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Mammoplasty

This is an operation to increase the breast size. The purpose of the operation is to increase the size or change the shape of the breast using a  silicone breast implants. It can also be used to correct light ptosis and asymmetry. Traditionally, plastic surgery for breast enlargement used one of  the three main methods: Increase in size using auto tissues, injected synthetic materials and using an implant.

We conducted the first breast augmentation surgery in the 1980s , by rotating the thoracodorsal segments. It should be noted that patients at that time were very afraid of silicone implants for breast enlargement and thus could only use auto tissues. 

Our clinic has been developed several methods of breast enlargement using auto tissues. As it is, this method was used in polandis syndrome (complete unilateral amastia - complete absence of a large muscle in the breast) and breast reconstruction at the time.

For our aesthetic breast surgeries our clinic uses implants from top leading firms, such as Mentor, Polytech. for implants to enlarge the world's leading companies such as Mentor, Polytech. We prefer the augmentation through breast implants placed intramuscularly , since this method allows getting a more natural shape of the breast and much less risk of developing contractures.

The first breast augmentation was performed by Czerny in 1995. She used tissues from the spinal cord lymphomas and transferred them to the chest to correct the asymmetry.

Later the surgeries used the tissues taken from the buttocks and the abdomen, as well as complex tissues (skin - fatty - muscle auto transplants). These methods do not give the desired results, since the transplanted tissue was desorbed and pronounced asymmetries were developed. It should be noted that at present auto tissues are widely used in breast reconstruction during oncological interventions.

The use of synthetic materials for the purpose of breast augmentation started in the 18th century.  In 1899 Gersuny was the first to use the paraffin injection for breast enlargement . This was followed by the use of wax and vegetable oils, which were injected subcutaneously. Such procedures were recognized as dangerous for health and have been banned since 1960.

However, it should be noted that in some countries, unscrupulous surgeons continue to use injection liquid materials for the purpose of breast enlargement, which causes injuries of breast lymph nodes and migration of these materials into deep tissues. In such cases, it often becomes necessary to conduct the radical postmastectomy (breast removal).

 

Among these three methods of breast enlargement use of implants is the most justified method. The first implants were made of ivory (runs) and glass, but later rejected them because of their non-natural qualities. Subsequently the attention was focused on the Ivaloni sponge-like materials  which will allow for a more natural breast shape. The use of such materials has been suspended due to complications following sponge compression, compaction, shape change, and distortion.

 

Evolution of modern silicone implants began in 1962, when Cronin and Gerow first used silicone implants filled with silicone gel . Over time, the silicone implant is completely expelled all other methods and materials from the practice.

Today, breast augmentation silicone implants are used in a variety of shapes and sizes. These are round, pointed and anatomical shape of the implant.

Implants can also be high- or low profile which allows the nipple - areolis be set at the desired height.

Indications for augmentation can micromasty (small size of the mammary glands) , post-lactation involution (breast volume zoom out ) , delivery and breast- feeding and subsequent loss of skin elasticity, weakly expressed ptosis , and breast asymmetry. In case of pronounced ptosis , it is possible to combine the Lifting with  breast augmentation.

Nowadays, as a result of many years of research, it may be safe to say that the use of implants does not increase breast cancer risk. Mammography and ultrasound examination is always an option. However, these tests are mandatory before the surgery, as well as mammalogist consultation to rule out any ongoing processes in mammary glands.

The operation is carried out under general anesthesia for the duration of 1-2 hours. Dental Implants can be fixed in as intra-mammary space (under the gland), as well as a large muscle beneath the breast (IM) . The incision may be made at skin wrinkles around areolis and under the armpit. The length of the incision is 4-6 cm. During the operation the drainage system may be used, which is removed in 2-4 days.

Typically, patients are released and remain on an outpatient treatment from the next day. The partient can go back to work in 1 week after surgery .

Stitches are removed in 10-12 days, sometimes nipple - areolis complex experiences temporary disruption or change of senses.

Driving a car is allowed 1-2 months later.

Full physical activity allowed 2-3 months after surgery .

Complete formation of scars is over about 12 months after surgery.

This is an operation to reduce the size of the breast. Its aim is to reduce the size of the breast, as well as giving a new shape and position of the breast nipple - areolis complex. The operation involves the resection of the excess breast tissue from the mammary glands. Reproductive mammoplasty had been performed at our clinic since 1990s and we use various methods of mammary gland reduction. 

Reduction of large mammary gland or the ones with ptosis was first performed y Chembers in 1896. 11 kg mass was resected , respectively.

In 1903 Guinard presented the breast reduction technique – half-oval incision was used to resect excess breast tissue and skin.

In 1928 Biesenberger provided extensive removal of breast skin and position move of the Parenchyma nipple-areolis of the breast.

In 1930, Schwarzmann first used the nipple - areolis complex nourishing and provision of adequate blood supply.

Brazilian surgeon Ivo Pitangious played a special role in reproductive Mammoplasty, who has developed several methods for this operation.

 

Indication of reductive Mammography are large breasts, excessive sweating under the breasts, difficulty to choose linen, swimming costumes, clothing, as well as medical problems (skin irritation under skin, fatigue, pain in the back, spine diseases) .

Young patients often develop an inferiority complex because of the large breast, which makes it difficult for them to interact with their peers.

It is verified that reductive mammoplasty does not affect breast mammary gland tissue and cannot cause various types of mastopathy or cancer .

However, before the surgery, breast ultrasound or mammography examination is mandatory for all patients . Mammalogist consultation is also necessary to rule out or determine the current condition  mammary glands.

The operation is carried out under general anesthesia; the duration of the surgery is 3-6 hours. During the operation the excess skin, fatty tissue and part of the gland is removed. Nipple - areolis complex soft tissues are repositioned to a new place. During the operation the drainage may be applied, which is removed in 2-4 days.

The patient is usually released on written outpatient treatment in 2-3 days.

The patient can return to work within 1 week after surgery .

Stiches are removed in 10-12 days. In some cases, the nipple areolis complex may experience sensory limitations. Driving is allowed after 2 weeks .

Full physical activity is allowed in 1 month after surgery .

Complete formation of scars occurs over about 12 months after surgery . In rare cases it is possible to develop a wide range of scars and may need to be removed later. 

Lifting the mammary gland during the masto-ptosis (lowering the breast).

The aim of the operation to change the shape and position of the breast tissue by raising breast and nipple - areolis complex. Lifting is carried out mainly at the expense of the skin resection.

At hour clinic the breast lifting is performed since the beginning of 1990s. We use peri-areolar, vertical and T-like Mastopexy. 

History of breast lifting is closely related to the history of breast reduction, moreover, these operations use similar technique in many respects. The main difference lies in the fact that the incision in the skin is smaller turning the breast lifting. Also , unlike the breast reduction the skin is usually resected during breast lifting.

One of the first breast lifting operations was conducted by Michael Poussin in 1897. He made the incision above the areolis to resect part of the skin , breast and fat tissue, but the size of the breast reduced after the operation and turned unaesthetic. He was better able to reduce breast size with lifting, but the repositioning of the nipple - areolis resulted in an asymmetric arrangement.

A partial solution to this problem was found by American surgeon Max Thorek in 1921. He resected the nipple-areolis complex during lifting for tis subsequent transplantation. In modern plastic surgery medicals rejected the method of resecting the nipple - areolis complex for its subsequent transplantation.

Nowadays they perform peri-areolar, vertical and inverted T- shaped lifting. Each type of lifting has its indications depending on level of breast lowering before the operation. 

Indications for mastopexy derive from the such changes in the breast as expressed ptosis and limited skin elasticity due to age or breastfeeding.  Mastoptozi also may develop as a result of weight loss. Mammary glands start lowering, wrinkles beneath the breast become pronounced, position of the nipples also lowers, the breast tissue moves downward, the upper contour becomes shallow, the skin is stretched.

If the patient expressed interest, the  lifting can be carried out in combination with silicone breast implant augmentation. With mildly expressed ptosis, breast augmentation with silicone implant may be sufficient.

It is established that Mastopexy (Breast Lifting) does not affect the condition of breast tissue and can not cause various types of mastopathy or cancer. However, before the surgery, all patients undergo breast ultrasound or mammography examination and mammalogist’s mandatory consultation in order to verify there are no ongoing processes in the mammary glands. 

The operation is conducted under general anesthesia for the duration of 1-3 hours depending on the method used. Lifting occurs by repositioning of  the mammary glands of the breast tissue, so that the papilla or areoli are moved to a normal position and shape of the breast is improved. Depending on the method used, the incision can be made around areoli, vertically from below the areoli or the wrinkle underneath the breast area. During the operation drainage system may be installed, which is usually removed in 2-4 days.

Typically, the patient is released on outpatient treatment the second day after the surgery. The patient can return to work 3-5 days after the surgery. Stiches are removed in 10-12 days. In some cases temporary disruption or change of nipple - areolis complex sensitivity occurs. The patient is allowed to drive after 2 weeks. Full physical activity is allowed 1 month after surgery.

Complete formation of marks around incision area occurs over about 12 months after the surgery. 

Asymmetry can originate from both congenital diseases, for example polandis syndrome, as well as the usual asymmetry. Various methods can be used to correct breast asymmetry: breast endo-protesis, breast lifting  along with endo-protesis, reductive mammoplasty.

 
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