Breast-rise (Breast Augmentation)

page15_1Dr. Grassetti exclusively uses high performance breast implants (never used breast implants PIP) and uses only implants approved by the Food and Drug Administration for breast augmentation, specifically the companies Allergan and Mentor with a lifetime guarantee.

Causes of small breasts

The size of the breast is genetically determined. Once developed, the breast can vary in size in response to changes in weight, pregnancy and breastfeeding. The aging process causes the gradual fall of the breast to the weakening of the suspensory ligaments of Cooper (called ptosis). This effect is greater as a result of a pregnancy, lactation, and in particular after a large weight loss. Most women have breasts of slightly different sizes, but occasionally you can also find a very marked difference. Rarely, however, the two breasts are perfectly symmetrical for both shape and volume.

Operation

The breast can be enlarged by placing an implant either under the breast tissue behind the muscle on which lies the breast.
Generally it is preferred to insert the implants under the gland when the thickness of the tissues ensures adequate coverage of the same. Instead, they are placed under the pectoral muscle in lean subjects with little or glands represented. A more recent technique prevente positioning “dual plane”, or under the muscle at the top and under the ghiando the bottom. In some cases it is also indicated the technique “inverted dual plane”, described by Dr. Grassetti and Prof. Di Benedetto on the book “Cosmetic Surgery: Art and Technique”, Part IV – Cosmetic Surgery, chapter 36 (pg 571-583) . Shiffmann M. A., Di Giuseppe A. Eds. Springer, 2013.
The implants are usually inserted through incisions in the crease under the breast (infra-mammary fold). Alternatively, the incisions may be made around the areola or under the armpit, with the placed plants both under the gland that behind the muscle (subpectorally) even with these additional incisions. The choice of venue of ‘incision is agreed before the operation and is dependent on local anatomic situation (size of areola, definition of inframammary fold), the type and especially the size of the prosthetic choices, preferences of the patient. Dr. Grassetti not using the technical introduction of implants through the belly button for several reasons: because of the limited access allowed by the subcutaneous tunnel that connects the ‘navel breast implant prostheses can only conteneti saline, ergo consistency with less natural in some circumstances causing noise due to the movement of the liquid, resulting in a sense of coldness breast and having a tendency to leak and then volume over time. Moreover allestimanto mammary pocket is made from a distant location that does not allow a mastery of the result symmetry nor a timely control and without sequelae (hematomas) of complications such as bleeding, intra-operative. That is to say that the concept would fail to operate in maximum safety for the patient, that it instead has always inspired the work knowledge and belief of Dr. Grassetti. Finally, any revision procedure that can not be practiced through the umbilical access, will require a traditional access, and then a new scar in place to reuse the old one.
The mastopexy (breast lift) can be associated to plant of the prosthesis in cases in which the breast over that small is excessively relaxed, ie ptosico.

Preparing to ‘intervention

At your consultation also you discuss on the preferred approximate size after surgery. Any idea of what will be achieved with the ‘rice tests’. For this, you put a little of uncooked rice in a freezer bag (or similar). Put this inside a (not padded) similar to the type of bra that usually worn, and measured the size of the desired cup. Start with rice 300g and add or remove a few grams until you are satisfied with the appearance. Wear it for all kinds of daily activities that you used to do. The actual volume of ‘facility used will depend on your skin elasticity, from the amount of breast tissue that has already, and on the judgment of Dr. Grassetti about what will look natural and appropriate, based on the width of your chest measures and consistency of the mammary gland which will be taken with care before the ‘intervention.
The surgery should not be performed in pregnant or breast-feeding and it is preferable to avoid the period of the menstrual cycle.

Before the operation you will be asked for the reports of mammography or breast ultrasound: for they have the dual purpose of ascertaining the presence of mammary tumors and to get a useful comparison for future diagnostic tests that will be carried out in the years to ‘intervention.
They should not be taken for two weeks prior to surgery or medications containing aspirin or acetylsalicylic acid, as well as taking oral anticoagulants should be adequately replaced with low molecular weight heparins agreeing everything with the patient’s GP. A month before the ‘intervention must be suspended progestogen therapy (birth control pills) in patients who use it: this to further decrease the risk of deep vein thrombosis in the legs.
If you smoke, you should reduce to one week before surgery the amount of cigarettes and three days to completely quit smoking before surgery to reduce the chance of post-operative complications.
And it recommended getting very beginning, a elasto-compressive bra with front opening to high-end, with an adjoining elastic band containment from below upwards, taking care to agree with health the possibility of change if the size purchased is not perfectly adequate to the “new breasts”.
The night before must be done carefully cleaning shower, shaved with a razor completely the axillary region, removed the nail polish for hands and feet.
Observe the fast of at least 8 hours before the intervention.

Anesthesia

The surgery can be performed under general anesthesia or local anesthesia more sedation, in relation to the clinical case and the pre-established surgical technique.
Duration of intervention
Within one to two hours.
breast implants
A breast prosthesis is constituted by an outer layer of silicone, and is filled with highly cohesive silicone gel. Some implants are round and others are more like a natural breast shape (anatomical or “teardrop”). In both cases, we can guarantee excellent results and the choice will depend on the desired result and the amount of breast tissue that you already have. The producers expect that the life expectancy of breast implants is at least 10-15 years and that good quality plants can be left in place without problems for a very much longer time. It is important to know that not all breast implants are the same, both in terms of quality and above all cost (a pair of breast implants used by dr. Grassetti has an average cost of € 1,500.00). If you are considering breast enhancement you should entrust to serious companies that give guarantees also to cover potential problems in the future.

Silicone Safety

Whatever the system is filled, the outer layer is made of silicone.
Some years ago it was suspected that the silicone breast implants could cause cancer or autoimmune diseases and could mask the presence of breast cancer in the course of mammography. Studies expanded to large numbers of women carriers of implants containing silicone gel in the course of more than thirty years have shown that well:
implants do not affect in any way on the development, nor the care of any cancer
There is no evidence that implants have directly caused an autoimmune disease such as the rheumatoid arthritis.
The presence of breast implants does not hinder the mammographic investigation. It should only inform the technologist. Any diagnostic difficulties encountered in the course of mammography may still be easily overcome by a radiologist experienced simply by some special screenings and additional maneuvers as well as, where necessary, by means of a nuclear magnetic resonance.

Rehabilitating post-operative

If they were placed drainage, they are removed after 12-48 hours, so before discharge. You may feel a slight pain in the pectoral region, more accentuated if the implants have been placed under the muscle. It regresses in any case within a few days.
After surgery you will need to wear day and night for a month, and another month of days, an elastic type sports bra with front lacing and elastic band containment that push from the top down. This until the body has not produced that thin layer periprosthetic capsule, which will serve to keep the correct position implants throughout their duration.
A fever is often reported in the first days post-op: is a normal reaction of the immune system, but it must be reported to the surgeon.
For the first 4 days after the ‘intervention is recommended complete rest of the pectoral muscles: do not force the arms to get out of bed, do not lift weights, do not make large movements with his arms. In bed it is good to rest with raised bust.
For the first week it will be forbidden to drive a car. In case some cutaneous points have been positioned, these will be removed after a week. At this point it will be possible to perform the first shower (not the bathroom!)
For the first 10 days it will be recommended instead a home resting, always avoiding efforts to pectoral muscles, performing instead walks also to open air.
The work can be resumed after 10 days, except in case of major manual effort.
For about a month will have to be avoided any kind of sports activity and exposure to the sun or heat (sauna, sun lamps, etc.). It must also be avoided prone position (face down) overnight. You will also have to begin to massage the breasts themselves on the recommendation of Dr. Grassetti.
After two months, at the end of the training process of the periprosthetic capsule, you can return to normal daily life including sports.
We should always indicate the presence of prosthetic subsequent visits and diagnostic radiology. Store and also exhibit the positive identification of the plants.

POTENTIAL COMPLICATIONS GENERAL

As with any surgery, though of mosta entities and performed on patients in good health, you may encounter:
A modest bleeding wound is normal. If important entities may require surgical reintervention.
wound infection. It is manifested by pain, swelling, warmth and redness of the skin, whether or not accompanied by fever. Any infection that can occur in the tissue around the implant can usually be treated with antibiotics and local dressings, but can also, albeit rarely, require surgical removal of the prosthesis and the waiting for some months before their reintegration.
The appearance of a hematoma in the first hours after the surgery is rare and is treated with immediate or suction drainage (whence the importance of the positioning of a safety drainage). However, it can occur up to a week after surgery. Is manifested by severe pain and sudden increase in volume and hardness of the breast should be reported immediately to the surgeon, as well as bruising on the overlying skin in the following days. If modest it reabsorbed spontaneously. If larger may require the evacuation including by reopening the wound, removal of the prosthesis and its insertion after stopping the bleeding.
The formation of seromas consists in accumulation around the prosthesis of a yellow and transparent liquid called serum, entirely similar to that which forms in blisters and bubbles of burn victims. Small amounts are absorbed spontaneously, while gathered more conspicuous that should form when the drains are no longer present may require ‘aspiration or surgical drainage as in the case of major hematoma.
Dehiscence (reopening) of the wound is very rare. Usually it heals spontaneously with outpatient medication; more rarely it may require a new suture. And ‘more common in diabetic patients and smokers. Even more rarely in the prosthesis exposure.
skin necrosis and the nipple areola complex. It ‘a very rare circumstance and due mostly to problems not reported at the time of the visit or to patients who smoke heavily. They can also lead to a surgical treatment.

COMPLICATIONS SPECIFICATIONS

Contracture of the periprosthetic capsule. In approximately 5% of cases it occurs an excessive reaction of ‘body and the capsule around the prosthesis suffers a progressive thickening and contracts. The contraction can be such as causar a feeling of painful tension to the patient and sometimes an alteration of the shape of the breast six or more months after surgery. It can also get to the prosthesis to migrate upward and laterally. Thanks to ‘use of textured implants it’s down to a rate of 2% of capsular contractions, and even less if you place the plant in the retromuscular. If the retraction is severe, it may be appropriate to proceed with a consistent corrective action in his incision and removal, hoping that the future capsule to develop normally.
Prosthetic rupture. It’s a very rare complication associated with high kinetic energy trauma such as car accidents or diseases of the patient’s lipid metabolism so the body’s lipids bind to the weakening of the silicone prosthesis. The significant changes in the shape or texture of the breast should induce the patient to contact the surgeon. A sometimes this symptom is the burning that pain. Where the suspected rupture was confirmed by ultrasound examination and magnetic resonance imaging (necessary in the rear intracapsular rupture), it will be necessary to replace the prosthesis.
silicone leakage can occur either as a slow seepage, or following the breakage of the implant. With highly cohesive gel implants of the new generation this problem has been reduced a lot. This silicone is also almost always contained within the fibrous capsule that the body forms around the implant even if this should break. Dispersion of Silicone however has never been shown to cause serious health problems
Displacement and rotation. The displacement of the prosthesis is rare and occurs mostly in the first two months, when it is forming the capsule. If you displace an anatomic prosthesis, it creates changes in form and must be re-positioned manually by the surgeon, if necessary even in the operating room.
Exposure of the prosthesis. very rare occurrence in a well-run operation. You can occur because of infection or wound diastasis. You will need to remove the prosthesis and wait six months before you replace it.
The sensitivity of the nipples and areolas may decline for a few weeks depending on the technique used, in some rare cases even permanently.
Double-bubble deformity. Deformities of the lower pole of the breast which assumes an aspect double profile, due to the memory of the pre-existing inframammary fold that creates a indentamento of the uppermost skin compared to the new furrow created by the surgeon. This new inframammary fold is in fact set lower to allow a correct housing of a size appropriate to the implant in a breast in which unfortunately the distance between the cappezzolo and the inframammary fold is particularly short (3-4 cm), that is, a lower pole constitutionally underdeveloped or even worse, forced as in “tuberous breast”. And more common in submuscular placement of the breast implant, and if you use a large plant. Even capsular contracture or migration of plant upwards can facilitate the creation of this deformity. The correction of the fault can also result in the return to the operating room to “loosen” the horizontal connections between the dermis and the superficial fascia, or to create a dual plane type III pocket (up to the upper edge of the areola) to enable the the lower pole of redistribuirsi skin and increase the distance between the nipple and inframammary fold in all those cases in which the subglandular placement is not recommended, or to create “strategic sutures” of the lower edges of the periprosthetic capsule.
Mondor’s phlebitis. Rarely a thrombosis of the superficial veins of the breast has been described. It looks like a hard cord, sore flushed along the course of toracoepigastrica vein. It resolves spontaneously in a few weeks, or less if you practice physiotherapy, sometimes resolves simply resorting to a skin traction, but concern the patient.

Nursing

The breast augmentation usually does not interfere with the ‘breast-feeding, and there is no evidence of significant amounts of past silicone in breast milk.

Results

Immediately after surgery the breasts will be swollen and may appear larger than you expected.
The improvement effect is immediately noticeable, however, with great satisfaction of the patient. There is usually a difference in the texture of the skin and numbness following the intervention of the nipple. The size and shape of the breast adapt with time. The final results must therefore be evaluated after six months.
Always you can not create the same breast for several chests. This depends on the shape of the rib cage. A ribcage very curved with prominent sternum makes creating a difficult plunging neckline.

Scars

Breast augmentation leaves scars on the breast even if hidden by the natural folds: the appearance of scars can vary between different individuals. This sign will be placed in a position such as to minimize the visibility even when wearing a swimsuit. Some patients with a tendency to irregular scarring, may develop reddened scars, raised or widened despite the utmost care taken in sutures. They can be corrected with medical treatment or surgery after 6-12 months by ‘intervention.

– Reduce Breast (Breast Reduction) –
If you feel that your breasts are out of proportion with the rest of your body, or you have difficulty finding clothes that fit properly or you feel uncomfortable when you take part in active sport, an operation of breast reduction can help. Large breasts can cause back pain, postural problems, painful tightness, dermatitis in submammary region decubitus breast hypertrophic on the chest wall and discomfort for some women.
Breast reduction is an operation to reduce the size and weight of the breast, as well as to lift and give him firmness as a side effect. The areolas also possonono become smaller (the darker skin around the nipples) and move higher up to give them more projection.
Preparing to ‘intervention
The surgery should not be performed in pregnant or breast-feeding and it is preferable to avoid the period of the menstrual cycle. Before the operation you will be asked for the reports of mammography or breast ultrasound: for they have the dual purpose of ascertaining the presence of mammary tumors and to get a useful comparison for future diagnostic tests that will be carried out in the years to intervention.
They should not be taken for two weeks prior to surgery or medications containing aspirin or acetylsalicylic acid, as well as taking oral anticoagulants should be adequately replaced with low molecular weight heparins agreeing everything with the patient’s GP. A month before the ‘intervention must be suspended progestogen therapy (birth control pills) in patients who use it: this to further decrease the risk of deep vein thrombosis in the legs.
If you smoke, you should stop for at least one month before surgery to reduce the chance of post-operative complications.
And it recommended getting right now a bra elastic-compressive with front opening high-end, making sure to agree with the health the opportunity to change it if the size purchased was not perfectly adapted to the “new breasts”.
The night before must be done carefully cleaning shower, shaved with a razor completely the axillary region, removed the nail polish for hands and feet.
Observe the fast of at least 8 hours before the ‘intervention.

Intervention

The surgery for breast reduction is performed under general anesthesia and usually stays in the hospital for one or two nights. It lasts for 2 to 3 hours depending of the ‘extent of the reduction and the technique used.
During a breast reduction Dr Grassetti removes excess fat and skin. Your residual breast tissue is then reshaped and sewn with special techniques and flaps as needed to make the small breast and raised. The nipples will be repositioned in the right place. The scars (see figure), depending on the technique used will be located around the areola, along the vertical which goes from the bottom edge of the areola to the inframammary fold, along the inframammary fold same, more or less extensive depending of removal entities. The sutures are usually made with all internal points which do not require removal.
At the end of intervention it is placed a drain for each operated side, a armpit level, which will be removed after 24-72h.
Adipose glands tissue removed is sent to histological examination, so as to also implement a screening of mammary tumors unrecognized.

Postoperative

You may feel a slight pain in the pectoral region, easily kept at bay with standard analgesics. It regresses in any case within a few days.
You need to wear a sports bra without underwire elastic compression within 8 weeks after surgery to support the breasts while the remodeled breasts settle into their new form, in the first 4 weeks day and night, in 4 successive weeks only during the day.
A bed should rest on two pillows to keep your head and shoulders elevated.
For the first 4 days after the ‘intervention is recommended complete rest of the pectoral muscles: do not force the arms to get out of bed, do not lift weights, do not make large movements with his arms.
For the first week it will be forbidden to drive a car. Likewise, it is absolutely recommended the abstaining from smoking for at least a week: it may be responsible for bleeding, necrosis of the nipple areola complex and acute exacerbation of pain. In case some cutaneous points have been positioned, these will be removed after a week. At this point it will be possible to perform the first shower (not the bathroom!)
For the first 10 days it will be recommended instead a home resting, always avoiding efforts to pectoral muscles, performing instead walks also to ‘open air.
L ‘work can be resumed after 10 days, except in case of major manual effort.
For about a month will have to be avoided any kind of sports activity and exposure to the sun or heat (sauna, sun lamps, etc.). It must also be avoided prone position (face down) overnight.
For about six months it is good to avoid pregnancy.
Report the successful execution of the ‘intervention of breast reduction during subsequent senologycal investigations.

POTENTIAL COMPLICATIONS GENERAL

As with any surgery, albeit modest and performed on patients in good health, you may encounter:
A modest bleeding wound is normal. If important entities may require surgical reintervention.
wound infection. It is manifested by pain, swelling, warmth and redness of the skin, whether or not accompanied by fever. Any infection can usually be treated with antibiotics and local wound dressings, but may result in poor quality scars.
The appearance of a hematoma in the first hours after the surgery is rare and is treated with immediate or suction drainage (whence the ‘importance of the positioning of a safety drainage). However, it can occur up to a week after surgery. Is manifested by severe pain and sudden increase in volume and hardness of the breast should be reported immediately to the surgeon, as well as bruising on the overlying skin in the following days. If modest it reabsorbed spontaneously. If larger may require the evacuation including by reopening the wound in the operating room.
The formation of seromas consists in ‘accumulation around the prosthesis of a yellow and transparent liquid called serum, entirely similar to that which forms in blisters and bubbles of burn victims. Small amounts are absorbed spontaneously, while gathered more conspicuous that should form when the drains are no longer present may require ‘aspiration or surgical drainage as in the case of major hematoma.
Dehiscence (reopening) of the wound is very rare and may occur in particular at ‘crossroads of the sutures, where c’ is more tension. Usually it heals spontaneously with outpatient medication; more rarely it may require a new suture. And ‘more common in diabetics, smokers and obese.
Although very rare, phlebitis and pulmonary embolism: the ‘incidence increases if the patient is not mobilized early.

POTENTIAL COMPLICATIONS SPECIFICATIONS

skin necrosis and the nipple areola complex. It ‘a very rare circumstance, but fearsome and two mostly to problems not reported at the time of the visit or to patients who smoke heavily or very large breasts and perishable. They can also result in a remote surgical treatment for the reconstruction of the nipple areola complex.
Decreased sensitivity of the nipple areola complex is planned between the sequelae of ‘surgery. Some techniques such as breast reduction based on the septum, the sensitivity is decreased temporarily and gradually can be almost completely regained, in other can be lost forever.
Necrosis of part of the adipose tissue (liponecrosi) may occur prematurely with leakage of oily liquid from the wound, or at a distance of time with possible formation of fibrous nodules, indurations and calcifications often asymptomatic.
Impossibility of breastfeeding after surgery, because many milk ducts are damaged.

Results

The improvement effect is immediately evident, although the breasts appear quite full at the upper pole and will tend to assume a more natural look only after two months. The final result must be evaluated after six months, as well as any “tweaks”: it must be said that a perfect symmetry in the volume of the breasts and in ‘teat orientation is realistically impossible to obtain.
The breast does not stop the normal aging process, so it is inevitable that with the ‘age the skin will relax or determine a new increase in breast size for deposition of adipose tissue in the event of weight gain. However, even without subsequent retouching, the appearance of the breast will still be better than you would if the intervention had not been executed!
Inevitably the intervention produces permanent scarring that improve over time. The horizontal scar in the inframammary fold, as needed in case of very large breasts, can go to the axillary region and toward the sternum, overflowing beyond the breast limits and resulting partially visible pertando. In addition some patients, due to excessive skin reactivity can develop reddened scars, enlarged or hypertrophic and therefore easily visible. They are treatable by surgery or require revision surgery after one year.