Endoscopic silicone breast augmentation
Endoscopic silicone breast augmentation
Breast augmentation with silicone involves the placement of the implant through the breast or armpit with the help of endoscopic surgery. It offers opportunities such as leaving minimal scars, preparing a controlled and clean implant pocket, and faster and smoother recovery. The procedure is a closed operation performed with 3-4 mm telescopes, creating tunnels and under the skin. The telescope is connected to a cold light source. The obtained image is transferred to a screen. Unlike traditional surgeries, the procedure is performed by looking at the screen. The area being operated on can be magnified dozens of times. The larger image allows for the preservation of all anatomical structures. The implant pocket is prepared with special endoscopic instruments. With the image transmitted by the telescope, the sensory nerves located at the edges of the pocket are better preserved. Both pockets are prepared more symmetrically. Small vessels that may bleed are noticed and cauterized.
There are different entry routes for breast augmentation with silicone. The safest and most controlled route is to approach from the inframammary fold. In some cases where the nipples are very large, the implant can also be placed from the nipple. In this case, the nipple circumference can be reduced during augmentation. For those who do not want any scars on the breast, the armpit approach can be used.
The plan where the implant is placed;
One of the methods of submuscular or subfascial placement is preferred. Subfascial placement is preferred when this fascia is thick and provides rapid healing. After the procedure, the person quickly returns to social life. When the fascia is thin, submuscular placement is preferred. This level provides additional tissue thickness and protection.
Types of implants;
In breast augmentation with silicone, fifth-generation, memory, textured surface medical silicone implants are among the most popular implants. The shape of the implant, whether teardrop or round, and even the shape of the teardrop is entirely determined by the person's breast and chest structure.
Cohesive gel implants are the most current implants. The word cohesive means gel that holds together. These types of gels are different from old technology liquid gels. This gel prevents dispersion in case of leakage or shell rupture. Also known as Memorygel, this name indicates that they have memory and retain their form.
There are also many types according to the length and projections of the implants.
Determining the Size of Silicone
The most important concern for women who decide to have breast implants is the size of the implant to be chosen. The most common reason for breast touch-up operations has been identified as changing the size of the implant. Although the aesthetic surgeon determines an approximate size based on factors such as the person's body structure, skin quality, chest width, and whether there is sagging in the breast, the actual size may vary slightly according to the patient's demands.
The person should live for a few days with the prosthesis size they are considering, while dressed, to see how it fits with their daily activities and sleep. Since prosthesis size is associated with a sexy appearance or being more feminine, the person should even question whether they want to attract attention. If they have a habit of sleeping face down, they should not choose a large prosthesis. After this, informing the doctor of the desired size is the best course of action. The doctor decides on details like the base diameter, profile, and projection of the prosthesis.
For this, a rice test can be done at home. The person buys a bra in the desired bra size. They can cut the foot part of a pantyhose and fill it with rice. The tied end of the stocking mimics the prosthesis. For example, if they want to mimic a 200 cc prosthesis, 200 grams of rice is used. By adding 20 grams of rice for every 20 cc, prosthesis measurements like 200, 230, 250, 270 cc are tried and noted. Once the desired volume is found, they should live with it for a while. The person reports the size they feel comfortable with while living. Therefore, the rice test provides a four-dimensional measurement.
With Saline Prosthesis
It may be possible to place it even through a space where a finger can fit. It offers advantages, especially for the armpit approach. However, it is not as advantageous as a silicone implant in terms of naturalness.
How to understand if a breast prosthesis is torn?
Meme protezleri yaşam boyu kullanılamayabilir. Yapılan çalışmalarda ilk 5 yılda % 2 oranında yırtılma olurken, 10 yılda bu oran %15 lere kadar çıkabiliyor. Ortalama silikon ömrü bazı çalışmalarda 16 yıl gibi verilirken bu konu biraz tartışmalı, yeni tip silikonlarda bunun 20 yıl civarında olduğu da söyleniyor.
In the USA, over 300,000 women have breast silicone implants placed for aesthetic purposes each year.
How does the patient realize it is torn? Nothing may be noticed. These are called silent tears. Most tears are like this. There may be sensitivity or a palpable swelling, and sometimes the shape is distorted.
American Plastik Cerrahi dergisinde yeni sunulan bir çalışmada MR ‘ın %94, ultrasonun ise %72 oranında yırtılmayı saptadığı belirlenmiştir. Bu tür yöntemlerde yanlışlıkla yırtılmış sonucu da elde edilebilmekte. Bu oran MR da % 5 gibi düşük, ultrasonda ise % 9 gibi daha yüksek. Bu sonuçlar daha önce yapılan MR güvenilirliğini de doğrulamıştır. Bu konu da tecrübeli bir plastik cerrah eli ile %30 oranında yırtılmayı teşhis edebilmekte.
Although very rare, a type of lymphoma can develop around silicone prostheses. The announcement shared by the Turkish Society of Plastic Surgery regarding this is below.
ATTENTION OF THE PUBLIC
Breast implants have been widely used worldwide since 1965. Patient data collected during this period have been evaluated, and no significant relationship between breast cancer and breast implants has been found. Reputable health organizations such as the U.S. Food and Drug Administration (FDA) and the World Health Organization (WHO) have stated that there is no evidence that breast prostheses cause breast cancer. However, in recent years, cases of immune system-related tumors originating from the capsule developing around breast implants have been reported. This tumor, called Anaplastic Large Cell Lymphoma (ALCL), is not breast cancer but originates from the capsule developing around the implant. To date, 359 patients with ALCL developed around breast implants have been identified. Considering that approximately 10-11 million women worldwide have breast implants, it can be said that the incidence is about one in three hundred thousand. This very rare tumor is generally slow-growing and has a good prognosis. If detected early, it can be successfully treated by surgically removing the implant and the surrounding capsule. All patients who received proper treatment have regained their health. The disease originates from the capsule that hardens and distorts the shape of the breast. The likelihood of development is higher around textured surface implants.
Patients planning breast implant surgery should request detailed information from their doctors about the characteristics and risks of the prostheses to be placed in their bodies. Anaplastic large cell lymphoma associated with breast implants is one of these risks. It is a very rare condition, and when it occurs, surgical removal of the breast implant and capsule is necessary.
The follow-up process after breast implant application is very important. Regular clinical and radiological follow-ups of the breast should be conducted before and after the surgery. In cases of pain, mass, swelling, fluid sensation, asymmetry, and shape changes in the breast, they should inform their doctors without delay. All ALCL cases diagnosed early and treated correctly have recovered.
Patients who have previously had breast implants and have not experienced any problems do not need to do anything other than not neglect their check-ups. Neither the World Health Organization nor the FDA recommends any medical or surgical treatment for patients without problems. Patients experiencing issues such as hardening, deformity, fluid accumulation, or significant asymmetry in their prostheses should consult their doctors. After clinical and radiological examination, appropriate treatment will be arranged. In patients with significant breast deformity due to capsule development, the appropriate treatment is the removal of the prosthesis along with the capsule and sending the capsule for histopathological examination.
As the Turkish Society of Plastic Reconstructive and Aesthetic Surgery, we will continue to inform our patients and the public about developments on this issue.
Turkish Society of Plastic Reconstructive and Aesthetic Surgery
If you have silicone, how will you have it monitored?
- You can perform your own breast examination; if there is palpable sensitivity or hardness, see your doctor.
- A plastic surgeon can detect tears at a rate of up to 30%.
- The easiest is to have an ultrasound done.
- If a conclusion cannot be reached with ultrasound, then MRI. However, it is more appropriate for it to be at least 1.5 Tesla MRI and for the radiologist examining to be familiar with breast implants.
The MRI image below belongs to a solid new type of memory silicone.
