A great number of women every year submit to some breast operation, to their enlargement by silicone implants, correction of asymmetry, breast reduction or reconstructive operation after mastectomy.
Every one of them wishes a more proportionate body figure, in order to feel better and more confident.
An individual approach to each patient and listening to their wishes by the surgeon leads to the common objective, a choice of the best operation for achieving a desired result.
Objective
Breast volume enlargement and shape improvement, with the help of silicone gel implants.
Operative technique
Most frequently used approach is the one under the breast, where the incision is placed in the length of 4 cm, so that it is hidden in the skin fold and completely invisible. Depending on the implant, a space is formed above or under the breast muscle, where the prosthesis will be placed, leaving the mammary gland fully intact. The operative approach can also be through nipples or from the armpit. The latter is used in persons that have almost totally underdeveloped breasts in whom any other incision would be visible.
Duration of procedure and anaesthesia
The procedure lasts from 1 to 1,5 hours and is performed in total anaesthesia.
Recovery
Return to normal activities after several days. The sutures are removed after two weeks. Wearing of bra is recommended.
Rare complications
Transitory nipple sensitivity disorder, mild swelling and sense of tension that withdraw within 1-2 weeks.
Objective
Reduction, lifting and re-shaping of large and sagging breasts.
Operative technique
Depending on the size and shape, there are many operative techniques.
The following are the most frequent: an inverted T technique that implies a circular scar around the nipple, one vertical and one horizontal scar, the latter in the fold under the breast; a vertical technique with a circular scar around the nipple and only a vertical scar from the nipple downwards, which in the first two months has small creases around it that vanish in time; periareolar technique leaving only a circular scar around the nipple that in the beginning also has creases around it, which gradually vanish under the pressure of the gland from the inside. This technique is not suitable for very large breast.
Duration of procedure and anaesthesia
The procedure lasts from 2.5 to 3.5 hours and is performed in total anaesthesia.
Recovery
Return to normal activities after 5-7 days. The sutures are removed after two weeks. Wearing of bra is recommended.
Rare complications
Transitory nipple sensitivity disorder, mild swelling that withdraws within 1-2 weeks, possible appearance of small cysts in the glandular tissue. There is no guarantee that the breastfeeding function will remain preserved.
Objective
Correction of the difference in size and position of the breasts for achieving symmetry.
Operative technique
Depending on the degree of difference between the breasts, as well as on the type of deformity, there are several operative techniques. If the difference is not extreme, the symmetry is achieved by inserting implants of various sizes by means of the same operative technique as in breast enlargement operation. In case of major unevenness, as well as when one breast is more loose comparing to the other, it is necessary, besides inserting the implants in the smaller breast, to perform a lifting of the looser breast as well. A special case of asymmetry is represented by Poland syndrome, characterised by a unilateral absence or underdevelopment of the pectoral muscle, absence of glandular tissue and smaller nipple, as well as changes on the fingers. The cause of this syndrome is still unknown, as well as the reason for its more frequent occurrence on the right side. It is corrected very successfully with the implant that corresponds to the size of the other breast, but often after the previous expanding the skin with the so-called tissue expander, as the existing space cannot receive a big enough implant.
Duration of procedure and anaesthesia
The procedure lasts some 2 hours and is performed in total anaesthesia.
Recovery
The patient remains at the hospital 24 hours after the surgery, and a gradual return to normal activities is recommended. The sutures are removed after two weeks, and wearing of bra is mandatory. In case of placing the expander in Poland syndrome, its gradual filling is performed over several months, and then it is replaced with the permanent silicone prosthesis.
Rare complications
Swelling, sense of tension, transitory nipple sensitivity disorder, incomplete symmetry.
Objective
Reconstruction or compensation of the non-existing breast tissue after amputation or in the congenitally underdeveloped breast
Operative technique
The amputated breast can be reconstructed in to ways, by means of silicone implant or with the own tissue. The application of implants is easier and simpler way, but as lack in skin is almost always present, first it has to be expanded with the expansion in the first act, by application of the so-called tissue expander, or Becker’s prosthesis – expander is first inserted, which remains permanently. In the next several weeks, the patient comes every 5 – 7 days when small amounts of physiological solution are inserted through a special spot on the skin, so that the implant gets gradually filled in up to the desired volume. The application of the own tissue from the abdomen or the back is also very much present in the breast reconstruction. However, the modern treatment of malignant diseases today also implies a primary reconstruction when the patient gets a compensation of the lost breast right after the amputation. Several months after the surgery, a possible additional correction may be performed, in terms of increasing the symmetry with the other breast (reduction and lifting of the other breast).
Duration of procedure and anaesthesia
Both operative techniques are performed in total anaesthesia, the first lasts around 1 – 1.5 hour, and the second much longer.
Recovery
Very short in inserting the prosthesis – expander, except that one should come several weeks for gradual volume increase. In reconstruction with the own tissue, or skin-muscle lobes, the recovery lasts much longer, as it is a large operative intervention.
Rare complications
Swelling, appearance of seroma which is drained longer, mild breast asymmetry, and in the reconstruction with the abdominal tissue, also a rare occurrence of abdominal hernia
Objective
Reduction of male breasts due to enlarged glandular or fat tissue.
Operative technique
The mammary gland is removed through a small incision around the nipple. In obese persons, the aspiration of the fat tissue that impregnates the mammary gland is often indicated, with or without the gland removal.
Duration of procedure and anaesthesia
The surgery is performed in total anaesthesia and lasts around 1 hour.
Recovery
The drains are removed after 24 hours, and the sutures after two weeks. A compressive elastic bandage is worn for several days.
Rare complications
Swelling, blood suffusions and prolonged creation of seroma.
