BREAST AUGMENTATION SURGERY

Author: Dr. Francesca Palumbo

Breast augmentation surgery is a very popular type of surgery among young and older women alike. This surgery is generally requested by women with a great desire to change the shape of their breasts and especially the volume; in women who have completed a pregnancy, and in those who have just finished prolonged breastfeeding, the results of which are often sagging and less firm breasts. 

To solve such problems, it is enough to readjust the volume by means of a breast implant. In cases of marked relaxation of the skin, sometimes a firming procedure called mastopexy (breast lift) is also necessary to obtain an optimal result. Breast augmentation surgery for the improvement of one's body shape is often associated with another surgery known as additive mastopexy (breast lift).

Breast implants consist of a silicone or polyurethane casing, while the content may vary, even if only implants containing a cohesive silicone gel are now used.

Surgery and its complications

Surgery involves an incision in the skin that varies between about 3 and 5 cm in length and will be in the submammary groove or at the lower edge of the areola, leaving a small scar, or in some cases at the axillary level with or without endoscopy. Afterwards, the pocket where the implant will be located is prepared, either behind the mammary gland or behind the large pectoralis muscle, or by means of a dual plane technique that involves the positioning of the upper half of the implant under the muscle and the lower half under the gland depending on the indications and at the discretion of the surgeon. Breast augmentation surgery lasts about one hour and during the same operation vacuum drains will be placed in most cases, which will be removed after about three days and will conclude with a compression dressing by means of an elastic bandage which will be replaced after a few days by a special post-mastoplasty bra and an elastic compression band.

In the days following breast augmentation surgery, you must rest. Afterwards you can resume your normal routine, avoiding tiring activities, saunas, Turkish baths and exposure to the sun. Swelling, bruising and soreness may occur around the breast region. Three weeks after surgery you can gradually resume all normal activities including sports and driving.

Possible complications of the surgery include:

1. Haematomas
2. Infections
3. Seromas
4. Capsular contracture
5. Lymphadenopathy 
6. Hypertrophic scarring
7. Pain
8. Rotation of the prosthesis 
9. Loss of sensitivity in the nipple and breast area, which usually resolves over time

Breast augmentation surgery is indicated for women who wish:

• to make their breasts more proportioned and add volume
• to give back shape and volume to breasts that have lost their shape as a result of pregnancy and breastfeeding
• to correct breast asymmetry, i.e. to improve a difference in volume between the breasts

Choosing the right implants

The choice of implants is a very delicate and important phase that strongly influences the final result of the surgery. It is the plastic surgeon's task to choose a type of implant that is suitable for the physical shape of the patient and the characteristics of her tissues in order to obtain the most natural looking breasts possible.

The implants can have a round or anatomical "teardrop" shape. The former are more suitable for patients who want a moderate increase in volume or for women who, following one or more pregnancies, have "empty" breasts, while implants with an anatomical profile are suitable for women with very small breasts.

Breast implants can be smooth or textured. Textured breast implants can be a little more rigid to the touch, especially in the initial phase compared to smooth ones, but they are the most widely used because they create fewer post-operative problems, especially since they greatly reduce the onset of capsular contracture, particularly when placed under the muscle.

Breast augmentation can be performed alone or in combination with other surgical techniques such as mastopexy, as in the case of "empty" and sagging breasts, where there is a need to eliminate excess skin.

Pre- and post-operative care

Breast augmentation surgery is a fairly simple surgical procedure that generally gives very good results, which is very satisfying for both the patient and the surgeon. Thousands of breast augmentation surgeries are performed successfully every year all over the world. 

However, it is important not to underestimate the nature and risks of a surgical procedure and not to give in to the temptation to go to non-specialist doctors who offer services at relatively low prices in unauthorised facilities. This is still a serious surgery, where complications are rare but can occur. However, they can only be easily overcome if the procedure is performed by a specialist plastic surgeon in a duly authorised facility.

Breast augmentation is a very personalised procedure which, as such, requires a thorough specialist examination. During the first consultation, the surgeon will have to evaluate the shape and size of the breasts, areolas and nipples and explain the possible changes in shape and volume that the most modern surgical techniques have to offer in your case. The surgeon will also have to evaluate your state of health to rule out the presence of alterations of any kind that could affect the final results of the surgery. Before surgery, you will receive precise instructions on what to do before and after surgery, with regard to medication, alcohol and cigarettes, and any concomitant pathologies that may affect both your health and the outcome of the surgery. You will be prescribed blood tests, electrocardiogram, chest X-ray and breast ultrasound. At the end of the examination, the surgeon, in agreement with you, will choose the type of implants to be used for the breast augmentation, the most suitable access route and the correct positioning of the implants.

Breast augmentation can be performed in a day-hospital or with admission and one night's hospitalisation, in both cases either under general anaesthesia or under local anaesthetic with sedation. Sometimes it can also be performed under local anaesthetic with sedation. Before the operation the anaesthetist will perform a thorough pre-operative examination.

Breast augmentation surgery generally gives very good results and great satisfaction for the patient and the surgeon. The results obtained are long-lasting but cannot be said to be completely permanent because they are subject to the normal ageing processes of the body and the effects of gravity.

The cost of breast augmentation surgery is conditioned by several factors including the type of anaesthesia performed, the type of hospitalisation, the difficulty and the expected duration of the surgery.

The costs of breast augmentation surgery are also related to the type of breast implants chosen: there are various models, but what is really important and cannot be ignored when deciding to undergo breast augmentation surgery is the choice of safe breast implants. For this reason, it is essential to rely on a plastic surgeon who guarantees the best breast implants on the market for their patients.