Mammoplasty contains:

– Breast augmentation
– Breast diminution
– Breast lifts

Breast augmentation

The operation is aimed to enlarge the breast size by means of implants. It is pursued the obtainment of a size of breast that is proportional with the body size, with the height and weight of the person. The mammary gland implants exist in a big variety of shapes and size and consist in a silicon sheath that can contain silicone gel, physiological saline, hydrogel.

Mammary implants

The mammary implants are used in the aesthetic surgery and plastic surgery of breast reconstruction of over 30 years, the experience acquired both from surgical and technologic point of view contributing to some spectacular successes. Apart from the surgical treatment there is not other medical method for evidently enlargement of the breast size. The augmentation mammoplasty became one of the most frequent surgical intervention utilized in aesthetic surgery.

This operation has a major psychological impact, helping many women to gain a better image about them, increasing the self confidence.
Preoperatively they are taken into account the size and shape of the trunk, the size of the breast, its projection against the thorax, as well as the position and size of mammary areola in order to understand as correctly as possible the existing problems with a view to their solving.

If the reduced size is also accompanied by breast fall, in a degree that cannot be corrected only by means of mammary gland implants, the skin excess can be removed through association of an operation of ascending mammoplasty. This intervention does not afflict lactation in the case of a pregnancy, because the implant will be positioned under the pectoral muscle by an incision of 4 cm at the level of the mammary groove.

This localization is preferred because the accessibility in the retrogland area is direct, there are not interferences with the gland tissue and the scar is very slight visible, unlike the periareolar approach that sections a part of the galactophorous channels, increasing the risk of bacterial contamination of the implant and the capsular contraction. The surgery does not modify the breast function, but however a modification of the sensitivity of areola can exist and this returns to normal in some months.

The breast augmentation neither increases nor decreases the risk of subsequent development of a mammary cancer. In the world have been carried out millions of breast augmentations and there is no study to demonstrate the connection between the treatment of breast augmentation by means of implants and the occurrence of mammary cancer.

The surgery

It should be remembered that both implants with physiological saline and those with silicone have the same type of cover, made up by silicone, thus the contact surface with the human body is identical. As advantage, the implants with physiological saline can be applied only by an incision of only 2-3 cm long, but they also present some drawbacks: the sensation to palpation is less pleasant and in some cases loss of the physiological saline can occur at the level of valve. This reduction in volume can appear some months after the surgery and is slow in time. As well, the loss of liquid has no connection with the possible palpation or the more aggressive massage of the breast.
When you decide for this kind of operation you have to consider some factors:

– the compatibility in time of the implant material in your body;
– a good result of mammography;
– absence of any infection focus, acutely or chronic, irrespective of localization.

The surgery is carried out under general anesthesia and takes about 2 hours to complete. The wound will be sutured with stitches placed inside and the skin will profit by the application of some adhesive tapes that favor the obtainment of some fine scars, slightly visible..
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Sometimes it is required the placement of some drain tubes, brought outside on the lateral aspect of the trunk that will be removed the next day after the operation. After surgery a sterile protective dressing will be applied but this one can be removed and the patient can have shower 48 hours after the operation. Post-operative, a discomfort sensation and even pain can occur that disappear after administration of some pain-killers. The movement of the arms can be confined and the usual activity can be resumed after 7-10 days.

The intense physical efforts and weight lifting are strictly forbidden for 3 weeks and the resumption of the intense physical activity can be performed gradually, in 6 weeks. It is recommended the wearing of a special bra made up especially for this kind of surgery. It is forbidden the treatment with aspirin or medicines that contain it 3 weeks before and three weeks after the surgery. In the same period it is not recommended the utilization of contraceptive pills.
It is not recommended the sun exposure or solarium for 8 months after the operation.

Risks of the surgery:

Apart from the general complications, common for every surgical intervention (allergic reactions, haemorrhagia, hematoma, infection, soft tissue necrosis) can also occur complications which are specific for this kind of operations. It should be emphasized that these complications are possible but little probable.

The preoperative analyses carried out in the day of the operation, as well as the detailed anesthetic-surgical consultation, to which is added the honestity of the patient as concerns the correct narration of the history and of the actual possible health problems are elements that contribute to the significant decrease of these risks, but cannot revoke them.

As likely complications, the specialty literature mentions:
– Bleeding controlled through careful haemostasis and/or drain tubes.
– Infection can occur only in a few cases, requiring the temporary removal of the implant and the cleaning of the area. Some months after the curing of the septic process, a new implant must be introduced, as the extracted one cannot be used any more.
– Capsular contraction represents the most common problem connected with any kind of implant. This phenomenon consists in the development round the implant of a layer of fibro-conjunctive tissue of reaction as a natural response of the body to the introduction of a foreign material inside it.

– The shape and the symmetry of the breasts: the enlargement of the breasts size does not correct in the same time their asymmetry (the implants usually assume the shape of the breast).

– Pain and a degree of discomfort can appear immediately after the operation, but they decrease at the same time with healing in the first 3 weeks.

– Breakage or rupture of the implant is less likely when modern implants are used.

– Sometimes modifications of the nipple sensitivity can occur, but this one usually returns to normal in a few weeks. Occasionally, the sensitivity modifications can be permanent or the nipple area can become hypersensitive. Moreover, the sensitivity in the distal areas of the breast can deteriorate until the restoration of the sensitive nerves. Some patients describe even a sensation of electrical shock. All these modifications disappear in length of time. Implant rejection is extremely rare

Breast repositioning (mastopexy)

Before deciding in favor of the operation performing, think carefully at all your expectations and we’ll discuss them together on the occasion of preoperative consultation. Many women make the option for ascending mammoplasty because the pregnancy and nursing left an excess of skin and a less volume of their breast. If you think to have other children it is well to postpone the operation. There are no special risks that can afflict the future pregnancies (mastopexy does not interfere with nursing), but a subsequent pregnancy can affect again the texture of your breast and the results of mastopexy will be cancelled.

Planning of the operation

It is important to discuss your expectations with the surgeon on the occasion of the first consultation and to taken into account his opinion. Every patient and every surgeon has an own opinion as concerns the desired size and shape of the breasts. We’ll examine and measure your breasts, we’ll discuss the problems that could afflict the procedure such as your age, the size and shape of your breasts, the skin texture – and if it is useful or not, the application within the same session of an implant. We’ll discuss where will be positioned the mammary areola and the nipples. These ones will be moved upwards during the surgery and will be positioned as equal as possible depending on the line between the breasts.

Preparation for the surgery

It assumes besides usual analyses the performing of a mammography and mammary echography. It is recommended alike for other operations that at least 2 weeks before, to stop the treatments with aspirin, contraceptives and to reduce or stop smoking. The operation is carried out under general anesthesia and requires hospitalization for 1-2 days.

Operation

Breast lifts takes between 1 hour and a half to three hours. They are described many techniques, but the most often used supposes an incision anchor-like that follows the natural shape of the breasts. The incision defines the area where the breasts skin will be removed and the new location of the nipple. After the removal of the excessive skin, the nipple and the mammary areola are lifted in the new position. The skin surrounding the areola is brought and cut until it is reached the desired shape; if mammary ptosis is associated with hypertrophy, apart from skin excess, it will also be removed the gland tissue in excess. The sutures are usually placed around the areola, following a vertical line that runs from the nipple area and ends with the lower fold of the breast.

The wounds will be sutured with stitches located inside; outside the skin will be fixed with adhesive tapes that favor the obtainment of fine scars, less visible. The patient mustn’t come back for the removal of stitches! Sometimes it can be required the placement of drain tubes, brought outside on the lateral aspect of the trunk. These ones will be removed 24 hours after the surgery.

After operation you will wear dressing and bra: the breasts will swollen postoperatively for 1-2 days producing a bearable discomfort that can be removed through adequate medication. 2 days after surgery you can have shower normally, the wounds being closed!

The bra especially made for this intervention should be worn permanently for 4 – 6 weeks. Postoperatively a slight desensitizing of the nipples and skin breasts can occur that alleviates and disappears in about 6 weeks. It is unwished, but an asymmetry of the breasts can be possible. However, taking into account that either in normal situations the two breasts are not identical, the obtainment of a perfect post-operative symmetry represents an unrealistic wish.

Rarely the scars that result are large, being required a subsequent operation revision. It is not recommended the exposure to the sun or solarium for 8 months after the operation.

Returning to everyday’s life

24 hours after the operation you can move for your own necessities and you can restore the activities progressively in 8 – 10 days. The resumption of the physical activity and of the efforts should be done gradually, within a period of 6 weeks.

Don’t forget that a reduction mammoplasty won’t keep your breast firm forever – the effects of the gravitation, pregnancy (in case you eventually get pregnant), nursing, ageing, weight fluctuations will put again their fingerprint on them. The women having implants in association with breasts repositioning state that the results are of a longer duration.

Mammoplasty is one of the most requested aesthetic operation with immediate good results and with beneficial effect on the patient’s psychic.

Reduction mammoplasty

Reduction mammoplasty is a surgical intervention conceived to solve several problems associated with excessively big and plunging (hanging) breasts. The big breasts can occur because of the excessive development of the gland tissue or of fat normally found in the breasts. The increase in size and the weight of breasts determine the stretching and relaxing of ligaments that sustain the mammary gland, causing the falling of the breast (mammary gland ptosis) and the loss of feminine shapes.

This condition reflects negatively over the woman’s psychic in the same way that the little breast determines uneasiness and dissatisfaction feelings. There are also physical problems associated with the big-sized breasts – discomfort, pains in the spine, neck, shoulders and back that become prevalent. The participation at a normal social life is confined, the patients with mammary hypertrophy avoiding to dance, the aerobic gymnastics or different other activities that produce the swinging of the body and the disgraceful movement of the breasts.

If this condition is not removed until maturity it can affect the posture (muscular compensatory contracture determines distortions of the spine). As well, the big-sized breasts do not allow the normal aeration of inframammary groove and the maceration of the skin can occur, accompanied by bacterial and fungal secondary infections). Other problems, minor but however present are the need of special linen for sustention (extra large bra) and difficulties in finding adequate clothes.

The treatment of this condition is not new and is practiced of over 50 years. The goal of this operation is to reduce the volume and weight of the breasts and to settle them in a normal position. That involves removing of mammary tissue and reestablishing of the normal contour, by keeping the proportions with the rest of the body. It is also required the repositioning of the complex areola nipple in accordance with the new shape of the breast.

Preoperatively, besides the ordinary analyses it is required a mammography in order to know the possible problems present in the hypertrophic gland tissue and to adapt the therapeutic plan accordingly.

Being a large operation (practically the most difficult intervention of aesthetic surgery) it is recommended that you are in as good as possible health condition, to do not catch cold, to be not in the period or in convalescence after other condition. Any treatment with aspirin or contraceptives should be stopped 2 – 3 weeks before surgery. You have also to stop smoking 2 – 3 weeks before and 1 week after the surgery. In the day of the operation you should not eat or drink anything.
The operation is carried out under general anesthesia and takes 2 – 3 hours to complete.

The scar will have an anchor shape, descending from the mammary areola in vertical direction to the inframammary groove where is localized a horizontal incision, with an arm to the breast bone region and the other one to the lateral region of the breast. Anyway there will be scars and even if they are hidden in the natural contour lines, the majority will improve spontaneously in a 6 months period. The position of these scars and other questions you want to get answers to will be largely discussed during the consultation.

In order to prevent the blood accumulation in the operated area and the occurrence of some complications in connection with these ones, you will have a drain tube on each side of the body, for a day or two. When through these tubes doesn’t flow anything they can be removed and you can go home. The sutures are performed with dissolvable stitches of the best quality, so that the scar can be as small as possible. On the skin surface is applied an adhesive spray and a special dressing that allow the optimal healing. It is recommended a control a month later and six months afterwards.

It is required to remain a night or two within the Clinic. Postoperatively you will receive a medication consisting of antibiotics, vitamins and pain-killers administered intravenously, with the progressive resuming of the normal nourishment in the first 24 hours. The antibiotic treatment shall be continued by oral route for 5 days. If it is established an anaemia condition, you will also get an iron supplement by oral route.

The post-operative pain is moderately and can be controlled with pain-killers administered each time they are required. After the operation a protective dressing will be applied and it will be changed daily for 7 days. In order to prevent the occurrence of a postoperative discomfort and to assure the optimal conditions for a cicatrization as aesthetic as possible, it is recommended to avoid for 6 weeks the difficult physical activities and to wear permanently the bra.

It is not recommended the exposure to the sun or solarium in the first 3 months after the surgery. It is required almost 1 year for scars maturation in order to the breasts reach the definitive shape.

Complications

Apart from the general complications, common for every surgical operation (allergic reactions, haemorrhagia, hematoma, infection, soft tissues necrosis) some complications specific for this kind of operations can occur.

After this operation, the possibility of nursing can be sometimes afflicted. If you intend to get pregnant again, postpone the surgical intervention because a new pregnancy will modify again the shape and the size of breasts and a part of its aesthetic result is lost.

It is recommended that the mammary reduction be performed only 6 months after nursing interruption, because after this interval the breasts have returned to a neutral condition from functional point of view.

The sensitivity of the areola can be partly or completely lost depending on the technique that has been performed. Sometimes a sensation of numbness can occur in the scars areas. It is unwished, but a lack of symmetry of the breasts can be possible after the surgery. However, taking into account that either in normal situations the two breasts are not identical, the obtainment of a perfect post-operative symmetry is an unrealistic wish.

Rarely the scars that result are large, being required a subsequent operation revision. The results of this operation are extremely good and full of satisfactions for the patient.