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BREST AUGMENTATION SURGERY
What is a silicone breast prosthesis (implant)?
Products containing silicone are used for different purposes in the cosmetics industry and in medicine. Breast prostheses, or implants, resemble balloons manufactured to resemble the shape of breasts. They come in round or anatomical shapes known as tear drops. One of these is selected on the basis of the status of the woman's breast. The back part is made from silicone; the surface of the implant is textured in order to match the tissues in the body. Various substances may be used to fill the implant. The breast implants in current use may be summarized as follows:
*A silicone outer surface, the back filled with a gel of silicone origin. These are manufactured for use in various sizes. Approval was granted by the Food and Drug Administration in the USA in November 2006.
*Silicone with a hollow back (saline solution-filled): these are filled with saline solution, popularly known as salt water, during surgery until the desired volume is achieved. Implants manufactured to be ready for use have also recently become available.
*PVP : In the same way, the back is filled with a chemical substance known as PVP (polyvinyl pyrrolidone povidon). This has a gel consistency and is ready for use. This has been reported to have been withdrawn from the market by the manufacturing company.
*Soybean Oil : The back of the ready to use silicone prosthesis is filled with soybean oil. New to the field. Little information is available regarding long-term outcomes.
What You Need to Know before Surgery
If the patient to be fitted with an implant is older than 40 mammography and if necessary the radiological tests known as ultrasound are performed. Every operation has general or its own particular risks. Complaints after surgery include pain and swelling in the breast region. Bleeding and infection associated with surgery are rare conditions. Some patients complain of increased or reduced nipple sensitivity or lack of sensation around the incision. These are generally temporary. It has been suggested that certain connective tissue diseases develop in reaction to the implant, a foreign object in the body, that it is harder to provide milk for the baby and that implants can lead to cancer. But none of these have been scientifically proved. Implant-associated problems can develop in breast augmentation since the size of the breast is increased by a foreign object in the body. There may be hardening and contraction associated with the growth of a membrane known as the capsule around the implant. While a thin membrane represents no problem, a medium-thickness membrane can cause a slight hardness in the breasts, prominent in the bottom of the breast. Very occasionally the body may reject this foreign object and a thick membrane (capsule) develops around the prosthesis, trying to enclose it or even expel it from the body entirely. If a thick membrane grows, this may result in hardness in the breasts and sometimes in asymmetry. In the event of mild and medium capsular contraction, external massage can be performed to overcome the capsule around the prosthesis, or additional surgery can be performed if required. When severe capsular contracture develops there is no alternative to removing the implant. Silicone implants have a very thin outer surface and are highly sensitive to impact from the outside. Normal and medium massage is not harmful. The patient can lie face-down two months after surgery. Sometimes the implant filling may leak. If a gel-filled implant has been used these leaking substances may cause lumps to form. The effects of soybean oil are as yet unclear. If a saline-filled implant has been used, the saline solution may leak out between the tissues, in which event it is rapidly absorbed without causing any harm. In fact there is nothing harmful about this substance that can be injected into the veins and is used for other treatment purposes. It is rare for an implant to rupture, though this can be caused by impact inside a motor vehicle involved in a traffic accident, falls and injuries by sharp objects. Subsequent mammography and surgical examinations in breasts with implants are not a problem. The implant shows up as an empty space in mammographs. Silicone breast implants do not increase the risk of breast cancer and are identical to normal breast tissue. If such a condition develops cancer surgery and other standard forms of treatment are administered to breasts with implants. Before deciding on breast augmentation, you should tell your doctor what it is that you are unhappy with and what you expect from surgery, and discuss the implant to be selected, the incision by which the implant will be inserted, type of anesthesia and the early and late-term outcomes of surgery.
The operation
Surgery is performed in an operating theater under hospital conditions and under general anesthesia. It lasts 1-2 hours. A 4-5 cm incision is made in order to insert the implant. Some of the sites for this are:
Beneath the fold of the breast (submammarian)
The lower part of the nipple (circumareolar)
The armpit (axillary).
It has recently become possible to enter endoscopically and install the implant through the naval. But this technique has not yet acquired wide acceptance. But wherever entry is made from, a scar will be left. These scars will be prominent at first and gradually become less visible. Depending on the structure of the patient's breast, the implant can be inserted wither behind the breast tissue or else behind the breast muscle (pectoral). Dual plan is a popular technique whereby the upper part of the implant is inserted under the muscle and the lower part beneath the breast. There are advantages and disadvantages to all procedures, and this detail should be properly considered prior to surgery.
After surgery
The period after surgery is generally comfortable. Pain is minimal. İf the implant has been installed behind the breast muscle, arm movement may be restricted for a few days. A bra or bandage is placed over the breast following surgery. Non-soluble sutures can be removed after 10-12 days. There is no need to remove soluble sutures. There may be swelling, lack of sensation in the nipple and a purplish discoloration in the early period. These disappear spontaneously within a short time. The patient can return to work in 3-4 days. The implant settles in place after three weeks and the breast regains normal functioning. The patient is advised to avoid strenuous sport (requiring her to run or jump up and down) for two months. Breast augmentation with implants generally gives could and permanent results, improves the individual's mental and psychosocial well-being and bestows a greater joy in living.
The most widely used implants today are silicone gel-filled, textured, round prostheses. Implant selection and implantation vary according to the patient, the condition of the breast and the preference of the surgeon.