Mammoplasty

Shape correction, breast augmentation is one of the most popular plastic surgery procedures. With the help of mammoplasty, you can correct congenital or acquired breast defects, restore its volume, elasticity after childbirth and breastfeeding. Correctly performed surgery helps a woman to become more attractive, more self-confident.

Indications for surgery

• Decrease and decrease in the elasticity of the mammary glands (mastoptosis).
• Increase in the volume of the breasts while maintaining their tone and position (macropathy).
• Reduction of the mammary glands after breastfeeding.
• Small breast size (micromastia).
• Enlargement of the breasts in men (gynecomastia).

Types of mammoplasty

1. Augmentation mammoplasty(endoprosthesis): breast augmentation, correction of its shape by implants. It is used after childbirth, lactation, with congenital asymmetry.
2. Reduction mammoplasty- Reduction in breast size with mastoptosis or macropathy.
3. Mastopexy- breast lift. It is indicated for mastoptosis, if the volume of the breast meets the requirements for the operation.

Endoprosthesis of the mammary glands.

The operation involves the installation of silicone prostheses (implants) in the mammary glands. The choice of the incision site is according to the woman. The implant is placed under the pectoral muscle, and if the volume of the breast allows it, between the muscle and the mammary gland. The incision is sutured, no drainage is required. The nipple and areola are enlarged after surgery.

Breast implants

Silicone or polyurethane stents correct the volume, the shape of the bust, give a feeling of natural body tissues.

The lifespan of implants exceeds 15 years, after which it is recommended to replace them.

Products differ in several indicators:

1. Fillers: cohesive gels or saline solution (sodium chloride). The composition of the gels is more elastic, homogeneous, lightweight, but dangerous for the body if it leaks. The salt solution is safer, gentler, and cheaper. Negative properties: gurgling when moving, prone to leakage.
2. Structure: rough (textured) or smooth. Textured implants are more stable, but skin folds can appear from the friction of body tissues against their surface. The downside to smooth dentures is the likelihood of displacement.
3. Shape: anatomical or round. The former have a more natural appearance, while the latter retain the symmetry and shape of the chest even when displaced.

Reduction mammoplasty

By performing this type of surgery, the fatty tissue and breast tissue are partially removed, their size changes, and they are given a new shape.

Excision of excess tissue reduces the chance of cancer.

Reduction mammoplasty options:

1. Liposuction. The method is considered conservative and does not leave seams. Designed for minor breast reduction with mild degrees of mastoptosis.
2. Short seam (vertical). A popular method in which the breasts maintain their natural shape and the nipples are sensitive. The operation takes little time and the proportion of complications is low.
3. T-shaped cut (anchor). The classic method, which is used to remove large amounts of tissue. Its disadvantages are the duration of recovery, a large scar.
4. Amputation with nipple transfer. It is used for very large breasts. The method is associated with a high risk of injury to the mammary glands, loss of nipple sensation, and the inability to breastfeed.

Mastopexy

Breast lift without implants is possible in several ways:

1. Vertical is used for 1-2 degree mastoptosis, the seams are almost invisible, the cosmetic effect is long-lasting. The method is ineffective in lowering the chest by 3-4 degrees.
2. Anchor mastopexy works well for ptosis of any complexity. Its disadvantages include a longer recovery period, noticeable sutures, and an increased risk of breast tissue injury.
3. Periareolar mastopexy is the removal of a small piece of skin around the areola. It is indicated for pseudoptosis, for other forms of sagging of the bust it is ineffective.

Stages of operation

To obtain an excellent result from plastic surgery, high-quality medical care in all 3 stages is important. The preparatory period lasts 1-2 weeks. The actual surgery lasts 1 to 4 hours.

Full recovery occurs in 1. 5 months.

Preparing for a mammoplasty

The operation is performed no earlier than a year after the end of lactation. 2 weeks before surgery, it is forbidden to take hormonal contraceptives, aspirin and preparations containing salicylates.

You should stop drinking alcohol, smoking.

In preparation, the research is necessarily carried out:

• general and biochemical blood tests;
• electrocardiogram;
• blood test for anticoagulants (coagulogram);
• Ultrasound of the mammary glands;
• general urinalysis
• Hepatitis and HIV virus tests.

The course of surgical intervention.

Breast plasty is performed under general anesthesia. A special type is expander dermotension. It is used to increase the volume of the breast with a lack of its own tissue and large implant sizes. The procedure is carried out in 2 stages. First, an expander is installed to gradually stretch the breast tissue over 1. 5 to 2 months.

When the desired size is reached, a stent is placed in the breast.

Methods of operative incision:

1. Through the crease under the breast (submammary access). Safe method for augmentation mammoplasty. A scar from an incision 4 to 5 cm long disappears over time under a slightly sunken breast. Access is difficult with micromastia in thin girls.
2. An incision around or along the lower arch of the areola (periareolar approach). Advantage: Surgical scars are almost invisible. For patients planning to breastfeed, this method is not recommended due to the high risk of breast injury.
3. Endoscopic augmentation by axillary approach. High-tech equipment helps install the implant without damaging blood vessels or nerve fibers. A 3-4 cm long incision is made in the armpit area, and then the scar is masked naturally. There is a limitation on the volume of the implant: up to 400 ml.
4. Endoscopic access through the umbilicus. This method is rarely used due to the remoteness of the entry point from the operation site, difficulties with the formation of a "pocket" for the prosthesis.

Rehabilitation after mammoplasty.

If the operation was carried out without complications, the patient remains up to 3 days in the hospital. After discharge, it is necessary to attend dressings. Moderate pain in the area of intervention that occurs in the first days is considered natural. Sensations of tightness in the skin are possible due to postoperative edema, which disappears after about 5-7 days.

After 4-6 weeks, the breast sags slightly, looks more natural, and capsules form around the implants.

Successful recovery rules:

• Do not load the shoulder girdle, do not lift weights.
• Do not visit gyms, swimming pools, saunas, baths.
• Sleep on your back.
• Don't raise your hands.
• After breast augmentation, be sure to wear compression garments.

Possible complications

• Capsular contracture. The body forms a shell around the endoprosthesis, which can lead to its displacement, violation of the symmetry of the mammary glands and their hardening.
• Infection. Infection occurs during the operation due to violation of the rules of asepsis or after non-compliance with antiseptic standards of care. The period of special risk is 1 week after the operation.
• Hypertrophic keloid scars. They appear if the body is predisposed to their formation. The formations look like dense ridges that rise above the surface of the skin and spoil the appearance of the breast.
• Accumulation of blood, serous fluid (hematoma, seroma) and, as a result, darkening of the skin color. It occurs when blood vessels, lymphatic vessels are damaged during surgery or during the recovery period. The complication appears due to low blood clotting, sudden increases in blood pressure, the wrong size endoprosthesis.
• Reduction or loss of sensitivity of the nipples, areolas. It often occurs when large breasts are reduced with reduction mammoplasty due to nerve damage.
• Implant rupture. It occurs due to the thin layer, which is often found in inexpensive prosthetics. The salt filling is easily absorbed by the body without causing harm. Damage to a stent with a cohesive gel is not always noticeable, but it is dangerous if the silicone penetrates body tissues.

Breastfeeding after surgery

The safest operation is through an incision in the armpit (transaxillary) or under the breast (submammary).

About a year after surgery, breastfeeding is allowed.

Lactation problems can occur in the following cases:

• The stent is placed in a way that compresses the mammary glands, reducing the volume of milk they produce.
• A cut along the areola is more likely to injure the nerve endings around the nipple.
• The reduction plastic, associated with a reduction in the size of the breasts, alters the milk ducts and blocks their functions.

In which cases is breast plastic surgery contraindicated?

• Cardiovascular diseases, varicose veins (thrombophlebitis, thrombosis).
• Severe forms of mastopathy.
• Oncology.
• Blood clotting disorders, diabetes mellitus.
• Infectious diseases (ARVI, influenza).
• Neurological, mental disorders.
• Pregnancy, breastfeeding.
• Age under 18 years.

Advantages and disadvantages of mammoplasty.

Advantages of plastic breast correction:

• Application of modern interventions.
• Correction of congenital and acquired defects of the mammary glands.
• Pronounced and long-lasting aesthetic effect.
• Short terms of the operation.
• The ability to choose the shape, material of the stents at will.
• Preservation of the ability to breastfeed.

Possible downsides include:

• Incision skin marks: sutures, scars (unless special absorbable materials have been used).
• Threat of complications (infection, breast deformity, bleeding).
• The need to change stents every 10-15 years.
• The high cost of mammoplasty.
• The need for general anesthesia.
• Painful sensations in the first postoperative days.
• The need to constantly wear compression underwear.
• A long period of rehabilitation (from several months to a year) with the rejection of sports, physical activity, pregnancy, breastfeeding.