Breast Aesthetics

BREAST AESTHETICS

Breast aesthetics, which holds an important place in surgery, covers aesthetic procedures performed to lift or reduce the breasts and to enlarge them.

Breast Augmentation

It is a surgical procedure performed for aesthetic and functional purposes on breast tissue that is naturally small or has shrunk because of atrophy after childbirth. It is performed on breasts whose volume is small or asymmetric relative to body contours. Breast augmentation with breast implants is generally performed to make asymmetric breasts symmetrical, and in women who have had a mastectomy (removal of breast tissue) because of breast sagging, atrophy or surgical breast disease.

Implants are used to enlarge the breasts or to create breast volume. If the skin and subcutaneous tissues are not sufficient to cover the implant, the patient's own tissues are used. Before surgery, the surgeon and the patient should discuss the factors that determine the surgical outcome and plan a defined process.

The patient and the doctor decide together on the location of the surgical incision. An incision in the crease under the breast is the most commonly used. In breast augmentation, unrealistic expectations, unsuitable implants and healing problems can cause difficulties.

The Breast Augmentation Procedure

Implants with a silicone gel consistency are used. Polyurethane-coated silicone implants in particular are high-quality implants with the lowest risk of capsular hardening and are fully rounded like the natural female breast. With these implants, even if the outer shell tears, the silicone gel does not spread and keeps its shape.

When placing the implant, the incision site may vary depending on the wishes of the patient and the surgeon and on the type of implant used. The implant is inserted through a 4–5 cm incision. It can be placed directly beneath the breast tissue or in a pocket created beneath the chest wall muscle. Placement beneath the muscle causes some pain in the early postoperative period, but it is preferred because it has fewer other side effects and gives a more natural appearance.

The operation takes about 1.5–2 hours and is performed under general anesthesia. The patient can return to normal life within a few days. A special bra may need to be worn for a short time. The patient is advised not to lift heavy objects or raise her arms overhead for 3 weeks. From the 6th week onward, all kinds of sports activities can be resumed.

Capsular contracture may develop as a complication in 1–2% of cases. In that case, the hardened capsule is removed in a second operation and the same implants are placed again. No adverse outcome that would threaten the patient's health is expected.

If sagging of the breast tissue accompanies small breast size, a breast lift (mastopexy) is performed at the same time.

Breast Lift (Mastopexy)

Mastopexy is the lifting, reshaping and contouring of the breasts without reducing their volume. In most patients, the breast skin has stretched and sagged, and the breast tissue has relatively decreased. The breasts sag and lose their firm appearance because of:

age,

gravity,

pregnancy and breastfeeding,

weight gain and loss.

Loss of elasticity causes the skin and the attachments of the breast gland to stretch and lengthen. As the breast tissue descends, fullness is lost in the upper part of the breast. If breast sagging (ptosis) is accompanied by a marked reduction in breast tissue, a breast implant is also added to the mastopexy. This is done especially to restore fullness in the upper part of the breast. Augmentation mastopexy is also preferred for congenital or acquired breast asymmetries.

The surgical technique used in a breast lift may vary according to breast size, the degree of sagging and skin elasticity. In people with mild sagging, a procedure around the nipple may be sufficient, whereas in cases of advanced sagging there may also be incisions and stitches in the crease under the breast.

Scars that are more prominent and reddish in the first months fade to white over time, become less visible and usually stay within the lines of a bra or bikini. The operation is performed under general anesthesia and takes about 3 hours; the drains placed afterward are removed the next day. Stitches are removed on days 10–12. Arm movements may be painful for the first few days after surgery. Simple painkillers relieve the patient, and patients can return to their daily activities within a few days.

Breast Reduction

Breast reduction surgery is preferred when the breasts are too large for the body's proportions. Causes of large breasts include:

• • hormonal disorders,
• • excessive weight gain,
• • pregnancy and genetic factors.

Women who want breast reduction surgery often experience neck and back pain as a result of large, heavy breasts that sag. This is one of the main reasons for choosing surgery. Large, heavy breasts cause bra strap marks on the shoulders. Dermatosis and skin sensitivity due to frequent sweating may develop under the breasts.