Breast augmentation is a surgery that, through the increase in breast volume, enables us to appreciate the harmony of the whole body shape of women. Patients who experience a slightly sagging breasts, small or undeveloped can benefit from breast augmentation.
The prosthesis can be inserted under the mammary gland (prosthesis retroglandular), behind the pectoral muscle fascia (retrofascial prosthesis) or under the pectoral muscle (retropectoral prosthesis) and the gateway (areolar, axillary or submammary) may vary depending on several factors. Today it is one of the most popular plastic surgery in the world: the reasons for this growing demand are dictated by patients’ desire to increase the volume or change the shape of their breasts for cosmetic reasons, because of congenital malformations or later demolition surgery because of breast cancer.
Preoperative preparation
To make the breast enlargement surgery it is important that the patient is subjected to a thorough medical examination and standard pre-operatory examinations: electrocardiogram, chest X-ray and blood tests. To these tests should be added the breast ultrasound and possibly mammography. The patient must be healthy and in good condition. In order to reduce the risk of bleeding, impaired wound healing, or problems such as phlebitis and venous thrombosis, you should stop taking antiplatelet agents or thinners like aspirin, stop smoking (at least two weeks before the surgery ) and using hormonal-based contraceptives (one month prior to the surgery). The patient must promptly report the surgeon the appearance of any symptom of the disease which could make it recommendable to postpone the surgery (cold, sore throat, cough, skin arisen recently arisen diseases). The day of the surgery, the patient has to fast (from midnight of the previous day), without nail polish on the nails of feet and hands and bra elastic recommended by the surgeon for the post operative.
The surgery
Breast augmentation is a surgery that can be performed under local anesthesia with sedation or general anesthesia. The selection varies according to the wishes, the clinical condition of the patient and the surgical technique chosen. The duration can be between 50 minutes and 2 hours. The surgical access may be from the inframammary furrow, armpit or areola, and allows you to create the pocket which will accommodate the prosthesis in the retroglandular, retrofasciale or retromuscular plan. Currently the choice of the prosthetic implant silicone is very wide: there are round prosthesis and anatomic implants (or "drop") whose measurements may vary on three dimensions: width and height projection. A further variable is constituted by the cohesivity (compactness) of silicon which fills the prosthesis: this can be more or less compact resulting in greater or lesser softness of the implant. Each of these variables must be considered by the surgeon at the time of preoperative visit, in order to choose the prosthesis that best suits both the preoperative anatomy of the breasts and the wishes of the patient. Once implants are positioned, two drainage are inserted and will be removed after 24-48 hours depending on the clinical course. After that , the procedure verifies the symmetry of breasts, of prosthesis and nipples. In each of these phases the surgeon focuses not to jeopardize the integrity of the milk ducts in order to allow the patient any breastfeeding. The surgery ends with the suture of the access route, the dressing and bandage that will be of type elasto-compressive in order to contain the edema post-surgery.
Post-operative treatment
After the surgery the patient will follow the surgeon’s recommendations. After 24 hours, however, and depending on the clinical course, drains will be removed and dressing will be controlled. Subsequently, the patient will be checked again after 7 days. The patient will have to wear a sports bra without underwire and very restraining, night and day for 4 weeks. 15 days after the surgery a massage, that will improve the mobility and the naturalness of the breasts, may be implemented, subject to the surgeon’s recommendations The first month it is recommendable to reduce the activity of the pectoral muscles (not strain on your arms to rise from bed, do not lift heavy weights or sports activities, ...), it is recommended not to smoke, to avoid direct exposure to the sun or intense heat (eg. sauna, UVA) and not to sleep in the prone position (on your stomach).
Possible risks and complications
In breast augmentation surgey, like any surgery, complications may arise. They are still rare and, in case, can be solved through appropriate treatments without compromising the final result. Surgical generic complications, also rare, are hematoma, bleeding, the seroma, infection unsightly scars or pathological (keloids). There are also specific breast augmentation surgery complications. The breast asymmetry, in which breasts differ in form, in the height of the nipple or areola of the inframammary fold; the rippling, the formation of palpable or visible folds, due to the reduced thickness of the skin; the alteration of the sensitivity at the level of the nipple areolar complex, very often transient phenomenon; capsular contracture, due to the narrowing of the scar tissue that is formed physiologically within the first month around the breast implant. This event is not predictable and may occur in 4-5% (depending on the series) of the patients. Capsular contracture can occur in the immediate postoperative or after several years and causes an unnatural "fixity" of the breast. In case you have one or more postoperative complications medications it may be necessary a further reconstructive surgery with very satisfying results. In case of capsular contracture you may require further surgery in which the prosthesis will come replaced. There is no scientific evidence of the relationship between the presence of breast implants and the increased risk of developing breast cancer. Breast implants can sometimes interfere with mammography screening. Women with breast implants are frequently requested ultrasound examinations and it may be necessary in magnetic resonance imaging (MRI).
Insurance
The breast augmentation surgery can be performed in agreement with the NHS if it forms part of an activity of reconstructive surgery and aesthetic, that it is necessary to correct birth defects or after demolition interventions for breast cancer, the last event it is also accredited by the major insurance companies.
Results
The result of breast augmentation can be seen immediately after the surgery. Initially there will be a diffuse edema with a slight feeling of weight on the chest but within a few weeks the patient can fully appreciate the final shape of the breast. In order to have longer lasting in time results it is very important that the operated patient keep a balanced weight with no alterations if not they will be evident in her breast.