Plastic surgeries associated with changing the size or shape of the breasts are of the most active interest to patients of aesthetic clinics. It seems to many of them that to enlarge the chest – it's very simple. You just need to come to the surgeon, describe the desired shape of the future bust – and go to the operating room, and after a couple of days begin to be proud of their perfect forms. However, in order to achieve success in breast correction, there are many very important nuances that both the surgeon and the woman who decides to undergo plastic surgery need to know.
Some secrets of success that can be achieved in breast plastic surgery, read in a special expert interview for Estet-portal.com – Denischuk Pavel Andreevich - plastic surgeon of the highest category, National Secretary of the International Association of Plastic and Aesthetic Surgeons ISAPS, ANA-COSMO Clinic
- What surgeries are most in demand among patients now?
Firstly, this is augmentation, that is, breast augmentation. In principle, this is the most demanded operation not only in our country. Breast augmentation is the most frequently performed operation in the world today. Since I am the national secretary of the International Association of Plastic and Aesthetic Surgeons (ISAPS), I receive the results of studies that are carried out annually. And now, the latest research for 2014 showed that in 2014, and even in 2015, the need for breast augmentation overtook liposuction, because previously the first place was occupied by fat removal surgery. And now the first place is held by breast augmentation operations.
Mastopexy is second only to breast augmentation surgery. It is needed, usually, in two situations.
First – when a woman gave birth, fattened the baby, from this the breast lost volume and shape, sank. And then you need to do a mastopexy. Sometimes the drooping shape of the breast can be corrected, raised using an implant, or the same augmentation done using an appropriately shaped anatomically shaped implant. And when this descent has already gone too far, then by and large it is already necessary to do a mastopexy, to raise the chest to its original place.
The second moment of the need for mastopexy is when a woman first gained weight and then lost weight. Such a problem can occur even in adolescence, when the breast is being formed. Often our girls do not restrain themselves in food, or their parents feed them incorrectly, and they gain weight. When the body is formed in adolescence, the breast is formed from two components – due to glandular tissue and, to an even greater extent, in girls who are overweight, due to adipose tissue. And when they come to their senses and begin to dream of losing weight, and lose weight, then, unfortunately, the amount of adipose tissue gained decreases, and the chest also sags. And if sagging has occurred, then the chest will never rise to its place. Even if the girl gains weight again later, the shape of the breast will still be lost.
Therefore, it is important to explain the rules of nutrition for developing girls, to tell why one should not gain excess weight in adolescence – after all, this then affects the shape of the breast.
- Maybe young girls just never thought about it…
No, they may be thinking, but it's too late. At the age of 11 to 14, they are not interested in this at all, but after 13-14 years (someone earlier, some later), when they begin to look closely at their bodies and compare themselves & nbsp; with others, then this problem arises. Yes, it is very difficult for them to restrain themselves in food, to force themselves to engage in physical activity, and then they have problems in the future.
The third group of operations – this is when a woman has congenital gigantomastia, and breast reduction surgery is performed. Here is such a paradox. Some want to increase their breasts, while others dream of reducing it. Because it's a big problem. After all, large breasts not only sag and lose shape under their own weight, but also create back problems, cause pain in the neck, headaches. And what's more, it would seem that big breasts – everyone admires and says: well, you will feed the baby. And nothing of the sort. It is just impossible to feed a child with such a breast, because the adipose tissue is so crushed, replaces the glandular tissue itself, that feeding becomes impossible. I had patients whom I reduced the shape of the breast, some already had children, but they were not breast-fed.
There are other issues that require a surgical solution: for example, a wide areola – also needs to be corrected. Lack of nipple, inverted nipple – also a problem of problems, because the baby cannot take the breast if there is no nipple. And this problem needs to be solved, the nipple should be pulled out. This is all included in the problems of the chest area.- Tell me, what breast size do patients want to have now?
As a rule, realistic patients come to me. Of course, I remember that there were patients who would like to have a very large breast size, despite the fact that there is no material, that supply of skin that could stretch for this volume. These are, as a rule, paradoxes: some people want to have big breasts that have nowhere to put them, while others would need to put a normal implant in order to raise this breast, but they don’t want this big breast. There are all sorts of paradoxes, but on average, such a gold standard – it's a three (plus half a size / minus half a size). Less often they want a noticeable four. On average, a good chest volume – this is a four, this is such a natural version of the breast with which a woman can feel confident without any additional lining that lifts the chest.
The result of the operation may be for life. There are several important requirements for a woman after breast augmentation – if she endures them, then this result may not change all her life. The first requirement – it's a stable weight. And we will already consider the option when the woman fattened. Because she can be at a stable weight, but she also wants to give birth, and childbirth, to a certain extent, violates the shape of the breast that we created before childbirth and before pregnancy. During pregnancy, breast engorgement occurs, a woman still, as a rule, gains weight. And when she, having already fattened the baby, acquires a normal weight, then the breast, against the background of what was before the operation, loses its shape. She can go down and remain very beautiful. But, unfortunately, the breast can change so much that an operation is required. Therefore, if a woman can withstand our recommendations – stable weight, wearing a bra – the breast shape we created can last a lifetime. But there are such studies, as a rule, starting from the second size, the third, and even more so the fourth size - on average for five years, the chest drops plus or minus up to one centimeter. This is a trend - even very small breasts will unfortunately lose their shape over time. Why? Yes, because with age, the elasticity and elasticity of the fibers are lost, and this process leads to the fact that the breast can lose the original shape that we created. Sometimes even its changed form can quite suit a woman, and sometimes it is deformed to such an extent that a correction is required. It can happen after 5 years, 10 or even 15 years.
I have such patients, whom I look at in 15 years – excellent breast shape. Every year we call our patients after breast plastic surgery to check the condition of the scars, do an ultrasound and make sure that everything is fine with their health. Sometimes patients say that only in connection with our letters and calls do they remember that they have implants. Thus, the factor of breast care and adherence to the doctor's recommendations is very important in order to get a long-term or life-long effect.
- What can you say about the quality of breast implants?
Implants do not need to be replaced after 10 years or so. Today, modern implants provide a lifetime warranty. Nothing happens to them, even if we are talking about implants of old shapes and designs, from old tissues that were used to create these implants. There are studies describing, for example, a situation where a woman had breast implants for more than 50 years, and when they were removed, they made sure that nothing happened to the implants. But the breast on the implant, unfortunately, tends to droop and can change. Therefore, due to the quality of implants, it is not necessary to change those for which the company gives a lifetime guarantee. You don't need to go there again. The main thing is that this implant should be accepted by a woman's body, by a woman's body, then she will live happily ever after with it.
- If a woman already with a breast implant wants to become a mother, will it interfere with breastfeeding?
Absolutely will not interfere. I have many patients who breastfeed while having breast implants. It has been proven by many studies that you can both give birth and feed – the implant does not affect breastfeeding in any way.
I want to answer the question of how the presence of a breast implant affects the possibility of developing breast cancer. Doesn't affect at all. The problem of breast cancer is certainly one of the most pressing for women. Regardless of the presence or absence of a breast implant – if there is a malfunction in the body, if there was a chest injury or some other provoking factors, then cancer can occur.
But there are other studies – which show that women who have breast implants are much less likely to see a doctor with advanced forms of breast cancer. After all, it is not in vain that we call our patients for examination every year. A woman over the age of 40 must definitely undergo a mammogram every two years, and before that, at least once a year, do an ultrasound of the mammary glands. But, unfortunately, not all of our women so closely monitor their health. But patients with breast implants are more principled in the issue of controlling their condition. They check their breasts more often, and even if there are some initial changes in it, they are detected in time and treated appropriately.
Nipple sensation may be lost for the first six months after surgery, especially when the implant is placed through the lower areola. Then gradually the sensitivity will be restored. If the incision is made under the breast, then the sensitivity of the nipple may be lost, numbness may be felt for 2-3 months, sometimes up to six months – due to the fact that we created volume, stretched the tissues, and the sensitivity of the nerve fibers was disturbed. But this is also temporary. The sensitivity of the nipple is absolutely restored.
Moreover, I have patients who claim that the sensitivity of the nipple after the operation has increased. Perhaps, in this case, we can talk about the increased sexuality of a woman after she became the owner of a beautiful feminine breast.
- What are the possible long-term complications after breast implantation?
The most specific complication after breast augmentation with implants – this is when, for some reason we do not understand (or we can trace the cause - for example, there was a chest injury, or the patient suffered some serious illness), the body begins to react to this implant, tries to push it away by forming a thicker capsule around the implant.
This condition is called capsular contracture, it is almost impossible to foresee it today. But when I ask her a number of questions at the first meeting with the patient before planning the operation, sometimes, based on her answers, I can assume an increased risk of such a complication. These can be patients suffering from polyvalent allergies, various allergic diseases, chronic gynecological diseases. I always recommend that patients first undergo the necessary treatment by a gynecologist, solve the problem of carious teeth – all this can provoke an undesirable reaction of the body to the implant. Very important is the overall health of the body, the absence of bad habits – smoking in the first place, as they may further affect the survival of the implant.
Reaction of non-survival of the implant can occur both in a year and in 10 years after the operation. The most healthy body and the most careful attitude to one's health guarantee a long-term good result after the operation.
- In what situation would you refuse a patient a breast augmentation?
Firstly, if the patient is under 18 years of age. Until the age of 20 – I will refuse if a woman comes without parents or without a husband, if by this age she is already married. I will not give breast implants to a woman whose husband objects to such an operation.
We definitely refuse those patients who have some inclusions found during breast examination on ultrasound or mammography. We will definitely send such a patient to a mammologist, who then gives or does not give the right to operate. As a rule, most patients in such situations leave for a year or two, are treated, and then some of them return with the permission of a mammologist – yes, you can operate. Sometimes a mammologist recommends that during an implant operation, for example, we remove a cyst or other inclusion. There are also such opportunities.
- Are there situations when a patient comes to you with problems associated with unsuccessful implantation in other clinics?
We have such patients. If there is a need – we operate, sometimes it is possible to solve some problems without surgery. For example, if we are talking about some kind of deformation or unevenness of the contour, breast asymmetry – this can be corrected using the patient's own fat cells with lipofilling, without touching the implant again and without having to do a major operation. You can use hyaluronic acid to correct some imperfections – it happens that the patient does not have her own fat to correct the breast contour.
- What usually does not suit patients who come to correct unsuccessful, in their opinion, breast plastic surgery?
Big problem – This is the correction of drooping breasts with the help of an implant. Sometimes it is difficult for the surgeon to choose the size of the implant and its placement. And when, after the postoperative swelling has subsided, the patient sees the result – she can say that the shape did not come out the way she wanted, & nbsp; disappointment sets in. Often there is a discrepancy between the result and the expectations of the patient.
Complications are also treated in the form of capsular contracture. In the early stages, this can be successfully treated conservatively. If the treatment does not help, you have to re-operate.
There is such a law: to operate – this is only half the success, and leaving the patient after the operation – this is the second, no less important, part of the operation. Therefore, in our clinic, a special rehabilitation system has been developed for each operation. And for patients after breast plastic surgery, there are special rehabilitation programs that allow you to minimize postoperative pain and quickly remove swelling that occurred during implant installation, accelerate the resorption of bruises that have arisen, and relieve the load on the scar so that it is minimally visible. The task of such a program – allow the woman to recover as quickly as possible after surgery.
The program includes various physiotherapeutic procedures, hirudotherapy. A very important point – the patient is wearing a special bra. First, you need to wear it for a month almost without removing it. Sex is allowed two weeks after surgery – And also only in a bra. After a month, you can wear your underwear, but when playing sports or during physical exertion, you need to put on a special bra again, which fixes the breast with the implant in the desired position, – for about another month. Then certain physical loads on the shoulder girdle are allowed. And, of course, we observe our patients throughout the year: in the first six months they come to us monthly (for ultrasound and other examinations), then – once every three months, and then – once a year.
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