What Is Mammoplasty?
The word mammoplasty consists of two words, “mammoth” and “plasty”. Mammoth means breast tissue and plasty means any plastic surgery. Therefore, mammoplasty is any type of surgical procedure designed to model the patient’s breasts. The main objective of this intervention is to change the shape of the breasts to a more desired appearance.
Mammoplasty is the most popular plastic surgery in numerous countries. According to statistics, more than half of the women are unhappy with their breasts and are ready for an operation to fix it. With mammoplasty, you can enlarge your breasts, reduce the size or change their shape.
Indications for mammoplasty are poorly developed and small breasts, asymmetry of breasts, ptosis (sagging breasts), deformation of the breasts after childbirth and during lactation, age related loss of form, restoration after surgeries such as mastectomy and women’s desire to change the size and/or shape of the breast. However, in many cases, this type of surgery is also performed for health reasons.
There are two main types of mammoplasty. One is Cosmetic mammoplasty which is used to describe any measure taken to change the shape or the size of the breasts for medical and/or aesthetic reasons. The other main type is therapeutic mammoplasty which is an operation to remove the breast cancer tissue (therapeutic) and then reshape the breast by removing skin and breast tissue (mammoplasty), to preserve a normal breast shape that will usually be smaller and more uplifted.
On the other hand, there are four general categories of cosmetic surgeries performed on the breasts: breast augmentation, breast reduction, breast lift and breast reconstruction.
Breast Augmentation (Incremental Mammoplasty)
Breast augmentation is performed to increase the size and enhance the contour of a woman’s breasts. Doctors recommend breast augmentation for the following reasons:
- Some women feel their breasts are too small.
- Some desire augmentation after their breasts change after pregnancy.
- Others desire to correct an asymmetry in breast size.
In general, it is a way to help people who are dissatisfied with the appearance of their breasts due to the small size of their breasts and lack self-confidence.
Breast augmentation is carried out in two methods: with the help of breast implants (also known as prosthesis) which is the common method and lipofilling. There are two basic types of breast implants: saline and silicone gel. Saline implants are silicone shells that are filled with sterile saline (salt water solution). Some are pre-filled and some are filled during the planting process. Silicone gel implants are silicone shells filled with a plastic (silicone) gel. Women determine their desired size by fitting trial implants.
The Incisions
The incisions to provide surgical access to the target area can be placed in:
- the axilla (armpit)
- areola (the area surrounding the nipple)
- lower breast fold (the crease under the breast)
In augmentations that the incision is made in the armpit, an endoscope (thin tube with a small camera and light on top) may be used during the procedure. Although this approach is too difficult, the scar will be hidden under the arm. Usually round breast implants are inserted with this method.
Implantation of the implants through the crease under the breast is the most preferred method. It allows the surgeon to install the implant as precise as possible. The scar gently hides under the breast. Advantage of this method is feasibility of using any size of prosthesis.
Incision in the areola of the nipple impedes breastfeeding. This type of incision is used to further adjust the size of the areola or nipple.
The method of insertion of the implants and the type of surgical access depend on the individual’s anatomical features and on the patient’s age. In each case, the surgeon chooses the optimal method of performing the surgery, taking into account all possible risks and complications.
As with any surgery, some uncertainty and risks are expected. Know your concerns and expectations. Review the benefits, risks, and alternatives. Seek consultation with a board certified plastic surgeon.
Frequently Asked Questions About Implants
What is the most suitable type of breast implant?
Tear-shaped implants with a gel-like state retain their shape better than other types of silicone and saline implants.
What is the safest implant in the market?
Some doctors believe that saline implants are a better choice for people who are concerned about the risks of implant placement.
What is the most common size of breast implants?
The most popular size of breast implants is between 350 cc and 400 cc.
What is the appropriate age to perform incremental mammoplasty?
Although incremental mammoplasty is an invasive procedure, fortunately there is no specific age limit for breast augmentation surgery, and even people over the age of 50 can undergo the procedure.
Breast prosthesis surgery has been performed in Iran for decades, and Iranian surgeons have gained extensive experience in this field.
Breast Reduction
Breast reduction surgery, also called reduction mammoplasty, is a procedure used to remove excess fat, tissue and skin from the breasts. Ladies may have difficulty performing daily activities due to the large size of their breasts, or they may experience chronic pain in their neck, shoulders and back because of the pressure effect of the breast on the spine or disproportionate size of the breast to the body. Also, some women who consider breast reduction surgery have complaints about chronic rash or skin irritation under their large breasts. One of the other reasons that women may seek to reduce breast size after childbirth is to restore the size prior to pregnancy. Breast reduction surgery might also help improve patients’ self-image and their ability to participate in physical activities.
During breast reduction surgery, some of the glandular tissues are removed, the milk ducts and nerves are cut, and the nipple may be relocated and lose its sensitivity, all of which can lead to impairment of milk secretion, so it should be postponed to after pregnancy and lactation. After breast reduction, most women report relief from the symptoms caused by having oversized breasts.
If you’re considering breast reduction surgery, consult a board-certified plastic surgeon. It’s important to understand what breast reduction surgery entails — including possible risks and complications — as well as presuming realistic expectations.
Breast reduction surgery generally isn't recommended if you:
- Smoke
- Have certain conditions such as diabetes or heart problems
- Are very obese
- Want to avoid scars on your breasts
You might postpone breast reduction surgery if:
- You have not achieved a definite family & childbearing plan. Breast-feeding might be challenging after breast reduction surgery — although certain surgical techniques may not affect it.
- You are planning to lose weight either by diet or exercise, you might wait to decide if reduction mammoplasty is fit for you. Losing weight can often result in changes to your breast size.
- You are too young. You can undergo breast reduction surgery at any age — sometimes even as a teenager. But if your breasts aren’t yet fully developed, you might need a second surgery later in life.
Risks
Breast reduction surgery has the same risks as any other type of major surgery — bleeding, infection and an adverse reaction to the anesthesia. Other possible risks include:
- Bruising, which is usually temporary
- Scarring
- Removal of or loss of sensation in the nipples and skin surrounding the nipples (areolae)
- Difficulty or inability to breast-feed
- Differences in the size, shape and symmetry of the surgically altered left and right breasts, which might lead to further surgery to improve your appearance
During The Procedure
Breast reduction surgery is usually done under general anesthesia, either in a hospital or outpatient surgical facility. The specific technique used to reduce the size of your breasts can vary. The procedure might include surgery through incisions and/or liposuction to remove the excess fat in your breasts. The surgeon usually makes an incision around the areola and down each breast to remove excess breast tissue, fat and skin in order to reduce the size of each breast, reshape the breast and reposition the nipple and areola. The nipple and areola usually remain attached to the breast, but sometimes the surgeon might remove and then reattach them at a higher position as a skin graft if your breasts are very large. Your surgeon will try to achieve symmetry between your breasts, but some variation in breast size and shape might occur. The size of the areola also might be reduced. Your incision scars might fade over time, but will never completely disappear.
After the procedure
Immediately after surgery:
- Your breasts will be covered with a gauze dressing or bandages
- A tube might be placed under each arm to drain any excess blood or fluid
- You will likely take pain relieving medication and antibiotics, in order to decrease your risk of infection
For the first days or a week after surgery:
- Your breasts will probably feel tender and sensitive
- Your breasts might be swollen and bruised
- Your surgeon might recommend an elastic compression bra to protect the breasts
After that:
- You’ll need to limit physical activities such as driving, exercise, swimming and coitus for 4 weeks while the breasts heal.
- Your surgeon might suggest avoiding underwire bras for 1-2 months after surgery
- Scarring usually fades over time. You will need a follow-up visit with your surgeon to remove stitches and check your recovery.
Results
Successful breast reduction surgery can alleviate pain in your back, neck and shoulders. It might also increase your participation in physical activities and promote a more positive self-image.
Although you’ll see results immediately, remember that it can take months for the swelling to completely resolve and the surgical scars to fade. The final result is generally permanent — although breast shape and size can change due to factors such as aging and weight gain or loss.
Breast Reconstruction
Breast reconstruction surgery is often performed post mastectomy as a treatment for breast cancer.
The procedure recreates a breast with the desired appearance, contour, and volume utilizing implants or patient’s own tissue. The nipple and areola are also recreated. Normal breast sensation and normal breast function, such as lactation, do not usually return when the sensory nerves or milk glands and ducts have been removed or significantly injured.
Breast reconstruction can be done at any time after you have had a mastectomy. The procedure has no known effect on the recurrence of cancer and it does not appear to affect cancer surveillance. However, you will be instructed on breast self-exams and scheduled for routine follow-up appointments for surveillance.
Can I have a breast reconstruction surgery right after mastectomy?
The answer is it depends. If the patient does not have a history of radiotherapy, breast reconstruction can be performed at the same time as mastectomy, because the skin has not yet lost its elasticity due to radiotherapy and there is enough skin to perform breast reconstruction. Also, those who undergo prophylactic mastectomy on both side can do both at the same time. However, people who have a history of radiotherapy and whose breast skin has become firm and dry should have breast reconstruction at least two years after mastectomy because the skin needs time to repair itself.
Breast Repair and Reconstruction Methods
Using a prosthesis (implant): This method is similar to the method of implanting a breast implant that increases the volume of the breast.
Breast Reconstruction Using Your Tissues (Flap Method): This method, also known as autologous tissue reconstruction, is a way to reconstruct the shape of the breast after mastectomy. The removed flap can be from fat or muscles inside thighs, back muscles, etc.
Combination of prosthesis (implant) and flap method: This method can be a combination of different prostheses and flaps.
Breast Lifts (Mastopexy)
In some ladies, the skin of the breast is not strong or resilient enough to support the weight of the breast, causing them to sag. With this condition, called ptosis, there is too much skin compared to breast tissue. The most common causes for ptosis include sharp weight loss; aging; childbirth and breastfeeding. In mastoprxy (medical term for breast lift), the plastic surgeon shapes your breasts in a higher position to have a firm and round appearance by removing excess skin around your breasts and reducing the size of the areola (the colored circle around your nipple). This operation is often combined with prosthetics, although this is not necessary. The surgery involves some degree of permanent scarring, but there are skin products available that may minimize the appearance of scars.
Does a breast lift reduce the size of the breast cup?
Women may feel that smaller bras are suitable for them after undergoing this surgery. According to a report published in the Medical Journal of the American Society of Plastic and Reconstructive Surgeons, there is one to two reductions in the size of the breast cup after breast lift surgery. The size of your breasts will only increase if breast augmentation surgery is simultaneously done.
Types of incisions for breast lift
There are four types of incisions that can be performed during this type of surgery:
- Crescent incision: This incision is suitable for those who have a slight sagging in which only one incision is made on top of the outer layer of the areola.
- Pre-areolar incision (donut incision): This incision is made around the areola and is suitable for people with moderate sagging in the chest.
- Vertical incision (lollipop incision): This incision is made simultaneously around the areola and the vertical line below it. This method is suitable for those who suffer from sagging but do not need to cut anchor shape and the desired result is achieved with fewer changes.
- Anchor incision: This incision, which is performed around the areola, the vertical line below it and also the crease under the breast, is used in patients who have severe sagging of the chest and do not achieve the desired results with any of the above methods.
In addition, mastopexy can be performed endoscopically through the incision under the arm; with the help of threads (polypropylene filaments with serifs hook up the tissues of the breast and are attached to the collarbone).
Therapeutic Mammoplasty
Previously, mammoplasty was exclusively done by plastic surgeons who were undertaking cosmetic breast surgery. With the breast plastic surgery techniques being incorporated into the training of the modern breast cancer (oncoplastic) surgeons, the skills of both cancer (oncology) surgeons and cosmetic breast surgeons are combined.
Therapeutic mammoplasty evolved from this combination of skills and is the term given to operations that remove breast cancers (therapeutic) and internally fill the resulting defect with your own breast tissue, then reshape the breast (mammoplasty).
This is done by removing skin and possibly other breast tissue in order to keep the normal appearance of the breast. This technique allows us to remove more breast tissue and usually leaves an acceptable aesthetic outcome compared to a standard lumpectomy.
Who is suitable for therapeutic mammoplasty?
Therapeutic mammoplasty has become the standard technique for breast conservation in the majority of patients. Approximately 70% of the patients are suitable for this procedure. If your surgeon has not offered you this technique, then please ask why.
This operation is usually not recommended to be done after radiotherapy if the initial cosmetic results are poor. The operation is most suitable for women with moderate to larger breasts who have some degree of droop. Modifications of the techniques, however, can sometimes be used for women with smaller breasts.
If there is a significant asymmetry between your breasts afterwards, you may wish for the breast on the other side to be reduced to reach to a better match in size and shape. This is known as symmetrisation surgery that can be performed at a later date.
What are the advantages?
The advantages of therapeutic mammoplasty include:
- It aims to produce a normal breast shape and is particularly useful for lower breast tumors, which are more likely to develop a deformity if a simple lumpectomy is performed. For women with larger breasts who desire smaller breasts, it is an added benefit.
- In cases where women have large breasts, reduction in size can make radiotherapy easier.
- A breast that is internally reconstructed using breast tissue displacement is more natural and stable when compared to total breast reconstruction with an implant or with tissue from elsewhere in the body.
- Recovery from the operation is also much faster in most patients.
What are the disadvantages?
The disadvantages are:
- The surgery is more extensive than a simple lumpectomy, so it leaves more scar.
- There are more risks associated with the surgery, including altered nipple sensation or numbness, the possibility of nipple (1%) and fat necrosis, and problems with wound healing.
- A specific cosmetic outcome is not guaranteed and there is still a risk distortion or indentation.
What are the other surgical options for breast cancer treatment?
The other surgical options are:
- Simple lumpectomy (wide local excision) without reshaping the breast.
- Mastectomy (removal of all the breast tissue). Please note a mastectomy followed by reconstruction surgery will usually not produce long term aesthetic result as therapeutic mammoplasty.
- Partial breast reconstruction using microvascular flap. This is generally reserved for patients who don’t have enough breast tissue left for a therapeutic mammoplasty. Therefore, they may have this partial volume replacement option.
Before The Mammoplasty Surgery
Regardless of the type of mammoplasty that you desire to do, each patient must meet some basic requirements. The team of specialists will perform a study of the shape of the breast and determine the most appropriate surgical technique for each case. The expectations of the patients regarding the desired change will be taken into account.
First of all, general health of the patient should be studied. Then, an ultrasound or mammogram will be requested to determine if there is any possible alteration in the breast tissue that contraindicates the intervention. Complete various lab tests must be done as well. In addition, anesthesia tests will be performed. All mammoplasties are considered as major surgery, which implies the use of general anesthesia.
You might be asked to avoid taking aspirin 7-10 days before the surgery and anti-inflammatory drugs and herbal supplements 2-3 weeks before the surgery to better control bleeding during and after the operation.
How you prepare
Your plastic surgeon will likely:
- Evaluate your medical history and overall health
- Discuss your expectations for breast size and its appearance after the surgery
- Provide a detailed description of the procedure and its risks and benefits, including scarring and possible loss of sensation
- Examine and measure your breasts
- Take photographs of your breasts for your medical record
- Explain the type of anesthesia used during surgery
Ask your surgeon whether you’ll be able to go home the day of the surgery or whether you’ll need to spend a night in the hospital. Arrange someone to drive you home after surgery or when you leave the hospital.
After The Surgery
Like any other type of surgical intervention, breast surgeries are accompanied by operational risks such as stitches separation, hematoma, scar formation, tissue necrosis, pus formation. The mammary glands may lose their sensitivity for some time after the operation. After 1-1.5 weeks, edema subsides and within 3-6 months, the breast will become firm.
After the breast plastic surgery, the following precautions should be considered:
- alcohol abstinence for 2 weeks
- sleep only on the back for 2 weeks
- wear compression bra for 1-3 months
- depending on the type of operation performed; avoid physical activity for 3 months
- avoid sauna and sun bath for up to 3 months
- take the prescribed medications
Gynecomastia (enlarged breasts in men):
Gynecomastia can occur for a variety of reasons, such as genetic problems, weight gain, side effects of certain medications, or hormonal imbalances (increased estrogen or severe testosterone depletion) that can cause male breast tissue to enlarge in one or both breasts.
Some forms of gynecomastia can be treated medically, but in some severe cases it should only be corrected with surgery.
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