Breast agmentation's brief history

Information on Breast Enlargement Surgery


Underdeveloped, misshaped, asymmetrical breasts or those with elongated skin quite regularly cause psychological problems and subsequently the patient ends up with low self esteem and finds it difficult to establish relationships with the opposite sex. The abovementioned deformations of the breast can easily be corrected with breast implants.

Breast implants
The breast implants, developed since the 1960’s, are actually resilient sacks filled with liquid silicone or high–density silicone gel, or with saline. Their shapes can be of “a section of an orb” or anatomic implants imitating the shapes of the natural breast. The surface of the implants can either be smooth or rough which can be of significance during the post-operational phase of crusting surounding the implant. .

The operation
The operation is performed on a previously examined patient, with an anaesthetic or occasionally, with a local anaesthetic. The implant of the proper size is implanted either under the big pectoral muscle or the glandural tissues. The operation can start with an entrance from the armpit, or through the crease under the breast, or through a 4cm long incision performed across the halo of the nipple. The incision is later closed with plastic stitches. A drain is then placed into the hole made for the implant. The drain is removed the following day.

Aftercare
Following the operation the patient receives a flexible bandage that she must wear for a week. After this period the tight, flexible bandage is replaced by a elastic sports bra that is to be worn for an additional five weeks so that the implant can settle. The stitches are removed after two weeks. For about two to three weeks following the operation the patient can experience some tightness in her breast which then subsides in the course of a few more weeks and the patient gets used to the tightness caused by the implant as well as to the excess weight. Following the post-operational monitoring period (an overnight stay after anaesthesia) the patient is released accompanied with aftercare notes. Homecare and the observation of instructions is the patient’s responsibility. We frequently monitor the patient after the operation and discuss with her the current duties, e.g., the commencement and technique for massaging the implanted breast for the sake of preventing the development of a capsula, (later discussed in detail).We ask the patient to notify her specialist of any events related to her breast and/or the breast implant, particularly more so for any injuries, accidents or intense pressure on the chest.

Complications
Every surgical intervention can have its complications, of which the patient must be aware and must accept. It is a fact that implantation is not an intervention that lasts a lifetime. Its duration depends on the type of implant, on the circumstances of the operation and on the patients’ customs and lifestyle. It is essential that the patient should understand there is always a certain risk involved in having an implant. The following complications occur rarely depending on the sort of the implant used.

1. Implant constriction
The host organism develops a capsula (a connective-tissue case) around the whole surface of the implant. If this case becomes stronger and crustier it may constrict later on and therefore compress the implant. Sometimes the breast can grow tight and inflexible. This may happen even after years following the operation but most often it occurs within the first few months. It can occur in both breasts, but in the case of implants with a rough surface there is a smaller likelihood.
There is no exact account for the development of a capsula so careful attention is needed for its prevention both from the doctor and the patient. Numerous theories and practical measures have been invented and developed for prevention but we still have no safely proved method. In most severe cases even the surgical incision or the removal of the capsula may be considered. No matter how unpleasant a complication may be, many still undertake another intervention.

2. Puncture, Loss of tone
Like all tanks filled with liquid the implant can also suffer a puncture. With a normal/ordinary lifestyle it is practically impossible considering the implants’ multilayered covering. The most frequent reasons are the ageing of the silicone, injury, or a rupture caused by a great mechanical impact. As for implants filled with the latest cohesive gel, the gel does not ooze into the breast, and can easily be removed and then replaced with a surgical intervention. In the case of the rupture of an implant filled with liquid salt the liquid released into the breast merely absorbs and causes no injury. An injured implant can be replaced surgically.

3.Ooze of jelly
In the case of implants filled with silicone gel it may happen that gel drops, microscopic in size, seep through the case of the implant. These drops can be found in the surrounding connective tissues but rarely get to more remote parts of the body. It has, until now, not been verified if they may cause capsula development or other complications and the long-term effects are still unknown. However, the chances of the cohesive gel filled implants (which we use) oozing have been reduced.

4. Infection
If an infection occurs (local red colouring of the skin, tightness, pain, fever), symptoms appear shortly after the operation. The infection is treated with antibiotics, surgical intervention and/or removal of the implant. If it comes to the removal of the implant the new implant can be inserted after 6 months of recuperation.

5. Other possible complications
• Increase of liquid volume: may occur immediately or later on.
• Necrosis of the skin: Usually occurs due to increased inner pressure that prevents normal blood circulation, but it may also occur for other reasons.
• Asymmetry: Although every surgeon strives for perfect symmetry still some factors e.g. development of a capsula, dislocation of the implant or the patient’s gait can cause asymmetry.
• Temporary or permanent alteration of the nipple’s sensitivity.
• Dislocation of the implant: This may occur as a result of external impact, causing a case to develop. If it has a considerable effect on the shape of the breast, surgical intervention is necessary.
• Creases, wrinkles on the breast, visible (tangible) implant: these problems may occur depending on the sort and location of the implant, especially after weight loss.

Other complications: Although silicone oversensitivity, post operational bleeding, increased liquid, and/or size change are rare, they can still occur some months after the operation.
If the patient is prone to it, a hypertrophic crust can develop at the spot of the surgical intervention, but its potential to appear cannot be predicted prior to the operation.
Should the patient plan to undergo a mammography, the X-ray specialist must be warned about the presence of the implant as it can be misleading during the check-up.

Research of unknown hazards: questions arise about the role of the implant in the development of breast cancer or autoimmune deficiency, particularly concerning the deformation of the surrounding connective tissues. Some medical cases may hint to the contribution of implants to the development of cancer although there is no factual evidence to that. Recognized plastic surgeons, rheumatologists and the American Medical Association emphasize the lack of evidence proving any correlation between implant and cancer. Another question for concern is if the babies of mothers with implants can develop immune deficiencies. A recent study confirmed that there may be correlation between mothers with implants and intestinal problems of their children. In spite of the proven benefits of breastfeeding and the approved utilization of silicone in toys and goods for children contradict this assumption. Mothers with silicone implants are advised to consult their surgeons on most recent research results and recommendations.

Recovery Time Advice

Important to know:
Please do not regard your implant as one that lasts for a lifetime as any of the abovementioned complications may result in its removal. As for manufacturers of implants, they also insist that implants should be replaced every 10 years as this is the guarantee period they offer.

During the months following the operation please refrain from:
• Exposure to direct sunlight or solarium usage to avoid any problems concerning the recovery of the wound.
• Doing sports, particularly in the case of muscular implants, to avoid dislocation of the implant.
As no effect of the implant on pregnant mothers has been investigated, please consult your Specialist.

The final shape develops only months after the operation as this is the time needed for the organism to embrace the implant so that it can solidify. Unfortunately with the passing of time even an artificially enlarged breast can sag. This development cannot be prevented. It is important to know that the breast, after removal of an implant, will not regain its original shape, therefore correctional surgery may be necessary, and as a result crusts may develop.

Breast augmentation's brief history

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