Mammoplasty surgery: reduction, augmentation, laser endoscopic, without implants, masculinizing. Stages, rehabilitation and complications

Mammoplasty is the general name for a number of surgical techniques aimed at correcting the size and shape of the mammary glands. This is an operation that is performed if there is evidence after preliminary diagnosis, the preparatory period and the exclusion of contraindications. The main purpose of the operation is to eliminate the aesthetic imperfections of the breast in girls and women.

What is mammoplasty

Mammoplasty is an operation performed to change breast sizes, eliminate congenital and acquired aesthetic defects, and correct age-related changes.

The operation can be performed with implantation of implants or without them. There are several methods that are selected for the patient individually, taking into account the objectives of the operation, individual characteristics of the body, wishes. Mammoplasty also eliminates physiological pathologies.

Plastic surgery on the chest eliminates the following problems:

• irregular breast shape;
• sagging skin, loss of shape as a result of breastfeeding;
• excessive volume of mammary glands;
• asymmetry;
• breast enlargement;
• prosthetics after amputation.

The main purpose of mammoplasty surgery is to return the breast to an aesthetic appearance and eliminate visible imperfections. The operation is carried out only in plastic surgery clinics, it requires preliminary preparation, and after the rehabilitation period follows.

The first results of effectiveness are evaluated 30 days after the mammoplasty operation, and for the final recovery it takes up to 3 months, depending on the chosen correction technique.

Mammoplasty is an operation that is carried out in several ways, depending on the goals, individual characteristics and indications.

To date, plastic surgeons offer 6 techniques for correcting the appearance of the breast:

• mastopexy (tightening and restoration of the shape of the breast);
• reduction mammoplasty;
• correction of the nipple-areolar complex;
• masculinizing plastic;
• endoscopic laser mammoplasty;
• mammoplasty without implants.

The methods differ in the technology of surgical intervention, have features in the preparatory phase and give different results. The method of corrective intervention is selected by the plastic surgeon after consultation and preliminary diagnosis.

Indications for

Plastic surgery clinics offer correction of the shape and size of the breast, as well as the elimination of physiological imperfections. Mammoplasty is an operation that is performed according to indications, or at the request of the patient.

The following pathologies, cosmetic defects and diseases are referred to indications:

• Sagging breasts (mastoptosis) as a result of active and prolonged breastfeeding, age-related changes, decreased skin elasticity, jumps in body weight.
• Congenital hypoplasia, or underdevelopment of the mammary glands.

  

• Elimination of other congenital or acquired cosmetic defects and abnormalities.
• Excessively developed and large mammary glands are a cosmetic and physiological problem. It leads to the appearance of pain, predisposes to the development of pathologies of the musculoskeletal system.
• Asymmetry – a mismatch in the size of the mammary glands. The anomaly can be congenital or manifest after the completion of breastfeeding of acute inflammatory diseases.
• Dissatisfaction with the appearance, size or shape of the mammary glands. The need to improve the aesthetic qualities of the breast.
• Gynecomastia, or excessive growth of the mammary glands as a result of hormonal imbalance in men.
• Removal of the mammary gland due to the development of malignant tumors. Plastic surgery solves the problem of aesthetics by implanting the implant in several stages.
• Physiological or cosmetic defects of the nipples.

Contraindications

For the operation to correct the shapes and sizes of the breast, not only the presence of indications is required, but also the absence of contraindications. Mammoplasty surgery cannot be performed for a number of reasons.

List of contraindications for corrective surgery:

• age up to 18 years (the mammary glands have not yet formed completely, therefore, surgical intervention may disrupt the development process);
• oncological diseases that do not require radical methods of treatment (in case of amputation at the same time, or after 3-6 weeks, breast plastic surgery with implantation of the prosthesis is performed);
• mental illness (may be a categorical or temporary contraindication);
• HIV
• viral hepatitis of all types;
• diabetes;
• chronic diseases in the acute stage (in the case of persistent remission, the decision is made on an individual basis, depending on the state of the body);
• phlebeurysm;
• thrombosis;
• decreased blood coagulability;
• acute bacterial and viral infections;
• the period of pregnancy and breastfeeding (not earlier than 1-1.5 years after birth, the beginning of preparatory measures for breast plastic surgery is allowed);
• excessive body weight, obesity (BMI over 30);
• rheumatism;
• lupus.

In the case of the diagnosis of one or more problems from the list, the mammoplasty operation is postponed until complete recovery or is strictly prohibited. The plastic surgeon makes the final decision.

Preparation for mammoplasty

Mammoplasty is an operation that requires thorough preparation, which begins with the choice of a plastic surgery clinic and a specialist. After this, the patient expects several preoperative preparatory stages.

Initial specialist consultation and examination – the beginning of preparation, assessment of the patient’s condition, determination of ultimate goals and further examinations. At this stage, the patient voices his wishes about the final result, receives basic information regarding the methods of surgery.

The doctor helps to make a decision in the choice of implants, helps to choose the best option based on the tasks, advises on the whole process and subsequent rehabilitation, timing and cost.

At the next stage of preoperative preparation, the following specialists are examined and consulted:

• gynecologist;
• oncologist;
• dentist;
• anesthetist;
• therapist.

In the presence of chronic diseases in remission, the plastic surgeon can refer for examination to a specialist to make a final decision on the possibility of surgical intervention.

In addition to examination and consultation of specialists at the preparatory stage, the following studies should be completed:

• ECG;
• fluorography;
• coagulogram;
• Ultrasound of the chest;
• analysis for the presence of antibodies to the hepatitis virus;
• HIV and syphilis testing;
• general and biochemical blood analysis;
• general urine analysis.

To obtain complete information about the state of the body, the patient provides the plastic surgeon with maximum information about previous diseases, pathologies present, and allergic reactions to medications.

After collecting all the patient’s clinical data, planning begins for the timing of the operation, taking into account the menstrual cycle – no surgery is performed during menstruation. After determining the date of the operation, the surgeon informs the patient about the need for two-week training on an outpatient basis.

Home preparation for plastic is to follow the rules described below:

• A two-week refusal of drugs, dietary supplements and foods that reduce blood coagulation.
• A two-week refusal to use alcohol, nicotine, psychotropic and other drugs.
• Switching to a diet – reducing the intake of salt, sugar, rejection of harmful products.
• Health care – any disease, even a runny nose, can become a reason for postponing the timing of plastic surgery.

In addition, experts recommend preparing life for the recovery period. In advance, take care of creating comfortable conditions for rehabilitation, based on the predicted terms, to acquire everything necessary for a quick recovery.

Augmentation mammoplasty

Augmentation mammoplasty is an operation that is performed to enlarge the mammary glands. The essence of the technique is to conduct a surgical operation to implant an implant, which provides an increase in breast volume. Surgical intervention is performed only under general anesthesia.

In plastic surgery, 2 types of implants are used:

• silicone – consist of a shell filled with a cohesive or viscous gel;
• salt endoprostheses – the membrane is filled with physiological saline.

The size and shape of the implant is selected individually taking into account the wishes of the patient regarding the result of the corrective operation. There are round implants and anatomical implants that allow you to recreate the most natural shape and size of the breast. The volumes of implants used vary, depending on the desired breast size.

Manufacturers present 3 options for sizes:

• 5,07 fluid ounce implant for 1 breast size;
• 10,14 fluid ounce implant for 2 sizes;
• 15,22 fluid ounce implant for 3 sizes.

Implants differ in shell texture. A prosthesis with a relief surface more effectively survives due to the filling of the cavities with connective tissue. Smooth implants have a lower percentage of survival.

Depending on the clinical picture, the method of surgery is chosen.

There are 3 methods that are selected based on the objectives of the operation:

1. The submammary method involves implantation of an implant through a surgical incision made in the lower chest, along the breast fold. The method under consideration allows you to mask the scar in a natural fold and is considered the safest because of the minimal risk of complications.
2. For implantation of round implants, a technique is used that involves an incision in the armpit.
3. Axillary technique – an incision for implantation is made on the lower part of the areola of the nipple.

After the implant is installed, the final stage follows – suturing. In plastic surgery, absorbable suture material is used, therefore, after the healing of the postoperative scar, the procedure for removing sutures is not required. The operation takes from 40 minutes to 2 hours.

Postoperative rehabilitation requires inpatient monitoring for 3-5 days. A preliminary assessment of the result is possible after 30 days, and its consolidation – not earlier than after 60 days.

Breast Lift – Mastopexy

Mastopexy is used for ptosis of the mammary gland, when the skin loses elasticity and the chest begins to sag. There are 3 degrees of ptosis that are used in diagnosis. The degree of the problem is determined by the position of the nipple with respect to the submammary (breast) fold, and appropriate methods are selected.

Mastopexy is one of the few plastic surgeries that can be performed using local anesthesia, which does not require general anesthesia.

For mastopexy, the methods described below are used:

1. Periareolar mastopexy is a surgical tightening of the breast skin using an incision around the areola of the nipple. The advantage of the technique is that breast tissue is not affected – only the skin is adjusted. The technique under consideration is used in the treatment of ptosis of the first degree for minor correction.
2. T-shaped mastopexy is a method of breast lift by partial excision of skin areas. An incision is made along the edges of the areola of the nipple, moving vertically to the chest fold. The technique is relevant for the treatment of mastoptosis 2 and 3 degrees. Sometimes combined with reduction mammoplasty to avoid postoperative complications due to excessive volumes of the mammary gland.
3. Vertical mastopexy – incisions are made along the contour of the areola of the nipple and vertically, up and down. During the operation, an unnecessary area of the skin is removed and the gland tissue is hemmed.

In some cases, with an insignificant degree of severity of mastoptosis, the augmentation method is used. The problem of sagging breasts is solved by implanting a small anatomical volume implant.

Reduction mammoplasty

An indication for reduction mammoplasty is breast hypertrophy – excessive volume.

Factors predisposing to breast hypertrophy:

• overweight;
• genetic predisposition;
• endocrine disorders;
• pregnancy.

Excessive mass of the mammary glands poses a threat to the health of the musculoskeletal system, increases the risk of developing osteochondrosis of the cervical spine, intervertebral hernias, chronic mastitis and pain.

Reduction mammoplasty is aimed at eliminating excess weight, as well as correcting related problems – mastoptosis, asymmetry of the mammary glands.

The essence of reduction mammoplasty is the partial removal of breast and skin tissues, while maintaining its functioning and the possibility of breastfeeding after the rehabilitation period. The operation is performed under general anesthesia. Time – from 1 to 3 hours, depending on the complexity and individual characteristics.

Correction of the nipple-areolar complex

Correction of the nipple-areolar complex is carried out as a separate procedure or in conjunction with other types of plastic surgeries aimed at improving the breast. The procedure is indicated for disproportionate sizes of the areola and nipples, for shape correction or recovery.

Depending on the goals pursued, various techniques are used:

• To correct the areola of the nipple, the method of partial excision of the pigmented tissue and the formation of the correct form are used. To restore the areola, transplantation of pigmented skin from the perineum, or the introduction of pigment by tattoo, is used.
• Restoration of hollow nipples is required to restore the functions of the mammary gland and eliminate a cosmetic defect. It is produced by opening the milk ducts. The postoperative scar in this case is not more than 0’4 inch, and the recovery period is up to 1 month.
• Reducing the size of the nipple is performed by the method of wedge-shaped excision of part of the tissue and subsequent stitching.
• Nipple repair is a complex operation performed during the installation of an endoprosthesis after breast amputation. A plastic surgeon forms a nipple from the skin of the breast, and donor skin from other parts of the body is used for the areola.

Repeated

Repeated mammoplasty is indicated if there are problems with the previously installed implant. The features of the re-intervention are determined depending on the problems that need to be addressed.

Reasons for repeated mammoplasty surgery:

• implant deformation;
• medical errors in the correction process;
• too large implants;
• discomfort, pain;
• inflammatory processes;
• bleeding
• implant rupture;
• changes in the shape of the breast after pregnancy, breastfeeding, weight loss.

Repeated mammoplasty is performed no earlier than 6 months after the previous operation, if the patient’s condition does not require urgent intervention.

Incisions are made along the line of scars. The essence of the operation is to remove the improper implant, excise the scar tissue and install a new, individually selected implant. Features of repeated plastic surgery are dictated by the presence of concomitant pathologies.

Masculinizing

Masculinizing mammoplasty is performed in conjunction with a sex change operation, as well as after removal of the mammary gland during the treatment of cancer. Masculinizing mammoplasty consists in a partial resection of the skin of the breast and directly of the mammary gland.

To restore the breast, a salt endoprosthesis is implanted, and cosmetic imperfections are eliminated by correcting the nipple-areolar complex.

A feature of masculinizing mammoplasty is the complete loss of breast function, without the possibility of recovery. Therefore, the operation is preceded by serious medical and psychological preparation. The time of the operation is from 1.5 to 3.5 hours, and the rehabilitation period is up to 3 months.

Endoscopic laser

Laser correction of the shape and size of the breast is an alternative to traditional surgery. The operation is performed using a hardware method using a laser endoscope. A feature and advantage of the technique is the minimum size of scars and quick recovery.

During the operation, incisions are made in the armpit or in the chest fold for implantation.

List of laser endoscopic mammoplasty benefits:

• allows you to minimize blood loss;
• low risk of further complications;
• short rehabilitation period
• due to the ability to visualize the process, the risk of medical error is reduced.

Implant-free mammoplasty

Mammoplasty is an operation that can be performed without the use of an endoprosthesis. An implant is a foreign body in the body, so if there are contraindications, an operation called “lipofilling” is used. The essence of mammoplasty without implants is to enlarge the breast and restore its shape due to transplantation of subcutaneous fat from other parts of the body.

The main features of the technique:

• long rehabilitation is not required;
• the duration of the procedure is up to 1.5-2 hours;
• minimum list of contraindications;
• low risk of complications;
• lack of rejection reaction.

The effect persists for 2 years, after which a second operation is required, after which a correction should be made.

Rehabilitation Procedure

Features of recovery after surgery depend on the methodology used, the individual capabilities of the body, the effectiveness of rehabilitation tactics. A universal approach involves the following steps during the rehabilitation period.

• Stay in the hospital from 1 to 5 days.
• The use of antibiotics to prevent the development of complications in the form of bacterial infections and suppuration of sutures.
• Local care (the use of ointments for healing of the postoperative scar, disinfection, application of tight dressings).
• Wearing compression underwear.

At home, patients continue local care for the postoperative scar, taking the prescribed drugs. During the healing period of scars, you can not visit the solarium, sauna, gym, pool.

Emotional and physical stress are contraindicated. After 14-30 days
, they undergo a scheduled examination to preliminary evaluate the results and determine the strategy for further treatment.

Possible complications

Mammoplasty is an operation associated with an increased risk to health, therefore, the surgeon warns the patient in advance about possible complications. Complications occur in most cases due to a violation of the technology of the operation, as a result of improper care during the rehabilitation period, or because of the individual characteristics of the body.

A list of possible postoperative complications is given below:

• Scar infection , the development of an acute inflammatory process is the result of the penetration of bacteria during the intervention or violations of the rules for caring for the suture.
• Soft tissue necrosis is the result of an inflammatory process or insufficient blood supply to the mammary gland.
• The accumulation of serous fluid occurs due to a violation of the drainage functions of the lymphatic system or surgical errors.
• Hematoma is the most common complication. In most cases, it does not require treatment, but if the bruising occurred in the cavity with the implant, an inflammatory process may develop and a second intervention may be required.
• Slowed tissue regeneration and rejection of the prosthesis occurs as a result of the characteristics of the body or a violation of technology.
• Cosmetic defects – keloid scars, stretch marks on the skin of the chest.
• Implant loss due to suture rupture is a rare complication after the implantation of large implants and poor tissue regeneration.
• Some types of operations make breastfeeding impossible in the future.

Cost

Mammoplasty is an operation the cost of which cannot be covered by standard medical insurance. The price of not performing the operation is determined individually, taking into account the features of the technique, the selected implants, wishes regarding the result. The average cost of plastic surgery to correct the shape and size of the breast is shown in the table below.

Augmentation mammoplasty	From 4000 to 7000 dollars
Mastopexy	From 2000 to 6000 dollars
Reduction mammoplasty	From 2200 to 7000 dollars
Correction of the nipple-areolar complex	From 800 to 2000 dollars
Repeat operation	From 4000 to 8000 dollars
Masculinizing mammoplasty	From 3000 to 5000 dollars
Laser endoscopic plastics	From 4500 to 7000 dollars
Without implants (lipofilling)	From 1400 to 2000 dollars

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