Breast augmentation surgery is an improving operation performed on women with small breasts. It is also corrects symmetry problem of the breasts and performed under general anesthesia. An incision is made to the breasts and artificial implants are placed. The Breast augmentation implants made of silicone shells contain salt water (saline) or gel. There are different breast augmentation methods depending on where the incision is made. The most common method is implant placement performed with an incision to the lower part of the breast, natural skin fold. Postoperative recovery process may take several weeks. It is crucial to follow doctor’s instructions during this period.
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What is breast augmentation?
Breast augmentation, is one of the mammoplasty surgical methods aiming to reshape the appearance of the breasts. This is applied in order to increase the size of the breasts, improve their appearance and corrects the symmetry of the breasts. This surgical method is also known as augmentation mammoplasty. Artificial silicone implants are placed on the back of breasts. The success of the surgery depends on the choice of surgeon and hospital. (1)
This surgery is performed on women who have breast development completed, are older than 18, have good physical and psychological health. Moreover, it is important that the patient has realistic expectations. (2) The breast augmentation is performed with the aim of improving existing situation. The breast augmentation cannot be performed on pregnant and breastfeeding women.
The breast augmentation procedure involves placing an artificial implant on breast area. (3) Four different methods are applied depending on the anatomy, breast size of the patient, and implant type:
An incision is made to the lower part of the breast, natural skin fold, and the implant is placed through this hole. This is the most common method performed.
The implant can be placed through an incision under the arm. This surgery is performed with endoscope.
An incision is made to the edge of areola (black-brown ring surrounding the nipple) and the implant is placed through it.
Saline (salt water) implants are generally placed through an incision made close to belly button. The endoscope is used in order to move under the breast. When placed in correctly, the implant is filled with salt water.
Implants used in breast augmentation
Saline (salt water) implant: These are elastomer (an elastic substance like synthetic rubber) silicone shells which can be filled with different amount of sterile salt solution. This affects the tightness and shape of the breast. If the solution leaks, this can be naturally absorbed by the body and removed. Furthermore, the size of many saline implants can be increased or reduced after the surgery without requiring a new surgery. The surgeon uses only syringes to put in more saline or remove it
Alternative composite implant: These are silicone shells which can be filled with polypropylene fiber, soybean oil or other material. (4)
Silicone gel-filled implant: These are made of silicone outer shells filled with silicone gel. If it leaks, the leakage remains in the gel shell or escapes into the breast implant pocket and implant either deflates or not depending on situation. This practice requires regular check-up and MRI or ultrasound scan is taken due to the risk. These implants placed under the breast muscle or the breast tissue can be flat or textured, round or tear drop-shaped. The average lifespan is 7-12 years for these implants.
Women prefer silicone gel-filled implants most commonly, as they are more similar to the actual breast tissue. Major features are as follows:
Silicone gel is a thick and sticky liquid which best mimics natural fat and tissues in the breasts.
Silicone implants previously filled according to the targeted breast size are placed in the breasts through an incision.
The incision made is larger; therefore, it is more distinct even though the scar may fade over time, but especially the scars of the incisions made under the arm or breast remain hidden.
The size of previously filled standard silicone gel implants cannot be changed as in the saline implants.
This implant is performed in women at the age of 22 and older.
If the implant ruptures for various reasons, it may not be noticed by either the patient or doctor with naked eye. This is called a silent rupture. Leaking silicone remains in the body and sometimes spreads outside the breast and to distant lymph nodes. Due to the risk, imaging tests such as MRI are required as often as recommended by the doctor.
As the leaking silicone gel is considered to lead to health issues such as breast cancer, reproduction problems, and rheumatoid arthritis, a ruptured implant detected through imaging tests should be immediately removed with surgical intervention. If a new implant is desired, it can be generally placed at the same time.
Even though a ruptured silicone implant cannot be easily noticed, it may cause mastalgia, breast thickening, and changes in the breast contour or shape over time. If you doubt that your silicone implant is ruptured, consult your doctor immediately.
The reliability of silicone breast implants was frequently discussed in the past as it was considered harmful to health. Today, it is concluded that if checkups are regularly made against the rupture risk, serious harm will not occur. However, there are ongoing discussions on its reliability and effectiveness.
What to consider before breast augmentation surgery?
When the patient decides to undergo the surgery, a written informed consent should be obtained on condition that she is well informed about all issues including possible risks and complications. (5)
After a routine examination, especially women over 40 years old should have a mammogram taken against the possible of breast cancer.
Pregnant women or patients planning to become pregnant should inform the surgeon.
Smoking and alcohol use should be quitted at least 6 weeks before the surgery to prevent complications.
The surgeon should be informed about over-the-counter drugs, supplements, and even herbs taken.
Blood thinners such as aspirin etc. should not be taken a few days before the surgery.
You may need to stay in the hospital overnight after the surgery, thus a companion should be arranged.
You should eat or drink nothing at the night before the surgery as anesthetics will be administered.
The patient may be asked to wear compression socks during the surgery to prevent deep venous thrombosis (sudden blockage of the veins in legs with a blood clot).
It is necessary to wear or bring loose, button-front or zipped clothes and baleen-free bra vest.
As recovery takes 1-2 weeks, especially those doing heavy work should take leave from work.
How is breast augmentation surgery performed?
While deciding on that the patient is suitable for the surgery, the breasts are measured and the surgery sites are marked considering the shapes of the breasts, the skin and the location of nipples. They can be photographed.
Tests can be performed, placing a bra to choose the implant size required by the patient.
General anesthesia and sometimes local anesthesia can be used. If local anesthesia is used, the patient will be awake, and the breast area is numbed to prevent pain.
To place the breast implant, the surgeon makes an incision to wrinkles under the arm or around the nipple and creates a pocket separating the breast tissue from the muscles and connective tissues.
The implant is placed into this pocket and centered behind the nipple. Saline implants are placed empty and then filled with sterile salt water. Silicone implants are previously filled with silicone gel.
If the breasts are sagging and cannot be supported with implants, breast lifting surgery can also be performed during the surgery.
When the implant is in place, the incision is stitched or closed with skin adhesive and surgical area is bandaged.
It may be necessary to stay in the hospital overnight as a tube will be inserted under the skin and excess blood or fluid will be drained.
The surgery generally takes 1-2 hours.
Drugs are prescribed for possibility of infection and pain.
If dissolvable suture is not used, sutures are taken after 1 week.
There may be pain, swelling and bruising in the surgery site for 15 days, but these symptoms will relieve over time. The size of the scar is decreased, but it will not vanish completely. (6)
Breast augmentation recovery timeline
What to consider after breast augmentation surgery?
You shouldn’t drive for 1 week.
You shouldn’t do forceful physical activities and carry heavy things for 6 weeks. In addition, remember that the breasts are sensitive to physical contact or shaking movements.
You should do exercises such as stretching and moving arms recommended by the doctor to relieve pain and discomfort.
It may be necessary to wear compression bandage or sports bra for 3 months without taking it off for the breast implants to be supported more and placed correctly.
Massage techniques recommended by the doctor should be applied 5 days after the surgery to prevent the hardening of the capsule surrounding the implant.
You should contact the surgery clinic immediately in case of infection symptoms such as burning, redness, unexpected swelling, chest pain, unusual heartbeats or shortness of breath.
While taking mammogram for cancer screening, the healthcare provider should be informed that there are implants in the breasts.
If the patient is not satisfied with the appearance of the breasts, further surgery may be required. Moreover, the appearance of the breasts may change over time due to aging, gaining or losing weight after the augmentation surgery.
It is possible to enlarge breasts naturally with exercise, massage, herbal mixtures and cosmetics.
Breast enlargement exercises
You can have rounded breasts by developing muscles in the upper and lower parts of the body with exercise. Some exercise examples done standing are as follows:
Hold your hands and arms straight, place on the wall and do push-ups movements, approaching the breasts to wall and pull them away.
While standing legs close and keeping palms facing upwards, open your arms to both sideways and back and then slowly approach your arms straight in front of the chest area, and open them again to both sides.
Keep your legs close, open your arms to both sideways, and move them by drawing small circles backwards and forwards respectively.
These movements should be regularly done, increasing gradually (for example, 3 times in the first week, and then 5 times). As strict diet will reduce daily calorie intake, the body may attack fat stocks in the breasts to meet its energy need. Therefore, a healthy diet should be followed along with exercises.
Breast enlargement with massage
If the massage is given correctly, it can help enlarge the breasts positively affecting the structure of the breast muscle and tissue. For example, you can give a massage from the inner part of breast to outer part with soft circular movements approximately 100 times. Then, you can approach the breasts to each other and move them away 30 to 40 times.
One of natural breast enlargement is herbal cures. There are many herbal cure recipes. One of the recipes said to be the most effective is hops cure. Preparation and application of hops cure:
Boil 5 to 6 gr hops and drink a glass of it when it is lukewarm.
This cure should be applied for 1 month to see its effects.
The mixture should be prepared daily and consumed fresh.
Hops are a medicinal herb that should be carefully consumed. To eliminate its adverse effects, a half avocado, raisin or walnuts should be consumed once in two days while applying the cure.
Breast enlargement creams
There are many breast enlargement creams and serums in pharmacies and cosmetic stores. How effective these are is a controversial topic. Especially some doctors argue that these creams containing phytoestrogen (herbal hormones) are harmful for health. (7)
Cost of breast augmentation surgery
Prices vary between 2.000 USD to 10.000 USD depending on the city where hospital is located, experience of the surgeon and the quality of the hospital. SSI and private health insurances do not cover costs of the surgery.
As in all surgeries, the breast augmentation surgery has the risk of developing allergic reaction to anesthetics, bleeding, pain, blood clot (deep venous thrombosis), infection and respiratory problems. (8) Possible complications are as follows:
Changes in the nipples or breast sensation
Feeling of hardness in the breast tissue
Irregular nipple position
Hematoma (collection of blood coming out of the veins under the uninjured skin)
Wrong or incorrect position of the implant
Implant leakage or rupture
Movement of the implant in breast losing its stability
Surge of the implant
Thick scar tissue formation around the implant (capsular contracture)
Fluid accumulation (seroma)
Wrinkling skin on the implant
Different size or shape of the breasts
Difficulty in breastfeeding
Development of a rare form of lymphoma
Possibility of revision surgery
If the breast augmentation surgery is performed by an experienced surgeon in a fully-fledged hospital, the possibility of risks above mentioned decreases.
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