Breast Surgery
Breast enlargement
Loss of weight, giving birth and aging, amongst others, can modify breasts, which can lose volume and change shape. The breast enlargement adds to the volume of the breasts to get the desired silhouette.
Your plastic surgeon will examine your breasts to determine the size, shape, characteristics of the skin and position of areoles. Breast implants may make it more difficult to read mammograms. All women have a breast cancer risk and the patient must assess the importance of this issue before making a decision about breast implants.
Your plastic surgeon will discuss with you the location of the implant relative to cancer screening.
Implants can be placed under the pectoral muscle or between muscle and breast tissue. Each choice has its advantages and disadvantages.
The same is true for the location of the incision through which the surgeon will slide your implant in. You will take decisions on the location of the incision and the implant in accordance with your surgeon.
The patient undergoing breast enlargement can leave the clinic the same day of the intervention.
Depending on your surgeon and your preferences, the size of the prosthesis and location of the incision will be decided. It should not be forgotten that the bigger the prosthesis is, more important are the risks of complications.
In Canada, for the purpose of breast enlargement aesthetics, most women receive breast implants filled with saline (sterile salty water) in a silicone envelope. Recently, new prosthesis filled with cohesive silicone gel were available in Canada. Unlike traditional silicone prosthesis, cohesive gel does not leak, transpire or move.
Patients tend to find that silicone gel implants give a more natural look than prosthesis filled with saline liquid. The waves or lines on the surface are less visible with silicone gel implants. Your plastic surgeon will discuss with you the choice of prosthesis.
To put the prosthesis in place, the surgeon makes an incision either in the folding of the skin under the breast, in the axillae (armpit), or on the lower edge of the areola. The surgeon then makes room behind the mammary gland or behind the pectoral muscles where he puts the prosthesis.
The bruising and swelling after surgery disappear soon. The swelling that remains usually disappears within a month.
In the days following the operation, the patient can gradually resume its activities, while being careful. Some even return to work after a few days.
The potential complications include infection, reactions to anesthesia and hematoma (accumulation of blood), which will require a surgical drainage. Rarely, it is necessary to remove the prosthesis for complete healing of the infection. With rare exceptions, changes in the sensitivity of nipples and breasts are temporary and sensitivity comes back after a few months.
Any prosthesis is a foreign body around which forms a fibrous hull. The scar tissue may tend to shrink and thus, compress the prosthesis - which gives the impression that the breast is hard. This phenomenon is called capsular contracture. The degree of hardening varies: in some cases it is hardly noticeable, in others it is very pronounced and may cause pain. It may require surgery to modify or to remove the scar tissue or to remove and / or replace the prosthesis.
Breast enlargement is not a single surgical intervention. You will have to replace your implants at least once and perhaps more often, because the implants break and are deteriorating. The failure of an implant requires surgery.
Breast reconstruction
Mastectomy (removal of one or both breasts) is often practiced on breats cancer patients. It is a traumatic experience, but breast reconstruction is possible at any age, provided that the health of the patient allows him to tolerate general anesthesia.
Breast reconstruction can be done mainly in two ways: either with implants or using tissue from the patient herself (autogenous "reconstruction"). Your surgeon will discuss with you the risks and benefits of the methods of reconstruction that are available to you.
Breast implants are the same as for enlargement surgery, usually silicone envelope that encloses saline solution or silicone gel. Although reconstruction with prosthesis can be simpler and shorter than reconstruction with tissue from the patient, there is a higher rate of complications associated with the implants, and later another intervention may be necessary . The rate of complications with implants is higher if the skin of the breast was irradiated.
The prosthesis inserted under the skin are more practical than those that are placed in a bra. However, the body may react by forming a capsule (an envelope) around the implant. This capsule hardens the breast, which can remain sensible or be painful.
If, because of the type of mastectomy practiced, the envelope has not enough skin to produce the insertion of the implant, it will be necessary to use a prosthesis expansion before inserting it.
The expansion of the skin is accomplished by using a prosthesis that the surgeon gradually inflates over time with salt water until there is enough skin formed around it to insert the prosthesis permanently.
The use of tissue from the patient herself is called autogenous reconstruction. It is a transfer of soft tissue (skin, fat) from a part of the body to another. Because there is often a surplus of tissues and because of the ease of access, it is commonly used tissue from the lower abdomen for the reconstruction. Less frequently, skin from buttocks, thighs or back can also be used.
Complications of autogenous reconstruction include a remote possibility that the tissue transplanted doesn’t survive.
The patient can usually go back to work after 2-4 weeks, but the skin stretch might require a few clinical visits, and even a second surgery to insert the permanent prosthesis. One or two months after the autogenous reconstruction is usually necessary to witness the final result.
It is important to understand that a surgeon will never create a "normal" breast through reconstruction. Yet with realistic expectations, this type of surgery normally gets a good level of satisfaction.
Breast reduction
If a heavy chest gives you back pain and neck or widening shoulders, breast reduction may be interesting. Although breast reduction can practiced in teenage years, it is recommended to wait until the end of the development phase of the chest and mature enough to understand the consequences of the surgery.
Pregnancy and lactation have a significant effect on the size and shape of breasts. Although some may choose to undergo breast reduction before pregnancy, it is recommended to discuss it with your plastic surgeon as it may have an effect on breastfeeding.
In assessing the candidate for a breast surgery, the surgeon carefully examine the size and shape of breasts, the quality of the skin and the location of the nipple and areolas. If you are overweight, your plastic surgeon may suggest that you stabilize your weight before undergoing surgery.
There are several ways to make the incisions used in breast reduction. The traditional method involves three incisions: one around the areola, the second vertically from the areola to the bend below the breast, and a third which follows the natural curve of the breast. Your plastic surgeon will discuss with you the incisions that best suit your case.
Once the excess skin removed, the nipple and areola are lifted. The skin that was above the nipple before surgery will be pulled down.
These maneuvers will give a new shape to the breasts. It will sometimes call for liposuction to improve the contour under his arm.
Because the link between the nipple and the areola is preserved, the surgery often succeed to keep the feeling in of the area. But is sometimes a loss of sensibility is resulted.
Some of the complications associated with this surgery are bleeding, infection and reactions to anesthesia; both breasts could be of different sizes or areoles could be asymetrical.
It takes a few days after the surgery to be able to move without any pain. You may have to wear a compression bra for a few weeks, until the swelling and bruising not diminish. The incisions will be red for several months after your surgery.
Normally, it is possible to return to work within a month.