It is in our cultural identity: when entering puberty, just because they’re getting bigger, young women get the urge to hide their breasts. Hunched stance that starts at those ages even causes poor stance in the later ages. By the way the name is breasts, we can’t even say boobs for some reason. But there’s a group of women that don’t go through these phases. And this is their story.
Anatomy of a Breast
A breast consists of skin on the exterior, and fat tissue and milk gland in the interior. There are about 20 suspensory ligaments that hold them together. Fat tissue and milk gland can lose volume caused by a lot of hormonal and/or metabolic factors. But the skin surrounding them might not always join those tides. When this is the case, in addition to volume reduction, there might be sagging. For now, this basic information will help you better understand issues regarding breast surgeries.
Why Breasts Don’t Develop?
Generally speaking, half of our patients are the ones who didn’t get enough breast development, and the other half are the ones who lost volume by the passage of time. But why does a breast lose volume?
Because a portion of breast tissue is fats, weight loss can cause breast reduction.
In pregnancy, hormonal values increase vastly. After birth, these values come down to normal but this sometimes can cause reduction in breast tissues.
During breast feeding period, because of milk gland atrophy, breast reduction might occur.
Breast cancer treatments sometimes require a portion or all of breast tissues to be removed. This can sometimes be fixed with a small implant, and sometimes with a new breast design.
If there’s a difference in sizes between breasts originating from birth, this can be fixed with breast augmentation.
Having undergone a breast augmentation operation before but wanting a bigger breast can be considered as a breast augmentation too.
Whatever the reasons, we have small breast volume and want to enlarge this. How? Of course by implanting. “But with what?” is on the other hand is a more interesting question. I want to skip the various hormonal and medical treatments and compare the surgical approaches. In theory, breast augmentation can be done via synthetic fillers, your own fat, or silicone implants.
What is Non-Surgical Breast Augmentation?
Generally speaking, it can be defined as enlarging breasts by injection of synthetic fillers in a clinical environment. It can be done by people other than surgeons. Sounds good right?
There are many types of fillers produced for this application. If you ask my personal opinion, I don’t recommend putting synthetic fillers to the breasts. Even though they are very easy to apply and have a high profit margin, they’re harmful to a patient’s health. It’s said that these fillers can be applied even in an office environment but this simple isn’t true.
In order to achieve the desired volume, there might be a need for high volumes of fillers. This causes there to be a huge pool of foreign matter to be accumulated inside the breast and cause an infection. And because these fillers are liquid, it’s hard to keep them on the desired position. Other than not being logical healthwise, cost of this procedure is much higher than implants.
Even if you have them despite all these negative sides, your body will process them out over time, thus turning to square one. A filler matter that can stay in the body for 9 years poses a greater threat for infection. You might say “but slicon implants are also freign matters and can pose the same threat”. You’re right, they might. But in such a case, they can be removed. In fact there is a really small chance of this happening. But what can you do with fillers? Removing an infected liquid that has been distributed inside the breast won’t be that easy, to say the least.
Breast Augmentation With Fat Transfer
Recently, breast augmentation with fat transfer is mentioned more and more. I strongly oppose this procedure. The transferred fat will dissolve in time, and this dissolvement might not be even.
Let’s say we ignored this part. But with high volumes of fat transfer, the percentage of dissolvement is higher, and the risk of infections are heightened. But the most important aspect of fat transfers is microcalcifications. Microcalcification is the crystallization of injected fat particles by calcium reactions. This is in fact a natural physiopathological process. But what does this all mean?
Most of these calcifications are miss diagnosed as cancer tissue by even the most experienced radiologist. This will cause you to be suspicious about cancer from the first mammography. Also because they don’t want to take risks with such an issue, the radiologist will immediately put you in the risk category too. Outside of biopsy, nothing will eradicate this suspicion.
There’s still another great risk with breast fat transfer. If there is a cancerous cell on your breast that won’t activate in your lifetime, this new transfer of fat might activate that cell.
What if your breast cancer gets triggered by this fat transfer? So far, noone with scientific credentials has come up with a counter argument to this hypothesis. If you can, please enlighten me.
At the end, the only healthy option left for this operation is breast implants.
What are Breast Implants?
Implants are put inside the breast in order to increase the volume and/or improve the shape. There are many types of implants, smooth surfaced, textured, drop shaped, round, double cohesive to name a few. There are many options, but which one should you choose?
The right thing to do is, don’t choose the implants yourself. Only describe to your doctor what type of breast you want to have. Your doctor will choose the best option for your expectations and anatomy. Do you want your clavicle to be more noticeable or not?
If you want a more prevalent cleavage, your implant should be a round one. Don’t think a round implant is round as a ball. When patients see round implants at my office they are usually surprised. Don’t push your imagination when it comes to surgical procedures. We do this for you.
Silicone Implant Types:
Round: Ova structures with identical domes. But this doesn’t mean they will seem like oranges. When a patient wants a more prevalent cleavage, this is our choice.
Anatomical: It’s also known as drop implant. Bottom half has more volume than the top half.
Smooth: Has a smooth exterior and more risk of capsule development.
Textured: Has a special surface that aims to prevent capsule development.
Micro-Textured: Has a textured surface that is less rough. It’s a relatively type of implant.
Teflon Surfaced: Made to eradicate capsule development.
Grade 1 Silicone: Has a soft gel
Grade 2 Silicone: Has a mildly hard gel
Grade 3 Silicone: Has a hard gel
Double Cohesive Silicone: Hard on some parts, softer on some parts.
Serum (salted water) Based
Soy Based (No more produced)
Ones with air pores inside that are more lightweight.
Ultra High Profile
Do you still want to choose your own implants?
What Does FDA Approval Mean on Silicone Implants?
Almost everyone has heard of the FDA (Food and Drugs Administrations) of the USA. In order for a product to be sold in the United States it needs to have the FDA approval. But this doesn’t mean not having FDA approval means low quality. If a product is not aimed at the USA market it doesn’t need to aim for an FDA approval.
But because of the seal of quality this approval carries with it, as surgeons we too try to use implants approved by the FDA. In short, in our operations we use the highest quality implants, and they have international guarantee papers.
Are Breast Implants Harmful?
Base molecule for silicone is extremely inert. This means it is a very stable substance and doesn’t change based on the external factors. It can’t change the trajectory of a biochemical reaction in the body. Based on this property silicone is used in drug and cosmetic fields for a long time. Since 1962 it has had its place in breast implants too.
What Should be the Size of a Breast Augmentation?
And then there is the issue of size. How much bigger will it be? As I said before, if a person didn’t have breast development, they don’t generally have the shyness period in their lives. But they start to go through this shyness period before the breast augmentation surgeries. They find it hard to express the true size of breasts they want to have. Ever since I discovered this, I try harder to understand their true wish for a breast size. I’m on the side of using the biggest implants possible for a person’s body type, that doesn’t meet in the middle, and that they can carry.
Can I Breastfeed After Breast Augmentation?
Breasts are of course used for breastfeeding but they are sexual organs first and should do this task sufficiently first. Don’t be alarmed by this definition. You won’t have any problems breastfeeding. In almost all of the surgical procedures, implants are put behind milk glands and canals. Meaning breastfeeding isn’t affected. You can breastfeed after breast augmentation.
Should My Implant be Textured or Smooth?
Textured or smooth? As a surgeon who experienced both types for a long time, my preference is on the textured side. Although they appear to have an advantage because of their smooth exterior, smooth surfaced implants tend to harden the breast and give a rock-like feel.
Also, because implants are put inside using a small incision, smooth surfaced implants tend to move right after implantation and make unwanted shapes. Textures on the textured implants must be good quality to prevent them from falling off the implants and mixing with the immune system, causing unwanted reactions.
In addition to these, there are micro textured implants, but in clinical applications, they also showed a tendency to slip after implantation just like smooth surfaced ones.
How are Implants Put Inside?
Another important issue is the placement of implants. It is possible to put implants through a cut under the breast, nipple, under the arm, or through abdominal tissue in case of a tummy tuck surgery. There is also another implant type that can be implanted through an incision on the belly and inflated afterwards using a serum solution. I have the experience to put the implant through wherever you want.
When we compare the pros and cons, my suggestion is on the side of under the breast. This method has many advantages such as; less pain, fast scar healing, comfort, safety, preservation of nipple sensation. We can also discuss and decide on this issue on the examination.
Should Implants Put Under Muscle or Over Muscle?
So, we have decided on which way we will put implants in, but in which plane will we put them? Under the muscle or over the muscle(behind milk gland)? Both planes have defenders and both groups are right in their own way. Then which one will we choose? At the beginning of the millenium, the idea of putting implants under the muscle membrane entered our field. The aim was to get the advantages of both under muscle and over muscle while avoiding the disadvantages.
This idea has been combined with the classic dual plan approach. In this classic approach, most of the implant is put under the muscle while a smaller portion of the implant is put under the muscle membrane. I have an exception to this in my practice. With women who practice sports a lot, functionally it is more beneficial to put the implant over the muscle. Because these patients use their pectoral muscles more frequently and we don’t want any deformities after the surgery.
Additionally, even if textured implants are used, the problem called motion effect appears more in these patients which we want to avoid.
Are Implants Noticeable After Breast Augmentation?
I mentioned a lot of technical details above. I also mentioned that I use a dual plan which puts most of the implant under the muscle and some of it under the muscle membrane. Another advantage of dual plan is to prevent implant from notice. This way your breasts will always appear natural.
What will My Size be After the Surgery?
This is one of the most popular questions. Answer isn’t appealing to patients at first, because in order to speak the same language, we first must discuss breast sizes. After this surgery, your breast size will increase, but neither you chest width nor your skeletal width will increase. Cup size is used to pronounce the size of our breast dome. The surgery increases this size from B to C or D for example. If your bra has the marking 85B on it B is your breast size and 85 represents the size of your chest. This size is given by measuring the chest width right under the breasts.
I always ask my patients for one thing: Show me pictures of bodies that you like. Not only breasts. What is important here is the ratio of breast that you like to the body that has it. Body height, shoulder width, and chest width of the women in the picture is important. It is more important for me to understand which body type you like rather than size of breast of your preference for size of the implants.
What’s Waiting for You After the Surgery?
Surgery takes 40 minutes and is done under general anesthesia. When you wake up, you will have a tight dressing. I don’t use a drain. You need to use the elastic band that envelopes your chest for two weeks after the operation. Stitches don’t need to be removed, they are self dissolving. You can swim at the sea after 4 weeks from the operation. Pain is minimal in this surgery.
Will I Need To Massage My Breasts?
After breast augmentation surgery, depending on the type and placement of the implants, we will ask you to massage your breasts. We used to start these massages really early but recent information shows us that we need to start it a little bit later. Reason for this time change is to prevent pieces from implants to be taken off, even if it’s on the microscopic scale. These are adjustments made based on very miniscule probabilities.
Do Implants Fix Sagging on Small and Saggy Breasts?
Not always, of course. Imagine the breast exterior as an empty shell. Implant we put inside will of course tighten that skin but don’t forget that implants have a weight of their own and pull down a saggy breast with the effects of gravity. In short, you would have breasts that are bigger due to implants but still saggy due to their elasticity. What is the solution? Mastopexy(Breast roundup) must be applied with breast augmentation according to your needs.
Of course there is an incision on your breast, and tied to this, you will have a surgery scar. This scar is usually a vertical one and starts from your areola going all the way down to the base of the breast. If there’s much more sagging on the breast, this cut will be in the shape of a T and you will have an additional horizontal incision on the base of your breast. This is not an important issue. The important factor is the quality of these scars and the shape of the breasts to be satisfactory.
What is the Life-Span of Breast Implants?
International laws prevent guarantees over ten years. For this reason, information cards on implant boxes give us a guarantee of ten years. But it is possible to use implants for a person’s lifetime. And you can use a quality implant for your lifetime. Only thing is, it is recommended by the FDA to get implants checked for liquid accumulation around them once a year. This is relatively new information even for the year 2020. If there’s a case of liquid accumulation, a sample must be taken for cytology laboratories in order to prove there are no pathologies. This has a probability of 1 in 500.000.
Price for Breast Augmentation with Silicone Implants
Because there’s a cost factor of the price for the implants in breast augmentation surgeries, prices change according to their prices. If you can recall the types of implant I mentioned before, you’ll remember there are quite a few options. Despite this, the main component of these implants, silicone has two major suppliers in the world. Because of this, in 2020, price of breast implants, and price of breast augmentation surgeries that use these implants are in the monopoly of these companies and the US Dollar.
And of course there should be a price of value added by the experience and knowledge of the surgeon who uses these implants. In life, less people see and judge your breasts than your nose. Unfortunately, because there’s such a difference between these surgeries, patients tend to make a choice based solely on pricing. And of course this is a mistake. Rather than looking for a better price for breast augmentation, you should assess how much you value your breast in relation to your whole body.
What are the Worst Case Scenarios?
This surgery is done with general anesthesia. All the complications of anesthesia, infections based on type of surgery, bleeding, healing problems might occur. Tied to silicone implants, there might be capsule contractures, silicone leakage might occur, although it is very rare. Sensation loss on nipples is very rare and usually temporary. I can safely say these complications have a very low percentage of probability. Even if they occur, they all have solutions. Breast augmentation is a really comfortable surgery that you can turn to your social life relatively fast afterwards.
Your whole world will change in an hour. Half in your left, and half in your right.
Can I Remove or Replace Breast Implants?
You had a successful breast augmentation surgery but want to return to your old self. Of course this is possible. The most frequent request we get is that because patients tend to be shy about expressing their true desire for size, they tend to find their new breast smaller and still wish for bigger breasts. With this patients it is possible to change the implants with bigger volumes. Only, a patient must give herself time to think and not to rush before making these kinds of decisions. You decide how you’d like them more, the rest is on our hands.
Can There be Sagging After Breast Implants?
As Newton said: “Everything rushes to gravity”. Of course breasts will get their share from this rule. At the end, an implant has its own weight, and isn’t exempt from gravity. Also I want to mention that a thin fibrotic membrane will form around the implant which will stick both the implant and the breast to the chest front and delay sagging. But what happens if they sag?
Depending on the level of sagging, an augmentation surgery can be done even with the current implants. Don’t get a wrong idea from this, implants won’t hasten breast sagging. In fact, they slow it. And this process we’re talking about is really extended. A proper use of bra makes this process even more extended. Because of this, focus on joys of bigger breasts for now.
What is the Process for Breast Augmentation?
First stage is of course the decision part. After an examination in our clinic, we need to agree on a surgery date. With before and after pictures of patients who have given permission, we can make the decision making easier.
We assess the pictures you’ve picked beforehand (preferable naked). This shows us what type of breast-body ratio you like. In fact I ask my patients to show them to me again on the morning of the surgery.
Of course, breast augmentation prices have been updated in 2020 too. In order to not carry the financial matters to the day of the operation, arrangements are made.
As with all plastic surgeries, taking before pictures before this operation is also a must.
After all the preparations, we bid you farewell until we meet again on the morning of the surgery.
If there isn’t a special condition we will have in the hospital early in the morning to get all the necessary tests done and prepare for anesthesia.
After everything is ready, we take you to the operating room for surgery that will last for 45 minutes. You will be given sedatives to make this process more enjoyable on your part.
What Should I be Careful About After the Operation?
When you give volume to a part of the body, tissues get stretched and give a strained feeling as well as pain to the body. The important thing here is as much as you relax, the healing process will get better with it.
Your incisions will be covered with a special bandage, so you won’t need to dress your wounds.
We will ask you to wear a special bra.
An elastic girdle which we call chest ribbon, you will need to wear for 2 weeks.
After breast augmentation surgery, I will see you on the 1st, 2nd, 3rd, 10th, and 20th days, depending on the state of your breast I will continue to see less frequently.
I don’t want you to turn to your sides while sleeping. 3-4 months is the closest you can sleep on your sides.
Keep the silicone implant identification and guarantee papers after breast augmentation.
When Will I be Completely Healed?
After the first week of the operation, your pain will be mostly gone.
You might find your breast a little stiff in the first month, if this is the case, you will see them getting softer in the first two months.
Usually, there isn’t a numbness on the nipples. If it happens, It will go away in the first 3 months. Seldom it may take two years for this to pass.
Please don’t be negligent about your check-ups.
As I mentioned before, massage used to start really early after the operation, but we need to wait a little bit before starting to avoid fragmentations.
As with all surgical procedures, don’t forget this: positive people heal better.
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