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Breast Augmentation

Breast augmentation, also called augmentation mammoplasty, breast enhancement or simply boob job, is among the most preferred plastic surgeries. It enhances both the size and the shape of the breast.

Options related to the type of implant, the incision and placement method should be discussed with the suregeon in detail. The final decision depends on many factors, such as, the age of the patient, the degree of sagness, the size of the nipple, whether the patient will breastfeed, etc. Not all methods are ideal for everyone, it is crucial to decide on the ideal method for the each patient.

In recent years, cohesive gel implants are more preferred over saline implants. Cohesive gel implants, which are semi-solid, look and feel more natural. The risk of rippling is lower and if rupture takes place, nothing leaks out, maintaining form and integrity. Deflation does not occur as in saline implants. Saline implants, on the other hand, look and feel less natural, and the risk of rupture is higher. When rupture occurs, the saline drains out and is absorbed into the surrounding tissue. The breast will look flattened or deflated as it loses volume. It should be noted that saline is salt water and quite harmless to the body.

Incision methods
There are four methods to place the silicone implant.

•    İnframammary ( incision from the crease under the breast)
•    Peri-areolar (  nipple incision )
•    Transaxiliary ( incision under the arm pit)
•    Periumbilical (incision from the navel)

The inframammary method allows an easier placement of the implant. This incision is generally less concealed and may cause fewer breastfeeding difficulties than the periareolar incision option.
The main advantage of trans-axiliary and peri-umbilical methods is the absence of scarring on the breast, however, it is impossible to place cohesive gel implants from the navel and hard to place from  under the arm pit. In both methods, it is harder to create a pocket behind the breast.  

In the Peri-areolar method, cohesive gel implants can be used and it is easier to create a pocket behind the breast. On the other hand, placing the implant may be harder if the nipple is small and  there is a risk of change in nipple sensation.     

Placement Options

The implants are either placed between the breast tissue and  chest muscle (sub-glandular) or partially or wholly under the major chest muscle (sub-muscular).

Sub-Glandular Breast Implant This position is frequently recommended for women who already have a fair amount of breast tissue. They may also have a mild degree of breast droopiness (ptosis). A moderate amount of breast tissue will help conceal an implant placed in a sub-mammary pocket. In addition, a mild amount of breast droopiness can be corrected.

Sub-mammary pocket placement is also recommended for women with unusually shaped breasts, as the implants will help to change the shape of the breast better than implants placed in a sub-pectoral pocket.
This method may help reduce your surgery and recovery time. It may also make your breast implants easier to access if re-operation is necessary. Implants that are sub-glandular may be easier to see and feel through your skin.

In Sub-muscular approach the chest muscle covers the upper two thirds of the implant, while the bottom third is covered by your natural breast tissue. Because the chest muscle covers the majority of the implant, it will act like extra padding, making the implant less visible through the skin and 'feel-able'. This allows for a tear-drop shape to the breast that looks more natural. Sub-muscular placement may result in less palpable implants and may reduce the risk of developing capsular contracture (Capsular Contracture: A tightening of the scar tissue surrounding an implant. May require an additional surgery to correct), as well as offer easier mammographic imaging of the breast.

What to Expect after the Surgery

•    Recovery time depends on the extent of the surgery, ranging from 2 to 6 weeks.
•    Bed rest, following a balanced diet and hydration in the first weeks is crucial.
•    Although there will be considerable swelling, 80% of it will subside within a few weeks. It may take a few months until all residual swelling to subside.
•    Pain can be controlled by pain medication.
•    You can go back to work in one- two weeks, depending on the extent of the surgery.
•    You should refrain from heavy weight lifting and vigorous exercise for at least one month.