Painless Breast Augmentation
The breast augmentation is obviously for patients who wish to increase their breast size and / or correct a slight drop breasts. Women who are now eligible for this surgery have always had small breasts or have lost volume and firmness after pregnancy or weight loss. Especially in this case, the operation is combined with erection / mastoplasty due to a coexisting fall. For a small group of patients, with breasts of different sizes, breast augmentation can be done on one side only or in a different way (using a different size or shape) from one breast to another. This case is described in anisomastia .
Especially painless breast augmentation is achieved with the technique of minimal tissue intervention ( no touch no pain ). They used special tools in order not to disrupt the tissue and avoid microhemorrhages and use drains. Drugs of long local (analgesic and relaxing) action take care of the wound. The surgeon ‘s movements are only the ones required to achieve the perfect result and therefore the surgical time and the anesthesia time are reduced . In combination with the minimum required anesthesia drugs, patients wake up from the operation without pain but this continues in the following days. There is only a sense of grip as after physical exertion.
The operation briefly
In breast augmentation, the implants are placed under the breast. In rare cases, the implants are placed directly below the mammary gland (subglandular). They are most often placed at the level of the chest wall, below the major thoracic muscle (submuscular) and just above the sides. Some subfascial or dual plane or muscle split placement techniques or their combinations with other specialized techniques, will not be described here, as they deviate from the purpose of updating this text and do not offer anything to the information of those interested. Where they are described, they are usually for advertising purposes, as they are highly specialized and not understood by patients.
Staying at the clinic depends on the surgery chosen for you, but you usually leave on the same day. A sports bra will keep the chest in its new position for 4-6 weeks. You need to abstain from sports activity for 4 weeks. For 3-6 months the new breast will react differently to menstruation, until you get used to the new condition.
At 6 months a mammogram or MRI will be needed to map the new breast. This image will be the basis for comparison of any subsequent examination.
The most practical position is at the lower limit of the breast, where the chest rests on the chest in the submandibular fold ( submaxillary ). It leaves the smallest mark and is practically invisible after surgery, as it is covered by the new breast. It is the most used as it allows technical ease and stability of results.
The incision around the nipple, at the border of brown and white skin ( perithelium ) is suitable for large nipples when we want to reduce them, according to the wishes of the patient or when we combine erection / mastoplasty .
The incision in the lower half of the nipple ( hypothalamus ) is supposed to leave the smallest mark, although immediately visible. However, in international statistics it is accompanied by high rates of postoperative infections (up to 18% while the same percentage in the subcutaneous section falls to 2-2.5%) and is therefore not preferable. Of course, all this will be discussed preoperatively and the location of the incision or incisions will be decided together with the doctor, depending on the case.
Under the breast or under the muscles?
Placing the implants below the level of the muscle (submuscular-submuscular), gives more “stuffing” over them and therefore reduces the chances of being felt on palpation or showing their edges. Positioning under the muscles is preferable in very thin patients, where the ribs are visible, and in very small breasts. There may be some discomfort because the muscle is cut, but the insert is more protected, which is what is required. Also, at this level, there is less chance of forming a painful capsule.
Placing the implants at the level below the mammary gland but above the muscle (submaxillary) does not require a partial incision of the muscle and is technically easier. It causes less discomfort postoperatively, corrects the sagging of the breast slightly better and therefore, can give a slightly better picture of “recovery”. However, it is not suitable for thin women and is more likely to form a painful capsule.
Anatomical or Round
The inserts are made in two main shapes.
Round when it is like a sphere cut in half. They have only two dimensions:
1) diameter of the base of the insert but practically its height. Indicates which area it occupies on the chest horizontally and vertically and
2) show how much the skin of the breast pushes forward.
They are used in patients who have normal or increased weight or when we also combine erection / mastopexy. They need attention in weak patients because they cause an obvious step in the area of transition from the nipple to the key.
Anatomically when it is like a tear or a drop. They have three dimensions:
1) diameter (the base of the insert) Indicates which area it occupies on the chest horizontally, from the sternum to the arms
2) height Indicates which area it occupies on the chest vertically, from the sub-line to the key and
3) show how much the skin of the breast pushes forward. They are usually used in lean patients with little subcutaneous tissue under the key. In these cases they create a smooth transition from the nipple area to the key, thanks to the special drop shape and therefore the harmonious shape of the chest on the chest.
The breast augmentation fat is a method of increasing the volume of the chest, using the patient fat. It started to be used for rehabilitation after mastectomy (for breast cancer) but with years of experience it has now shown good and safe results in cosmetic surgery.
The fat is removed from the belly or the buns (or where we can collect it), prepared and re-injected into the breast with very small needles. It is done only on small and not sagging breasts. It does not lift the nipple but only fills the existing breast. The great advantage of the technique is the ability to permanently increase the breasts with the fat of the patients themselves without the use of silicone implants. The big disadvantage is the unpredictable survival of fat. Usually more than 50% of the injected fat is saved so the operation may need to be repeated two or even three times. There are almost no wounds and depending on the extent it is performed, it is done under local or general anesthesia.
The marks will depend on the technique used. They tend to be quite brown in the first 6 weeks, turn pink in the next 3 months and then the incisions fade and become white. The use of a special laser but also special films and silicone gel will help a lot. Most of the patients will have very good quality scars over time. Scars from other wounds give a relatively good indication of how they will mature in the chest.
Drugs and smoking
The breast augmentation requires proper preparation, as each surgery.
It is always better if you do not smoke. If you are a smoker try to quit smoking for 4 weeks before and 4 weeks after surgery. If you can not quit smoking, you will definitely be able to reduce the number of cigarettes you smoke per day to 5, which will significantly reduce the chances of complications (bruises, bruises, swelling).
Do not take herbal medicines for about 10 days before surgery or for 3 days after (arnica etc.). Also avoid aspirin (salospir), 7-10 days preoperatively, and anti-inflammatory 3-4 days preoperatively.
The following are the most common but there are others that are mentioned in the international literature.
Wet / Hematoma : serum or blood collection normally in 2 to -4 is week. Reoperation drainage is required.
Bleeding : needs immediate treatment.
Contamination : Prophylactic antibiotics are always given but microcysts / microabscesses may form at the suture site.
Long-term infection : after usually two years and appears as unilateral (ie on one side only) swelling. Needs reoperation or replacement of implants.
Rupture of implants : usually becomes apparent as diffuse transient and intermittent pain in the area. It is revealed by MRI and the implants do not always need to be replaced.
Painful caustic capsule : when the capsule surrounding the implants collapses and then the breast hardens, hurts or even changes shape. The capsule needs to be removed and the implants replaced.
Wavy deformity : usually on the outside or inside of the implants due to the existing capsule. It does not cause any other problems, and if it is not accompanied by excruciating pain, it does not need reoperation.
Nipple anemia / hypersensitivity : usually the aesthetics return in a few weeks.
Deformed scars : prevented by using a special laser but also special tapes and silicone gel.
Asymmetry / Wrong nipple position : requires correct preoperative measurements but if it occurs it is easily corrected with a little local anesthesia.
Painless Breast Augmentation
Before and After Photos