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A Brief Review on Breast Aesthetic Surgery

Dr. Moises Lopez Pozas, Specialist Plastic Surgeon at Marble Plus Medical Center

Every woman would like to have attractive breasts. Women who experience an alteration in the breast shape, size, or both at the same time or breast mutilation will suffer from complexes and psychological repercussions. It is a much sought-after aesthetic surgery, and the most frequent breast-related problems that women suffer from when they go to a plastic surgeon’s office are hypertrophy (excess volume), hypoplasia (lack of development), asymmetry, ptosis (descent and flaccidity) and postmastectomy amputation.

In the case of breast hypertrophy, surgery may be indicated for aesthetic reasons or also for orthopedic causes such as back pain or spinal deformities due to excess weight. An adequate and aesthetically desired shape can be achieved with breast reduction surgery. This type of intervention leaves residual scars that will become less visible over time, which is why the correct placement of the final scars and following the surgeon’s advice for proper healing and subsequent scar treatment are important in order to achieve a good result.

In the case of loss of volume, some types of ptosis or asymmetries or mastectomy, the solution could be breast implants with or without a mastopexy or other technique depending on each case. It can be placed to restore a natural looking breast following a mastectomy, to correct congenital defects and deformities of the chest wall or, cosmetically, to enlarge the appearance of the breast through breast augmentation surgery. The safety of implants and choice of shape and volume have given a range of choices and predictability to patients for aesthetic and reconstructive reasons. Breast implants are basically a silicone shell filled with physiological serum (which has the advantage that if the capsule is broken, the serum is simply reabsorbed without consequences) or silicone gel (which offers a more natural consistency). 

Depending on the shape, they can be anatomical, which, as the name indicates, resembles the drop shape of a breast. Regarding the surface, they can be smooth, macro-textured, micro-textured or nano-textured, the latter are the most used due to the lower incidence of encapsulations.

They can be placed in different ways through the areola, the sub mammary fold, via the armpit or via the abdomen during a tummy tuck. They are positioned behind the mammary gland, behind the muscular fascia or behind the pectoral muscle depending of course on the characteristics of each patient. In all cases, it does not interfere with lactation or the sensations of the breast.

In all cases of breast surgery prior to the surgical intervention and with the patient sitting or standing, the surgery is designed and marked and the final desired size is discussed with the patient. There are no standard measurements. Usually, the woman asks the specialist for guidance, but she is the one who makes the final decision, regarding the size and shape. This does not mean that the surgeon should do exactly what is asked, if according to her criteria it does not make sense. We have to think that once the tissues have been incised, there is no turning back without leaving the mark of the scar. A surgeon can refuse to operate on a patient because she does not share his criteria, but if he agrees to operate, he has a moral and legal obligation to obtain the result requested by his patient.

The intervention is generally performed under general anesthesia. Hospital admission usually ranges between 24 and 36 hours post-operation. Sometimes, drain tubes are needed usually for 24 or 48 hours after the patient is discharged; she usually does so with a minimal dressing and a soft bra.

Regarding complications, this surgery presents the same health risks common to any surgery, such as adverse reaction to anesthesia, hematoma (post-operative bleeding), seromas (fluid accumulation), opening wound or infection of incision site, others specific to breast augmentation include breast pain, altered sensation, visible wrinkling, asymmetry, thinning of the breast tissue, and symmastia, the “bread loafing” of the bust that interrupts the natural plane between the breasts also must be mentioned. The FDA has identified that breast implants may be associated with a rare form of cancer called anaplastic large-cell lymphoma which some experts believe is associated with chronic bacterial inflammation.

Breast implants are granted for life, however 20 or 30 % of patients need to change it after around 10 years in case of any complications. It can be checked with MRI or simple exam by the doctor.

A proportionately developed breast is an important feminine feature, a sign for fertility and sexuality; it is extremely important for women’s self-confidence so plastic surgery with breast surgery techniques is a tool to make your dreams come true.

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