Preoperative Evaluation
During examination you must speak candidly about your expectations from breast surgery. You should be able to express why you want undergoing breast augmentation and what you would like to accomplish with the procedure. Your medical and gynecological history will be reviewed along with information about number of pregnancies, whether or not breastfeeding was performed, breast pathologies, birth control pills, etc. Your doctor will listen to you carefully and discuss with you your expectations. Remember the type of procedure depends on your current breast anatomy.
Examination of the breast must be performed to assess for the presence of palpable breast masses. Also nipples´ position is evaluated. Preoperative mammographic screening of the breast is utilized for a malignant mass-detection. Depending on your circumstances, your surgeon will determine whether you are a candidate for a submuscular or subglandular breast augmentation. Preoperative photographic documentation is taken for planning surgery and analyzing postoperative changes. All potential risks and side effects will be discussed with you in advance of the procedure. Some potential complications are:
Breast surgery risks and potential complications
Bruising (Haematoma)
Your doctor will take the preventative measures during and after surgery to minimize potential complications. However, in some cases drainage are used to minimize bruising.
Infection
Despite all preventing measurements, as with any surgery, risk of infection may occur. The use of perioperative prophylactic antibiotics may prevent surgical site infections. You must contact your physician immediately if you develop symptoms or signs such as fever, sensitivity in the surgical site, if the area around the wound becomes red or if it feels swollen. Patients´ ability to care their surgical wounds is the key to optimal healing. Patients must avoid applying substances on surgical site, and avoid baths until the incision is completely healed.
Scarring
Scarring may be a side effect of surgery. Some scars are less visible than others, but it is impossible for a surgeon to know how the skin is going to heal. Some types of skins have a better healing process than others. The new skin usually has a different texture, but the patient must understand that injuries need time to heal. Skin appearance after surgery is temporary and may improve over time. Scars are more visible during first months, but after this time gradually wounds improve as they mature. Surgeons perform plastic surgery techniques to make scars less visible. Also surgeons may recommend some methods to minimize appearance of scars.
Wounds final appearance depends on many factors such as:
| |
Unexpected reactions of skin. |
| |
|
| |
Skin type. |
| |
|
| |
Location of the incision. |
| |
|
| |
Presence of old scars around the new wound area. |
| |
|
| |
Wound and tissue tension. |
| |
|
| |
|
| |
|
| |
Surgical technique. |
| |
|
|
|
|
Every patient develops a different wound healing process, even in the same procedure. Even with the best planning and the most meticulous surgical techniques, development of scars is unpredictable. You can be sure your doctor makes every effort to hide, camouflage and have a less noticeable incision. However, some marks may be obvious. In these cases, remember that a scar is a consequence of an enhancement in your appearance, and it may improve in time following some medical treatments. Enough time must have elapsed to allow healing of tissues before judging results. As every person has a different wound healing response, the time this process may take is unpredictable. Body response to injury is a very complex process. Be sure to ask your surgeon specific questions about your procedure, the incisions and expected scars.
A well informed patient may have also realistic expectations.
In the wound healing process you may expect:
| |
Inflammatory phase |
| |
|
| |
Proliferative phase |
| |
|
| |
Remodeling phase |
| |
|
In each patient every stage develops in a different way. However, in most healthy patients´ wounds heal in a satisfactory way and with minimal intervention.
Abnormal scar formation
Some patients have an abnormal wound healing process. This is known as hypertrophic scarring. This is a complex matter, but what you have to understand is that scarring occurs as a natural part of the healing process, and therefore the way how tissues repair is uncertain. There are special treatments for skin scars. Before proceeding with any scar treatment, surgeon must identify the wound´s stage. Remember, you need to give the injury enough time to heal. Please ask your doctor about abnormal scars.
Loss of sensitivity
Alteration of nipple and areola sensitivity may be a result of nerve injury during surgical procedure. This condition may be temporary or permanent. Even the best surgeon cannot ensure complete nipple-areola sensitivity. For many patients nipple sensitivity is an important part of their sexual life. Therefore, you must consider this risk before undergoing breast surgery.
Capsular contracture
Silicone breast implants can be placed under the muscle (submuscular) or under the mammary gland (subglandular). In both cases, body develops an organic tissue which grows around the implant. This tissue is called capsule.
This is completely normal and expected event. Usually, this capsule is soft, no palpable, elastic, and undetectable. However, sometimes a capsular contraction occurs and the capsule becomes hard.
The capsular contraction is a body´s natural response to protect us from foreign objects. But this contraction may cause an aesthetically unpleasant appearance, pressure and pain. There are many degrees of contracture. In the worst case of capsular contracture, breasts look unnatural, and a new surgery is necessary to remove the capsular tissue. Many surgeons believe that submuscular placement along with textured-surface breast implants can help decrease the risk of capsular contracture. However, this thesis is not accepted for all surgeons.
Breast massage is often recommended by the plastic surgeon as an effective method of preventing capsular contracture. Your doctor may advise you, from the fourth day following surgery, a gentle massage in all directions. This prevents scar tissue from tightening around the implant. However, capsular contracture must be understood as body´s response condition, and it has nothing to do with the surgeon´s skills.
Breast implant rupture
Implant rupture and implant deflation risk persists, despite the technologic advances of implants. When saline implants break the contents usually leak and the body absorbs it.
When a silicone gel breast implant breaks, the contents usually remain intact, though the implant is broken. In very rare occasions silicone passes through the implant, but silicone may migrate. A breast implant rupture occurs by a loss of implant shell integrity. Two types of rupture may occur:
| |
Intracapsular rupture occurs when silicone escapes the membrane shell but is contained in the fibrous capsule.
|
| |
|
| |
Extracapsular rupture involves the escape of free silicone gel through the fibrous capsule with escape of fluid into the breast tissue. |
| |
|
A woman with breast implants should be on the same schedule of routine mammography as other women.
Other potential complication:
| |
Breast implants displacement or movement.
|
| |
|
| |
Asymmetry. |
| |
|
| |
Calcifications. |
| |
|
| |
Extrusion: (when breast implant comes through the skin) very rare. |
| |
|
| |
Granuloma: Reaction of soft tissues to capsular rupture. |
| |
|
| |
Nipple and areola necrosis: It is produced by poor circulation. |
| |
|
| |
Galactorrhea. |
| |
|
Breast augmentation – information & indications
| |
Nipple and areola size can change after breast surgery.
|
| |
|
| |
Many women experience changes in the breasts size after pregnancy, even when they have implants. |
| |
|
| |
Most often surgeons may obtain symmetry in size between the breasts than symmetry in shape. |
| |
|
| |
Breasts are not perfectly symmetrical. |
| |
|
| |
There is no evidence that breast implants can cause breast cancer. |
| |
|
| |
Surgeon cannot ensure complete nipple-areola sensitivity. Each woman should consider possible loss of nipple or breast sensitivity, especially if it is an important factor in sexual life. |
| |
|
| |
A woman with breast implants should be on the same schedule of routine mammography as other women. |
| |
|
| |
Breast implants are not permanent and may require replacement during your lifetime. |
| |
|
| |
A serious surgeon prefers not to perform breast augmentation in young women that have not yet completed their growth. Usually, girls have reached full physical development by age 16. |
| |
|
| |
Young girls need their parents´ permission to have breast augmentation surgery. |
| |
|
| |
The surgeon may refuse to operate on patients who suffer from a particular pathology, on individuals with emotional disorders or patients who appear to have unrealistic expectations. |
| |
|
|
|
