BREAST AUGMENTATION SURGERY

Today, breast augmentation is one of the most common aesthetic surgeries. Several methods have been described to increase breast volume. Among these, breast augmentation with prosthesis is the most commonly used method. Apart from this, there are Fat Injection (Stem cell and/or PRP supported) or filler injection methods. Although the necessary approval documents are obtained to increase the volume with the filling material, I do not recommend applying it because there are reports in the literature about side effects and it is very difficult to remove these substances from your breast tissue in case of a possible side effect. Discussions about increasing breast volume with fat injection have been going on for a long time. Current knowledge is that fat injections do not cause cancer, do not imitate the appearance of cancer and are safe. It is a method that can be applied to patients who do not accept having even a small scar on their body, who do not need too much volume and who accept a few sessions of surgery, whose fat reserves are suitable. Breast augmentation with prosthesis is performed by placing silicone implants of different shapes and contents under the breast tissue. Although the life of the prosthesis may differ from person to person, it is between 15 and 25 years unless there is a problem. It is recommended to remove it even if it is not desired to be replaced later. A meaningful relationship between prosthesis use and cancer development has not yet been established. Prosthesis is a reliable method because it can be easily removed from the body in case of a problem.

REASONS TO DO
This procedure is typically done to enlarge small, undeveloped breasts or breasts that have lost their volume after pregnancy/breastfeeding.

The small size of the breasts causes trouble in the body perception and self-confidence of the person.
Disproportion between hip and chest size
Postpartum breast shrinkage, sagging or relaxation
Breast shrinkage and mild sagging disorders after weight gain and loss
The difference in size between the two breasts

POINTS TO BE CONSIDERED BEFORE SURGERY
Breast examination must be done before the surgery. In dangerous situations or in people over 40 years old, breast should be evaluated for cancer by using ultrasonography and mammography and a decision should be made for the surgery.

SURGERY AGE
The surgery is recommended after the age of 18 when breast tissue completes its development. However, in cases, such as POLAND SYNDROME, in which one breast is highly developed in adolescence, the other breast does not develop, and TUBEROZ BREAST DEFORMITY, a developmental disease that can cause serious deformity in the breast, in cases that may cause serious psychological problems due to asymmetrical and problematic breasts, it is possible to perform breast augmentation with prosthesis at an earlier age with the approval of the parents.

SURGERY METHODS
One of the 4 different entry areas used for the placement of prostheses is under the breast. These are the colored edge of the nipple, under-breast fold, the armpit or belly button areas. Prostheses that are only inflated with water through the belly button are used and require special equipment. Therefore, it is rarely used today. Which of the other regions will be chosen is decided according to the patient’s examination and the doctor’s preference. In order to place the prosthesis, it is necessary to create an empty space that normally does not exist in our body. Our chest muscles are located under the breast tissue. The pocket formed can be under the breast tissue between the muscle and the breast tissue (subglandular-upper muscle), under both the breast and muscle tissue (subpectoral – under the muscle) or partially under the breast tissue, partly under the muscle (Dual Plan). However, based on the patient’s examination, it is decided which of these different methods will be used.

SHAPE OF BREAST PROSTHESIS
Implants used in breast augmentation are divided into two main groups as round and drop (anatomical) shaped. In drop model prostheses, the nipple and the part underneath are fuller. It is more preferred in cases where breast tissue is very scarce and therefore the covering tissue is not sufficient. These prostheses are produced in different width, length and height combinations. It may be preferred according to the body type. However, there are advantages as well as disadvantages. If the prosthesis rotates in the created cavity, there will be a change in its appearance effect. Round prostheses can be preferred in cases where more fullness is desired on the upper part of the breast. If you have enough own tissue, it provides the desired effect without revealing itself and without the risk of rotation. In a study, plastic surgeons themselves could not highly predict the type of prosthesis placed under the muscle. For this reason, if a sub-muscular prosthesis is planned to be placed, the use of an anatomical prosthesis or a round prosthesis does not make any difference except in special cases. When deciding on the type of prosthesis, take into account your doctor’s recommendations, and do not allow the information you will receive other than your doctor to confuse you. When determining the size of the prosthesis to be used to enlarge a breast, the structure, height, weight and body dimensions of the person’s breast and rib cage are taken into account. Provided that these physiological boundaries are not enforced, the patient and the doctor decide on the approximate size and shape of the prosthesis to be used together. After preparing the pocket for the prosthesis during the surgery, the final result is determined by placing the trial prostheses provided by the companies. These prostheses are not your permanent prostheses, they are only used for testing during surgery. Sometimes test prostheses belonging to a larger or smaller size of the planned prosthesis are also tried and a permanent prosthesis is used according to whichever gives the best result. It is not possible to use the permanent prosthesis placed on your body for trial purposes. Once unpacked, it can only be used for you. This is the reason why test prostheses are used.

ANESTHESIA METHOD AND DURATION
Surgeries are performed under general anesthesia in a hospital environment. The duration of the surgery is between 1.5 and 3 hours, depending on the technique and scope of the surgery. At the end of the surgery, dressing is applied to the breasts and a bra is used. Special bra without underwire is beneficial for edema and pain control. The person can stand up a few hours after the surgery, and is discharged the next day. Spending the night in the hospital is beneficial in terms of the position of the bed, pain control and close monitoring of possible complications.

HEALING PROCESS
After surgery, the pain can be easily controlled with medication and disappears in a few days. Surgery scars will fade over time and will become vague after 6 months – 1 year. In the first few months after surgery, your breasts are slightly larger and more tense than they are due to edema. Over time, it returns to its real size and softens. After 3-5 days, you can take a shower and start work. After the surgery, a check-up should be done at times determined by the doctor (such as 1st week, 2nd month, 6th month). Tapes or ointments can be used to help the incision scar heal smoothly. The incision scar will take its final form in an average year and will turn into skin color.

POINTS TO BE CONSIDERED AFTER SURGERY

• Walks can be done, but sports that require intense effort and force the chest muscles (such as tennis, swimming) should be postponed for 6-8 weeks.
• Although patients can usually return to work within a few days, it is recommended not to drive for 1 week, not to lift heavy things for 3 weeks and not to move their arms up.
• Sweating should be avoided during the first 15 days when wound healing is intense.
• The bra recommended by your doctor should be used during exercise.
• In the first year, the incision scar should be protected from the sun with a high protection factor sunscreen or tape, otherwise the scar will turn darker.
• Breast implant does not prevent pregnancy. Breastfeeding can be done without any negative situation.
• The technician, who shoots before the mammography checks, must be informed. Shooting should be done accordingly. The breast implant is not affected by MRT and computed tomography, and films can be easily interpreted by the radiologist.
• Silicone breast implants do not have an expiration date. However, it is recommended to remove or replace it after 15-25 years due to possible deformities in the implant and thinning of the implant capsule.
• Bras with wire support (underwire) underneath should not be used for at least 3 months.