Breast enlargement

Breast augmentation surgery

(increasing mammoplasty, augmentation mammoplasty, endoprosthesis mammary glands)

When talking about plastic surgery, the first thing that comes to ordinary man’s mind is breast enlargement. This is not surprising, breast enlargement surgery takes the first place among the most popular plastic surgeries for many years. Reason for the popularity of breast enlargement surgery is obvious – beautiful breast is associated with femininity, attractiveness and sexuality.

History of breast enlargement surgeries

First breast enlargement surgeries were made in the late of 19th century. To enlarge breast, there was used liquid paraffin which was injected into the breast tissue with a syringe. Further, there were attempts to enlarge breast by the injection of caoutchouc. As well as, glass balls, wool and ox cartilages were installed in breast tissue. Such surgeries led to the occurrence of chronic inflammation, deformation and induration of breast and purulent fusion of tissues.

Injection methods of breast enlargement, by means of synthetic gels (liquid silicone, polyacrylamide gel, etc.) were widely used in the 1950-1960′s. Appearance of such synthetic gels and the results of their use inspire breast enlargement surgeons a great optimism in the first years. However, over time complications, such as granulomatous, fusion of tissues and migration of the gel made surgeons to refuse from the injections of free liquid fillers.

First breast implant, filled with liquid silicone was created by breast augmentation surgeons Thomas Cronin and Frank Gerow in 1961. This was a significant progress in the breast enlargement but implants were far from perfect at that time. Implant shell was thin and missed the molecules of liquid silicone that over the years accumulated in the surrounding tissues and caused aseptic inflammation.

In the early 1980s, there were many reports of the possible development of oncological diseases in patients, undergoing breast enlargement surgery, using silicone implants. Lengthy court proceedings, medical expertises did not confirm the danger of silicone implants but indisputable evidences of their safety also were not submitted. As a result, the silicone implants use for aesthetic breast enlargement was prohibited in the USA. Silicone implants were used only in reconstructive breast surgery. Numerous studies, carried out both in the U.S. and in Europe in subsequent years did not reveal any potential danger in the cancer development in women, enlarged breast by means of silicone implants. In 2006, silicone implants were recognized as safe and authorized for breast enlargement in the USA.

Since 1961, breast implants have been continuously improved. Now, breast enlargement surgeons in their practice use a fifth-generation implants. Distinctive feature of these implants is an exceptional strength of the shell, consisting of several layers. Each layer has its own function. Part of inner shell layers gives the strength to the implant, other part of shell provides a barrier function, eliminating the diffusion of silicone molecules and surface layer is specially prepared for the application of texture. Gel of fifth-generation, used in implants is a non-flowing, viscous gel, possessing shape memory.

Technical improvement of breast implants has led to a sharp reduction in the number of specific complication, such as capsular contracture up to 0,5-1%.

What is breast augmentation surgery?

Breast enlargement is a plastic surgery, aimed at the increase of breast volume and improvement of breast shape. Breast enlargement surgery can be indicated for patients with hypertrophy, as well as patients, who previously have undergone surgery due to a breast disease.

Indications for breast enlargement surgery:

Primary cell aplasia (absence) of mammary glands;
Primary hypoplasia (underdevelopment) of mammary glands;
Aesthetic dissatisfaction with shape and size of mammary glands when normally developed breast;
Post-lactational involution of mammary glands;
Breast reconstruction after total or partial removal.

Despite the diversity of the reasons, causing aesthetic dissatisfaction with breast, the main problem is reduced to the increase of the breast volume. Patients with congenital hypoplasia, i.e. small breast, genetically predetermined, the problem is solved by setting a suitable implant.

Owners of large high breast, usually after giving birth and breastfeeding face the following problems:

Reduction of breast volume (sometimes at 2-3 size).
Problem of “empty” breast when the shape and size of mammary glands is acceptable, but loss of skin elasticity.
Breast ptosis – in other words, the omission of mammary glands that leads to the displacement of the nipple-areola complex. Often patients call such breast the “spaniel ears”.
Deformation and stretching of areola.
Cicatricial changes of the mammary glands skin (striae).

In varying degrees, these problems occur in any woman after childbirth and breastfeeding. Usual breast enlargement, using implants is enough for some women, others have to do simultaneously breast lift and breast enlargement, as well as correction in shape and size of areolae. Regardless of mammary glands changes, the purpose of surgery is to restore aesthetic appeal of breast.

Purpose of breast enlargement surgery is an installation of special implants. Implant replaces the lost breast volume, gives the breast natural shape.

What is the best breast enlargement method?

There are 2 methods of breast enlargement surgery:

1. Under the mammary gland

In this case, implant is placed under the breast tissue. In this breast enlargement method, surgeon forms an implant pocket directly under the breast.

This breast enlargement method has the following advantages:

Technical simplicity of the surgery performance;
Location of implant under the mammary gland sometimes allows to correct the minor ptosis (omission of breasts);
Absence of significant pain in the postoperative period;
Rapid rehabilitation period.

This breast enlargement method has also certain disadvantages:

Location of implant directly under the mammary gland can lead to the contouring of implant in the postoperative period, i.e. during examination you can see the edge of implant. This is especially important for thin patients with a deficit of soft tissue on the breast. For some slender women, this breast enlargement method absolutely is not appropriate.
Weight of implant entirely lays on the breast tissue, in subsequent years this can lead to excessive stretching of tissues and sagging of breast.
More high risk of capsular contracture.

Thus, breast enlargement by implants installation under the mammary gland can be recommended for women with well-pronounced and elastic soft tissues of the breast. In this case, the probability of the contouring implant, as well as its displacement are minimal.

2. Under pectoralis major muscle

In this breast enlargement method, implant is placed under the pectoralis major muscle. Pectoralis major muscle is located just outside the mammary gland and lays on the chest wall. Implant pocket is formed between the muscle and chest wall. To do this, breast augmentation surgeon gently forms the implant pocket in the lower part of muscle.

This breast enlargement method has the following advantages:

Implant is covered by a large number of tissues that allows to perform breast enlargement without the danger of its contouring even in very thin patients with a deficit of soft breast tissues.
Low probability of contouring and visualization of the implant. Even in palpation, the implant is difficult to feel.
Implant is securely fixed by the pectoralis major muscle. Probability of displacement of implant is the minimum.

This breast enlargement method has also certain disadvantages:

Breast augmentation by implant installation under the pectoralis major muscle is technically more difficult surgery;
Pronounced pain in the postoperative period;
Prolonged recovery after breast augmentation surgery.

Some breast enlargement surgeons describe the third method of implant installation – under the fascia of the pectoralis major muscle. However, the fascia of the pectoralis major muscle is a thin film which is not any significant covering for implant. This is the location of implant under the mammary gland.

Surgical approaches in breast augmentation surgery:

1. Submammary approach

Incision is located in submammary fold, i.e. in the fold, which is formed immediately under the breast. This is the safest, most reliable and convenient way of breast augmentation for surgeons.

2. Periareolar approach

Incision is made along the edge of areola. This approach is technically more difficult, but it is believed that post breast augmentation surgery scars on the edge of areola are less noticeable. In addition, in such approach, there is the probability to damage the milk ducts that are fraught with complications during pregnancy and breast-feeding.

3. Underarm approach

Incision is located in the armpit. Underarm approach is the most complex and traumatic approach in the technical execution. In some cases, implant installation is not possible without special endoscopic equipment. Advantage of this approach are invisible breast augmentation surgery scars.

Breast augmentation surgery recovery time

In the early postoperative period, patients note pronounced painful sensations for 3-4 days, then pain decreases. It is desirable to take vacation for 2 weeks for a complete rehabilitation and restoration. Within a month, it is necessary to wear compression bra and not to raise the hands above shoulder level. Sutures are removed in 7-14 days. Physical activity should be restricted for 2-3 months. Breast will take its final shape 6-12 months after surgery.

Possible complications of breast enlargement surgery:

1. Bleeding (hematoma formation in the implant pocket);
2. Suppuration.

Capsular contracture is a specific complication in breast augmentation surgery.
Aim of this complication is reduced to the gradual formation of a dense capsule around the implant, which eventually greatly compresses the implant, leading to deformation and thickening of the breast.

Causes of capsular contracture are the following:

Hypersensitivity of patient to the foreign body;
Non-compliance of implants size and implant pocket (too large implant is installed which strongly presses on the surrounding tissues);
Rough work with tissues during breast enlargement surgery;
Hematoma of implant pocket.

Contraindications to breast augmentation surgery

Diseases of the cardiovascular system and their severe complications;
Acute and chronic diseases of respiratory system (chronic bronchitis, pneumonia, bronchial asthma with frequent exacerbations, etc.);
Diseases of other organs and systems during the exacerbation (pyelonephritis, gastritis, peptic ulcer and others.);
Oncological diseases;
Mental, neurological diseases;
Systemic connective tissue disorders (systemic lupus erythematosus, rheumatism, glomerulonephritis, etc.);
Severe forms of varicose disease (thrombosis, thrombophlebitis, trophic disorders);
Cold diseases (influenza, SARS) before the recovery.

Conclusion

Breast augmentation surgery, using implants is a reliable and safe way to correct the shape and volume of of mammary glands. Breast enlargement surgery gives a stable and predictable result and to date, it is the only way of effective aesthetic correction of the breast. Breast augmentation surgery can be recommended for aesthetic correction of breast shape, as well as for reconstructive surgery.