Breast Augmentation Surgery

Breast augmentation is done in two ways: 1- breast prosthesis, 2- fat injection. Sometimes a combination of these two is applied.

In practice, the more common method is breast augmentation with breast implants (prosthesis). Since these prostheses contain biocompatible silicone tissue, most people also call these prostheses "breast silicone". In our clinic, we select and apply these prostheses approved by FDA and CE according to the patient's body type, needs, brand, size and surface quality of the prosthesis. There is a lot of true and false information about breast augmentation surgery with breast implants. Here we will answer questions about these issues.

Who Do We Perform Breast Augmentation Surgery?

We apply to women over 18 years of age who do not have a medical problem that would prevent this surgery.

How to Apply?

A pocket is opened under the breast tissue through an incision made in the lower fold of the breast. The breast prosthesis is inserted through this incision into the pocket.

What does it mean to place the prosthesis above or below the muscle? Which is Better?

The breast prosthesis is basically placed in one of two planes: 1- Between the breast tissue and the muscle tissue 2- Under the muscle. 

The layers of our visual field are as follows from superficial to deep: Skin, Breast Tissue, Pectoral Muscle, Ribs. Under the breast tissue in our chest is the "Pectoral Muscle". This muscle is quite bulky and strong. The most important factor in deciding which prosthesis to place in which plane is the amount of breast tissue in the patient and the sagging condition of the breast. In women with very little breast tissue, we place the implants under the muscle tissue both to provide extra volume and to reduce the visibility and palpability of the breast implant from the outside. We also know that "capsular contracture" (the formation of a hard capsule around the implant) is less likely to occur after implants placed in this plane compared to above the muscle. The disadvantage of placing the prosthesis under the muscle is that the surgery is a little more painful than the under-breast plane and there is a possibility that the prosthesis may move with muscle movements in the future (we call this animation). 

We use the placement of the prosthesis above the muscle, that is, in the plane between the breast tissue and the muscle, because it has a better recovery and lifting effect in cases where the breast is sagging. In prostheses applied in this plane, capsular contracture is more common and revision rates are higher.

What is a Textured Surface and a Smooth Surface? What is the Difference? Which is Better?

Breast implants have a silicone gel inside and a durable surface surrounding this silicone on the outside. It is this surface that comes into contact with our internal tissues after entering the body. Due to the capsular contracture problem we mentioned earlier, over the years, companies have developed a rough surface implant in order to prevent this situation. Indeed, when placed in the inter-breast-muscle plan, rough surface implants caused less capsular contracture. However, new information and studies have begun to publish that rough surface breast implants may be associated with a new type of cancer. This disease was defined as "Breast Implant Associated Anaplastic Large Cell Lymphoma - BIA-ALCL" or "Breast Implant Associated Anaplastic Large Cell Lymphoma". In various countries around the world, rough surface breast implants have started to be banned. In our clinic, we continue not to prefer rough surface implants, which we have not used in the past, and we think that they will soon be banned in Turkey.

On the other hand, there are no such cases about smooth surface implants. When placing smooth surface breast implants, we usually prefer submuscular placement to reduce the risk of capsular contraction.

In short, we think that prostheses with a smooth surface should be used.

What is Anatomical Breast Implant? What is a Round Breast Implant? What is the Difference? Which is Better?

Round breast prosthesis is the most commonly used type of prosthesis that is symmetrical and has an equal amount of silicone gel everywhere. 

The anatomical breast prosthesis is a drop-shaped prosthesis with less volume at the top and more volume at the bottom when placed under the breast. This prosthesis is produced to mimic the natural breast type, but we do not prefer this type of prosthesis in our clinic. The reason for this is that in general, the part of the breast that we want to fill is the upper part that will appear in the décolleté area. In anatomical prostheses, since the upper part is thin, it cannot volumize this part to the extent we want.

Whether we place round breast prostheses in the inframammary plane or in the submuscular plane, we observe that they give the natural upper pol (upper part) fullness we want much better. Of course, drop-shaped anatomical prostheses are also a type of prosthesis that many of our colleagues use and have experience with. However, in our own clinic, we prefer prostheses with round and smooth surfaces, which we think provide more natural and more desired results. We prefer to place these prostheses in the submuscular plan.

What Determines the Size of the Breast Implant?

The size of the breast prosthesis to be implanted is decided according to the patient's body type, wishes and the correspondence of these wishes with reality. Basically, what we mean by body shape is the breast base. The breast base is the projection area of the breast on the skin and determines the area where the implant will be placed. In women with a narrow rib cage, prostheses with a small base are placed, while in women with a wide rib cage, prostheses with a wide base are preferred. As the base of the prosthesis expands, the volume of the prosthesis required to achieve the desired height (projection) will increase. In short, the first factor that determines the volume of the prosthesis is the body structure.

The second factor is what size the patient wants. Some patients express that they want their breast to grow a little bit, they want it to be unnoticeable. Some patients want medium-sized breasts, some want large breasts. Some patients, on the other hand, want to have breasts that do not coincide with reality and that are much larger than natural. Obviously, we approach such unnatural requests cautiously, and most of the time we do not perform such applications. However, we discuss small, medium and large prostheses with patients during the consultation, sharing their wishes, reservations and expectations. This decision phase is an important process, because once the prosthesis is in place, surgery is required to replace it.

Can Breast Implants be Placed Under the Armpit?

Yes, a breast implant can also be inserted through an incision in the armpit. However, this is not a very preferred method, and there are several reasons for this. First of all, the scar remains in the armpit and is more prominent in daily life than the scar under the breast. Two; bleeding control, which is very important for breast implant surgeries; even minor bleeding increases the rate of capsular contracture in the future. In the armpit technique, the desired bleeding control cannot be achieved compared to under the breast. The third is that it cannot be placed under the muscle by entering the armpit. Although there are publications and reports on underarm placement, this only complicates the surgery and does not provide any benefit.

How is Anesthesia in Breast Prosthesis? What are the Recovery and Discharge Times?

It is performed under general anesthesia or local anesthesia with sedation.

Patients are discharged the same day or the next day. On the 3rd day, the bandages are removed and a special medical bra is used. This bra is used for 1 month. It is recommended to avoid physical activity for the first 7-10 days. The most important point here is not to load the arms. Especially if the prosthesis is located under the muscle, arm movements should be restricted for faster and more comfortable healing. Patients fully return to their normal lives in the 1st month.

What is the Surgical Scar in Breast Prosthesis?

After the operation, it takes 1 year for the scar under the breast to take its final shape. A scar of 3 to 5 cm in size remains at the level of the breast fold, depending on the size of the prosthesis to be placed. As these scars heal, they first crust, then turn pink, then return to skin color within months and become normal. We do not encounter scar problems in breast prosthesis. The final scar is an average of 4 cm in the same color as the skin, hidden in the breast fold.

Does Breast Implant Prevent Breastfeeding?

In this surgery, no damage is done to the milk glands and ducts, so it does not interfere with breastfeeding.

Does a Breast Implant Explode?

The surface durability of breast prostheses produced with old technology was weak, so we used to often hear news of breast prosthesis explosion such as "The silicone exploded". However, nano surface technology is used in breast prostheses produced with today's technology and these prostheses do not explode even if a truck passes over them. So this situation is no longer a situation to be feared.