Breast Augmentation

In 1960, Dr. Cronin from Houston cooperated with the company Dow Corning and developed silicone gel-filled implants. In 1964, it was included in the field of application in many places. The disadvantages of liquid silicone injection were not applicable to them, and therefore, their use spread rapidly. Plastic Surgery instantly became the most commonly performed surgery. It has been reported that breast implant has been applied to approximately 2.5 million American women until 2000. However, there are some diseases affecting the breasts, like other organs of the body. Women with breast implant may suffer from the same disease.

As in the nature of human beings, they search for a culprit when something bad happen to them. In such cases, silicone implants were the things that came to mind first. Thus, a community of women worried about implants came about in the course of time. In fact, some of them were complications related to implants, such as capsule formation, and palpable implants. However, the ones such as fatigue, headaches, joint pains, and rash were also interpreted as silicone leakage. Moreover, silicon was alleged to be carcinogenic. In 1992, the FDA banned the use of it for cosmetic purposes, alleging that there is not adequate evidence regarding the existence of any connection between silicone and those diseases. After that, a jury at a court in Houston has imposed a $4.5 billion fine on the company Dow Corning, which would be covered the treatment costs of 400.000 women thought to be victims of the company. Upon that, the American companies stopped the production of silicone gel implants. However, implants filled with physiological serum (saline solution) were continued to be used, on condition that they were under the control and monitoring of the relevant institutions. As a result of many studies carried out in various universities in the following years, silicone implants have been reported not to be associated with those diseases. However, lawyers earning big moneys from that job did not intend to take steps backward. They claimed that those studies did not reflect the reality. Eventually, the FDA accepted breast implants to be nonhazardous, and approved their use at the end of the year 2000, based on all this data. However, it stipulated to give patient the required information about risks.

In conclusion, these operations are the second most commonly applied interventions intended for aesthetic purposes across the world, after rhinoplasty operations; and until today, no data indicating the presence of a relationship between implants and breast cancer or immune diseases was found. Moreover, medical silicone has already been used in various drugs, cosmetics and food industry. Breast enlargement (augmentation) is a process intended for making the breasts bigger by placing an implant (prosthesis) behind the breast tissue. After the process, the diameter and projection of the breast increase. At this point, the differences are related to the size and type of the implant, as well as the entry point and the implant's position to the muscle. Each of them has certain advantages and disadvantages specific to it. Capsule formation is the most important problem in breast implant applications. The capsule is a scar tissue created by the body against a foreign matter. It also occurs against implants, like all other foreign matters. But it often remains soft and is not felt. Sometimes, the capsule gets contracted due to a variety of reasons, and takes a ball-like shape. In such a condition, it is dislocated and generally causes pain. Although it is not possible to absolutely prevent capsule formation, there are two approaches that reduce the this possibility. The first one of these approaches is the placement of the implant under the muscle. In this way, the muscle is thought to give message while moving, and consequently reduce the capsule formation. When placed under the muscle, the breast tissue can be controlled more easily, both manually and radiologically. It is inconvenient in people with improved pectoral muscles. And the second one of these approaches is the use of rough-surfaced implants. Such rough surfaces are thought to prevent the formation of parallel concentric fibers. Recently, there are also some people, who argue that there is no difference between smooth and rough surfaces in terms of result.

Breast implants:

According to the content: All of them are covered with a silicone sheath. What are different are their contents. The ones filled with silicone gel have the same consistency and firmness with that of the tissue. Especially when touched, it gives a more natural feeling. Implants with physiological saline have been produced because of the possibility of leakage of silicone gel at micro level. They have thicker membranes; and therefore, they are felt harder. They can be placed through smaller incisions. Since they have thicker membranes and rough surfaces, they cause the feeling of a wavy surface. The possibility of their collapse due to leakage of their saline solution is high. In such a case, secondary operations may be needed. Different materials such as soybean oil are also used as content. However, their productions have been discontinued. It is highly unfavorable to choose this kind of implants, which are still at the experimental stage. An anatomic implant is oval, when looked from the front side. When looked from the side, it has a projection mostly from the bottom. Its content is mostly in its lower side. In this state, it can be thought to be more suitable to the normal breast structure. The difficulty in orientation is another challenge in anatomical implants. Even a slight rotation may cause an asymmetry. In addition, upper pole fullness is a feature desired by women, and anatomic implants do not provide it.

Which incision?

There are three widely accepted places for incision types, which give good results. What is important in the selection of these techniques for patients is how easy the scar could be hidden. The form of the scar will vary depending on the person and the region of the body. 1- Periareolar: It is in the lower half of the boundary ring between the normal skin and areola. 2. Bottom of the breast (Inframammary incision): It is at the joint area of the breast tissue and the trunk below it. 3- Armpit (Transaxillary incision): It is in the underarm pit. The fourth incision place is belly button but is rarely used. It is known as TUBA (transumblical breast augmentation) but is not a reliable method. Some people do this with the aid of an endoscopic device called mammascope. But in this way, it is difficult to say that a surgeon has a complete command of placing an implant and opening a suitable pouch in the breast tissue. Since it brings along many problems, it is not a technique that has come into routine use. For a surgeon, the easiest entry is the bottom of the breast and the most difficult entry is the armpit in an implant placement process. Axillary intervention requires the use of an endoscope. Although some people consider this to be unnecessary, performing the operation blindly increases the risk of all kinds of complications. At least, hematomas developed from uncontrolled minor hemorrhages may lead to capsular contracture in the future. Axillary intervention causes no scar on the breast. It has been introduced as a scar-free intervention. However, since the armpit is a pigmented area, a scar remains that can be considered to be noticeable. In such a case, if the individual raises her arms when wearing a sleeveless dress or swimsuit, the scar can be seen from the opposite side. Inframammary intervention is unfavorable for young girls. Since the breasts are firm and projected, the scar on the skin is noticeable, and in a completely visible position. When all these are evaluated, periareolar incision might be considered to be the best choice in terms of scar. The jointing between the colored part of the areola and the breast skin is not a definitive line but a transitional zone. Therefore, the scar of the incision to be made in this area will disappear in the course of time. The only disadvantage of the intervention is the difficulty in the placement of especially gel-filled implants in women with a small areola diameter, in whom the entry place will be small.

Breast Size Measurement

Breast size is generally assessed with the measurement of bra. The numbers used for the bra gives the chest circumference. And the letters (A, B, C, D) shows the bigness of the breast. However, bra sizes sometimes vary from brand to brand. It would not be realistic if a patient states breast size that she wants, before the surgery. Perhaps, it would be the best way to evaluate this if the patient takes along the bra, selected according to the new size she wants, when visiting the surgeon. Thus, the surgeon can have information about the patient's expectation. Breast augmentation plus mastopexy. In the cases of slightly sagging breasts, just placing implants can provide a lifting by positioning the nipple to a higher level and increasing the skin tension. However, if the sagging is at a considerable level, just placing an implant causes the breast tissue to sag more, on the implants. Mastopexy alone can recover the breast by bringing the nipple to a proper position. However, this method alone cannot provide fullness in the upper half of the breast. In such cases, breast implantation in combination with a mastopexy gives a better result. Tuberous breast: In these deformities, the base of the breast attached to the body is narrower and firmer compared to the areas of the breast, which are closer to the front. The breast tissue and areola are herniated forward on the breast in a tubular-like shape. With intent to correct this, a pouch is created for the implant, and then the lower part of the breast base is cut for its release, with a radial incision.

Complications:

Such problems are extremely rare in skillful hands. They can be reviewed in two categories:

Early (the ones that occur in the first two weeks): They are the ones that develop mostly due to surgical treatment. Symptoms such as burning, itching, feeling of firmness are temporary, and they are not complications. * Hemorrhage: Much hemorrhage, clotting caused by hemorrhage, and the resultant hematoma. In such a case, a breast is bigger and more painful than the other. If it is excessive, the patient is taken into operation again to remove the implant. After taking the hemorrhage under control, the implant is put into its place again. * Infection: It is very rare. A few days, weeks or even months after the operation, it shows itself with redness, pain, as well as with leakages in future periods. It requires the removal of the implant and all foreign matters, hematomas etc. It also requires a proper antibiotic treatment. It is required to wait for at least 6 months after the re-implantation process.

Late (the ones that occur after the second week): * Capsular contracture: A capsule forms around all foreign matters. Since silicone is an inert substance, this reaction occurs less. But in some cases, the capsule gets contracted, and causes the displacement of the implant, pain and stiffness. Although its formation differs depending on the body structure, there are different opinions about its causes. Treatment options:

Closed capsulotomy: The breast is pressed to burst the capsule

Open capsulotomy: The breast pouch is opened under anesthesia, and then the capsule is scored.

Capsulectomy: The capsule is completely removed under anesthesia, and then mostly the place of the pouch is changed.

Reduced sensation: Generally it is temporary, and its possibility increases in parallel to the size of the implant. It is recovered within a few months.