Breast augmentation: features and risks of mammoplasty

The shape of the breast for a woman is very important and largely determines her self-esteem, so mammoplasty is one of the most sought-after branches of aesthetic medicine. Today, women are interested not only in breast augmentation, but also in other plastic surgeries that help make their breasts more beautiful. The estet-portal asked a plastic surgeon, a specialist in breast shape correction, about the features of such operations, about the expectations of patients and possible difficulties during mammoplasty.

Edgar Kaminsky - aesthetic and plastic surgeon

1. What breast plastic surgeries, in your opinion, are the most popular among patients today?

If we evaluate the level of demand for various breast plastic surgeries, then at the consultations that I conduct, approximately equal requests fall on patients who have not previously had any operations, and on patients who have previously had surgery or they are after breastfeeding. breasts would like to correct its shape. The most demanded today are operations for primary breast reconstruction, that is, primary breast augmentation. Firstly, girls who initially have their own small size ask about it - say, cup B or even A, when there is no breast at all. In this case, the patient resorts to the services of a plastic surgeon and wants to increase the size so that at least some breasts are. And secondly, breast reconstruction is asked by patients whose breasts have lost their shape after breastfeeding, and they want to regain the lost volume. Also come patients who have already had surgery, for example, 10-15 years ago, when the implants were not of such good quality as they are now, and they want to replace them with more modern ones. And of course they want bigger breasts too.

But gradually with the development of plastic surgery, and especially in Ukraine, more and more often mammoplasty is of interest to girls who initially have their own large breast size, and they want to reduce it in volume. Some patients agree to do this without using breast implants. But most still want implantation so that the breasts are more elastic  and dense.

2. For what indications do you consider it appropriate to increase or decrease, breast lift?

It is not expedient to call a plastic surgeon at all, because plastic surgery, and especially aesthetic medicine – it is, as a rule, beauty medicine, and the question is debatable - whether such treatment is necessary or not. Therefore, when a patient just wants to increase her breasts, I will not say whether it is necessary or not, and I never persuade her. The patient herself must convince the doctor of this.

Breast reduction or breast lift – that's another question. When the breast has lost its shape, when it is 5-10 cm lower than the submammary fold, when the breast is simply heavy, large or asymmetrical - then, of course, this can affect both the psychological state of the girl and her health, especially if the breast is heavy and large. Therefore, such operations for breast reduction, perhaps, may be appropriate. The moment of using the implant – very individual, this is already a moment, as it were, of internal sensations of what shape of her breasts in lingerie a girl wants to see.

3. What requests are preferred today by patients – regarding breast size and shape?

Now the fashion for the natural shape of the breast is back. Girls less and less want anyone to notice or know that the breast is not their own, made by a surgeon. If five or six years ago round implants were in fashion, and on social networks there were a lot of photos of girls in tops, T-shirts, where it was clearly visible that the breasts were not their own, now the fashion for anatomical implants has come. Today,  girls want to more and more often give naturalness to their forms, the same applies to size. The most standard query – this is 2.5-3 size, that is, a cup C or B and a half. But this choice concerns Ukraine. In Europe – fewer requests. In the CIS countries, in Ukraine, girls want to have breasts a little larger, more magnificent than, as a rule, in European countries. In our countries, the average figures for the volume of an implant, which the patients wish to put is 320, 360 ml, and 295 ml – it is already considered small for girls, and in Europe the most common breast  implant – it's 250, 280, even 220 ml.

4. How long does the result of breast correction last and when may a second plastic surgery be required?

I always answer in such a way that the surgeon never knows the exact answer to this question, because a lot depends on the quality of the patient's skin. I usually give the example of girls after childbirth. There are girls who gave birth to one, second, third child, and they have a very beautiful belly just a week or two or a month after giving birth. And there are girls whose stomach sags after the first birth, and they need abdominoplasty or liposuction to bring it into shape.

The same thing happens with the breasts. If the skin is in good shape, the skin is good, if initially the breast was small and an implant was placed, then with such beautiful breasts you can walk for 5 or 10 years. If the breasts are large and the skin tone is weak, then, for example, if you do not think about childbirth, then the beautiful shape will be 3-4 years, well, maybe 5 years maximum. If, however, future childbirth is taken into account, then, I think, after childbirth, it will already lose its shape. Well, with an implant, breast correction is always much easier, it is also better from an aesthetic point of view – there are fewer scars. This is also the answer when it is better to do this operation – before childbirth or after.  I answer in such a way that if the skin tone is good, the chest is small, then you can do it before childbirth. If your chest is already large, and the tone is bad,

The American Association of Plastic Surgery, one of the largest organizations in the industry, provides the following statistics: for example, in America, 3-4 years after breast surgery, girls turn to a surgeon for additional correction of the shape of their breasts. But there it is often due to the fact that the girl wants to get an even larger breast size. In addition, they use a lot of saline-filled implants, and these implants can burst and rupture, so they are replaced.

5. In what cases can you refuse a patient a breast correction?

First of all, if there are medical contraindications – these are oncological diseases, these are blood diseases, liver diseases, structural inflammatory diseases of the breast. All these points do not exclude surgery, but require preliminary treatment. Like any other operation, breast plastic surgery must take into account the peculiarities of changes in the human body that will affect the implementation of anesthesia, because all these operations are performed under general anesthesia.

If we talk about a consultative moment, then if I see that a person is inadequate, psychologically unstable, if a girl associates the development of her personal life with this form of breast, etc., then I, of course, will refuse. Because you always need to remember that this is done primarily for yourself, and you need to be a psychologically stable person and calm  in this plan. Be aware of all the risks, always understand that each operation can have any complications.

I would never advise an operation if a person does it with the last money. Because the patient must always understand that more funds may be needed at any time, for example, due to a protracted rehabilitation period. In addition, no one is immune from possible complications, it is important to remember this.

6. Patients often ask if they will be able to breastfeed a baby after plastic surgery. When is this not possible?

This is possible in all cases, except when we reduce the breast. When the chest is large, when it sagged, and our task – raise it, remove excess volume, then a part of the mammary gland is excised, resected, removed, and then breastfeeding is in question. In all other cases, when the patient simply enlarges the breast, the mammary gland is usually intact, not particularly affected, especially if the operation is performed using an incision under the breast - then the mammary gland is not injured at all. When the implant is placed under the fascia or under the muscles of the mammary gland, then the patient can be absolutely calm. When the patient wants to enlarge her breasts with an incision through the areola, then, of course, I warn you that the gland will be injured, and breastfeeding will already be in question in a 50/50 ratio.

Does nipple sensitivity persist after breast augmentation? In what cases is it lost?
As a rule, the sensitivity of the nipple, on the contrary, even increases. In addition, after breast augmentation, the nipples stand erect, and this attracts special male attention, while increasing the woman's sense of sexuality. Sensitivity can be lost only in cases where a large amount of intervention has been performed, when a radical operation has taken place, when a mastopexy has been performed with the nipple moving to a high level. In such cases, the nerve endings may be affected, and the nipple will become insensitive. But, again, in 90% of cases from my practice, the nipples not only retained the same sensitivity, but even became more sensitive.

Which breast plastic surgery do you think is the most difficult and why?
The most complex – this is a mastopexy, this is a breast reduction operation, a breast lift, and also secondary operations, that is, repeated operations, especially if you have to redo the work after another surgeon, because you never know how the operation was performed, how  way, what technique. Perhaps, repeated operations   are the most difficult, especially when a lot of tissue was removed, and incorrectly removed, when the muscle was incorrectly undercut, and then there are very, very many questions.

Well, at the top positions in terms of complexity is also the operation to restore the breast, which was enlarged with fillers. At one time, it was very fashionable to increase breasts with a biopolymer or polyacrylamide gel. The difficulty here is that first you need to extract all this gel, then fight inflammation, then restore the shape of the breast.

What moments of the postoperative period, in your opinion, are the most important?
The most important thing for a patient – obey the doctor. Very important – It's like walking around in compression stockings. Walk in it for a month, or even one and a half or two. Since the surgical technique often involves placing half or even most of the implant under the muscle, any load associated with the tension of the hands, especially the shoulder joint, is prohibited. You can’t play tennis, swim, do push-ups, lift weights, etc. for 2-3 months, or even more. If you follow all these recommendations, then the risks of all possible complications are reduced to zero.

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