, your vital signs are checked, anamnestic data is taken and some tests and examinations are performed. Anatomical measurements for confirmation of breast implant selection are done too and if necessary, some possible additional questions are discussed.

ANAESTHESIA

Breast augmentation is usually performed under general anaesthesia, whereas regional anaesthesia is used only in some exceptional situations. You stay in the polyclinic until afternoon/evening hours or until next morning.

PROCEDURE

There are several surgical techniques for breast augmentation. Implants are inserted through an incision on the skin which can be placed in different areas like inframammary sulcus (skin wrinkles under the breast), around areola and not that often under the armpit. Implantation technique on each specific place has different pros and cons and the choice depends on surgeon’s recommendation, as well as patient’s characteristics, wishes and expectations, which all are discussed during consultations with a plastic surgeon.

Breast implants can be placed directly under the gland, then under tunica albuginea of pectoral muscle or under pectoral muscle itself. Selection also depends on surgeon’s recommendation, anatomical characteristics and patient’s desires. Sub-pectoral placement of the implants (they are placed under the pectoral muscle) usually gives more natural breast appearance, whereas sub-glandular placement of the implants (under the glandular tissue) usually shows bigger volume enlargement and fuller upper half of the breast and are usually indicated with breast that show certain level of ptosis (“drooping” breast with skin surplus). There is also a dual plane technique where the implant is placed only partially under the muscle, with a better projection of a lower half of the breast.

When you are prepared for the beginning of an operation, a mild sedative is given to you in your room, which serves a better and easier beginning of the procedure and after that you are taken to an operating room.

Operation usually takes between one and two hours. A selected implant is being implemented and then different tissue layers are being closed. The skin is stitched by an intradermal technique where the threads do not have to be removed and stitches are not visible.

IMMEDIATE POSTOPERATIVE PERIOD

At first tape bandage is placed on augmented breast and the next day it is replaced by a special elastic bra. After the procedure, we put you into a room where your recovery process begins. Postoperative pain is usually moderate and if is necessary adequate analgesics are given. You can start taking food a few hours later and during that time a close person can stay with you.

All the instructions regarding care are going to be included in your discharge summaryon your departure from the polyclinic. Light massage with circular motions while taking a shower is recommended at the very beginning. The purpose of the massage is to reduce the emergence and development of the solid capsule around the implants and it should be performed on a regular daily basis up to 6 months. It is necessary to wear elastic bra for 2 months after the surgery and to avoid wearing bras with metal wires during that period. Stitching threads are degradable so there is no need for removing stitches. First postoperative check is going to be in your closest dispensary, within 7 days after the surgery.

Your return to work will be possible several days after the surgery, although sports activities should be avoided during first 3 to 4 weeks after the surgery. After 6 weeks, you will return to your normal activities.

FINAL RESULT

Breast augmentation resultsare visible during first wound bending in our polyclinic, but it will take up to 6 weeks until breasts receive their final shape. In most cases, patients are immediately pleased with the result and they already feel satisfaction on their departure.