Breast Augmentation (Breast Prosthesis-Breast Silicone)

Fastest, lasting method in breast augmentation

The contribution of voluminous and perfectly shaped breasts to a woman’s visual beauty is indisputable. A woman with small breasts may be distressed by the appearance of her breasts. In time this distress can be transformed into a feeling of inadequacy and deficiency. This physically incomplete feeling that people other than those who have the same complaint cannot fully perceive can only be banished when this complaint is eliminated and the person’s self-confidence increases. The best results in aesthetic surgery and patients who are delighted by the results are achieved with breast augmentation surgery.

Before puberty when only a nipple is present, girls’ breasts are the same size as male breasts. However, with the onset of hormonal activity at the beginning of adolescence, they start growing, some more some less until the age of 18-19 when the development is completed. Genetics influence breast size to a major degree. It is normal for a person whose mother has small breasts to likewise have small breasts.

Breasts are very much affected by hormones 

As a result of the milk glands included in the breast structure, they are highly influenced by many hormones. Milk glands are constantly changing throughout life as a result of the periodical increase or decrease of hormonal impact. While the shape of the breast is a semi-sphere in youth, hormonal changes (post-partum, post-menopausal), and weight loss, convexity in the upper half of the breast decreases and flattens while the lower half of the breast sags.

Breast augmentation is performed when breast growth is insufficient or hormonal changes (postpartum, after menopause) and reasons such as weight loss cause the convexity of the upper half of the breast to decrease and flatten due to reasons such as weight loss. If there is a serious sagging of the breast due to reduction of the breast volume, breast augmentation is carried out together with a mastopexy.

Optimal treatment for breast augmentation 

Various creams are available for breast augmentation. However, some of these creams have no effect, while others contain various hormones which can affect the glandular structure of the breast and cause changes in the breast or even cancer.

We also use autologous fat injections (the incumbent’s own tissue) to enlarge the breast. However, slightly built individuals do not have enough fat. Furthermore, breast augmentation with fat injection is not a single-session procedure, but requires a few sessions and it is difficult to obtain a very large breast.

Hyaluronic acid fillers can be used for breast augmentation. However, these types of fillers are not very popular because they provide a provisional augmentation for 1 year and the high cost of the volume of material used. Furthermore, Aquafilling (98% physiological sodium chloride, 2% Polyamide) filling injections, which provide long-term volume, are also applied. However, it is important to know that in this type of breast augmentation serious problems due to the filler may be encountered.

Currently Silicone Breast Prosthesis is still the only method for breast augmentation that is fast, permanent, safe and logical.

Initially a patient who applies for breast enlargement must be examined to determine whether she is a suitable candidate for breast prosthesis. If the patient is suitable for this procedure, it is necessary to talk in detail about what incision is to be used during the operation, where the prosthesis will be placed as well as its type and size.

What is a breast prosthesis ? 

Breast prostheses have a hard sheath on the outside while the inner cavity contains a filler. The outer hard cover can be silicone or polyurethane. The inner cavity may contain colloid silicone gel or saline. Silicone is an inert substance. Therefore, it does not interact with the body. Body tissues form a structure called a capsule around the hard silicone sheath, limiting it to a certain area. No capsule formation is formed around polyurethane sheaths.

The outer sheath of a breast prosthesis is smooth or rough; the filler is colloid gel silicone or isotonic serum (salt water); its shape can be round, anatomical (drop) or asymmetrical anatomical. Round shaped silicone prostheses are disc shaped. What we mean by disc shaped is a sphere, the ends of which have been gently pressed. The anatomical (drop) shaped silicone prosthesis is not as symmetrical in terms of shape, but more pear-shaped. Similar to a pear its lower part is more prominent while upper part is narrower.

In the past, there was a belief that silicone-filled breast prostheses caused cancer. In fact, the FDA stopped the use of silicone-filled breast prostheses because of these rumors in the 1990s, allowing only the use of isotonic-filled breast prosthesis. However, it has been clearly manifested that this is not true after many years of research monitoring many patients. Colloid gel-filled silicone breast prostheses were re-approved by FDA in 2006

Incision and prosthetic localization in breast augmentation surgery

A breast prosthesis can be inserted through an incision made at the edge of the areola, under the armpit or an incision made in the inframammary line. The length of the incision is determined according to the volume of the planned prosthesis, the structure of the outer sheath of the prosthesis and the nature of the cohesive gel filling. The placement of a prosthesis with a polyurethane structure or one larger than 350 cc requires an incision of at least 4 cm while a 2.5 incision is sufficient for the placement of an isotonic filled prosthesis.

Depending on the structure of the chest wall and existing breast volume a breast prosthesis can be placed under the mammary gland or under the pectoral (chest) muscle under the mammary gland. An application name the Dual Plan in which a cavity is opened simultaneously below the mammary gland and under the muscle and a breast prosthesis is inserted in a different plan above and below has become very popular in recent years.

The base diameter of the mammary gland should be consistent with the base diameter of the planned breast prosthesis. When placing a prosthesis under the mammary gland, it should be ensured that there is a sufficient amount of mammary gland tissue. Otherwise, since there will be no breast tissue covering a part of the implanted prosthesis, the edges of the prosthesis will immediately be noticeable under the skin, which creates an unpleasant appearance. If the mammary gland is not enough, placing the prosthesis under the muscle will give a better result. Muscle tissue can be included between the breast prosthesis and skin to compensate for inadequate breast tissue. In such cases, a composite breast augmentation can be performed by applying fat injections to the inner and upper-outer sides of the breast with fat extracted from the person’s body.

Silicone prostheses used in silicone prosthesis applications are available in any volume from 100 cc to 800 cc and increase by 25-30 cc. The size of the prosthesis which will be suitable for the patient in breast augmentation is always raised by the patient. It is a good way for the patient and the plastic surgeon to decide jointly by placing a prosthesis under the bra in the preoperative aesthetic surgery examination. However, the result may not always be the desired one because this method does not manifest the actual prosthesis application and can therefore be misleading. When deciding on the size of a breast prosthesis for breast augmentation, the patient’s request is taken into consideration. However, the physician decides the most appropriate size according to the patient’s chest diameter and original breast size and shape. The patient may request a very large breast prosthesis. However, placement of breast prostheses larger than 450 cc for breast augmentation increases the likelihood of capsular contracture, and increases problems such as sagging and excess widening of the areola. Once these conditions have been explained, the choice should be left to the patient.

 

After breast augmentation surgery 

If the breast prosthesis is placed under the mammary gland, the patient feels very little pain after the operation, if placed under the muscle, the patient will feel more pain for the first 3-4 days especially when raising their arms. The pain rapidly decreases after the first week. If the breast prosthesis is placed under the mammary gland in breast augmentation, the patient can return to her daily life in 1-2 days and go back to work in 3-4 days. If the breast prosthesis is placed under the muscle, the patient can return to daily life in 4-5 days and go back to work  after 7 days. If the sutures are under the skin, they do not have to be removed. Patients fitted with breast prosthesis under the breast tissue can start sports after 1 month. Patients with breast prosthesis placed under the muscles can start sports after 1.5-2 months.

Complications 

As with all surgeries, there is the possibility of infection and hematoma (accumulation of blood due to bleeding) as a short-term complication (unwanted condition) in breast prosthesis surgeries. Infection is one of the most unpleasant incidents in breast prosthesis surgeries. Even if antibiotic treatment is applied, the removal of breast prostheses may become necessary. If a hematoma is observed, it may be necessary to open the sutures and stop active bleeding.

Capsule contracture is the most important undesirable condition that can be observed in the long term in breast prosthesis surgeries. Capsule contracture is observed at the rate of approximately 5-8% and the cause is unclear. A thin barrier (capsule) is formed by body tissues to limit the hard silicone sheath around the breast prosthesis. This thin capsule usually does not create a problem. However, sometimes this capsule thickens and contracts. The capsule, which has been soft so far, wraps the breast prosthesis like an armor and starts to harden and tighten. In such cases, the breast is massaged and the capsule is loosened and softened. The capsule contracture remains as it is or may progress to cause the breast prosthesis to be removed. Over time, this capsule contraction can progress too far, causing the breast to lose form and the patient to feel pain. In this case, the breast prosthesis is removed and the capsule is either removed or radially cut and loosened, and replaced with a smaller prosthesis to reshape the deteriorated breast and eliminate the pain. Since polyurethane breast prostheses form a very thin capsule or do not form one at all, capsule contracture is not encountered either.

 

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