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Breast Augmentation

Breast Augmentation Aesthetics “Bigger Boobs”

It is in our national traits to develop the drive to hide our growing boobs during our adolescence. It enhances slouch among young girls. Even we call the organ as “breast” since we cannot say “boob”. I can’t understand why. And there is one group of people who never experience this shyness. This is exactly their story. Certainly, it is always not the same way. We observe that half of our patients get satisfying boob size after adolescence; however, pregnancy and sharp changes in weight result in volume loss in breasts. Boobs consist of skin outside, fat and mammary glands inside. There are around 20 suspensory ligaments (cooper ligaments) inside breasts to hold them. Due to a number of hormonal and metabolic reasons fat and mammary glands can get smaller, but skin covering them may not be able to adapt to these changes. When breast volume gets smaller and skin cannot adapt itself for it, in addition to small breast problem women also face breast sagging problem. Whatever the reason is doesn’t matter. The thing only matters is that we have a small breast problem, which had already been small or got smaller later, and we need to get them bigger. So, how? Certainly, by filling it. But, fill them with what? Well, that’s a nice question. I would like to skip the bullshit solutions like a variety of medication and hormones, and would like to compare surgical options instead. Theoretically, you can enlarge your breast size in three ways: synthetic fillers, your own fat, and breast prosthesis (silicon breast implant). I don’t recommend synthetic fillers. Even if it is claimed that it is an easy operation that can be performed in the office; however, it is not actually true. You would need too much injection until you get the desired volume in breasts. Besides, you would create a big bulk of foreign body in the breasts, which increases the risk of infection. What is more, it is too expensive that you can have not only breast prosthesis but also butt implant with that budget. At the end of the day, your body will destroy it in a time period like 1.5 year, and you will find yourself where you began all the story at. Recently, breast filling with your body fat is very popular. Although I have performed it a couple of times, I don’t recommend it as well. It is because some part of injected fat will dissolve in time, and the amount of fat dissolved may not be equal in two breasts. High volume injections results in more dissolvability and high risk of infection. Nevertheless, the most important problem with fat injections is micro-calcification, which means small crystals created by calcium sticking to the fragmented parts of the injected fat.  Actually, it is a natural physiopathological process. So, what? Most of the radiologists confuse these calcifications with cancer tissues. The first mammography you have will be enough for them to make you feel suspicious of cancer. And nothing can make you calm down until you have a biopsy.

As a result, we ended up with the only reliable solution which is breast prosthesis. In other words, silicone implants. You should not think simple when we say silicone implant since there are a variety of silicone types such as plane surface,  knobbly, anatomical (drop shape), round, double cohesive… There are a lot of kinds of it. But, which one you will choose? What is right is that you should not be the one making the decision. Just explain to your physician what kind of a breast you want. Do you want your breast to look curved between your collarbone (clavicle) and your nipples when you wear decollate outfit, or not to look too explicit in that part and go in low slope through your nipples? If the first look is your choice, you require to have a round prosthesis. The second look; on the other hand, can be obtained by anatomical prothesis which is described as round shape. But, don’t imagine it like a ball. My patients seeing round and anatomical prosthesis next to each other in my office tell me that they did not imagine something like that. Please don’t force your imagination about surgical issues. We, physicians, will do it for you. 90% of my patients choose round prosthesis after consultation in my office. And there is also size issue. How big we are going to do it? I have just told you a story above that women who has small boobs do not experience this period of shyness during their adolescence. These people start experiencing shyness right before breast enlargement surgery. They get shy while explaining what breast size they desire. Since the day I realized it, I don’t leave the breast size decision to the patients. Suitable breast size should be the one that can be carried by the ratio between shoulders and height, not meeting in the center, not sloping over armpits. I support the idea of applying the biggest prosthesis which is suitable for the body fulfilling above mentioned requirements, and believe me I usually perform in accordance with this idea. In the past, I had patients who said “I wish we made them bigger”; however, I never had a patient who says “we made them too big”. Although boobs also have breastfeeding function, it is primarily a sexual organ; and our purpose is to satisfy this function first. Don’t be scared when I say that. Surely, your breasts will keep breastfeeding function, and you will not have any problem about it. Nearly in all of the declared surgical interventions, mammary glands and ducts are protected. Knobbly or smooth? Absolutely knobbly prosthesis should be used. Our purpose is to keep prothesis capsules in every shape within the accepted limits and to prevent them creating contracture problems. This topic has a lot of technical details in it, and I don’t want to confuse you more. If you want, we can talk in detail later in the office.

Another important point here is where you will insert the prothesis through. It is possible to insert a silicon implant through under breasts (submamarian), nipples (periareolar), armpits, and under abdominal tissues during the abdominal lift surgery. And there is also an inflatable kind of prothesis   (implants inflated by physiological saline), which I don’t use. You can insert it through belly and inflate it inside the breasts. Certainly there is always a mark left after incision, but those are slight marks (nearly invisible) as your incision is made carefully and under esthetical principals. Yet, if there is personal health problems regarding the recovery process (such as hypertrophic scar and keloit), it is a different story. We will decide to the place to insert your prothesis together. After making the insertion place decision, we have to decide the place where prothesis will stand. Under muscles, or under mammary glands (upper side of muscles)? There are advocates of both of the places for prothesis, and both sides are right in their claims. There are both advantages and disadvantages for both of the places of prothesis (under muscles or above muscles). Then, which one we will choose? In the early 2000s, an idea called “subfascial” which means inserting prothesis under muscle membrane showed up in surgical practice. The purpose of starting this practice is to get benefit from the advantages of both under muscles and above muscles practices, but also to avoid their disadvantages. And subfascial practice proved itself with its results. I have been using this technique for a very a long time. It doesn’t create the risk of “motion effect” like in under muscles technique, and not a painful one. Or, it also doesn’t create the risk of visible line like in under mammary gland technique. Now, I would like to touch upon some questions asked during the consultation.

What will be my bra size after breast enlargement surgery?

It is the most popular question. But, when they get the answer, patients don’t find it satisfying in the first place. After breast enlargement surgery, your boobs will get bigger, but neither your breast diameter nor its anatomical width will change. There is a term which is called “cup size”. It means volume of the breast.  For example, think about 34 B/ 85 B bra size. “B” here is your cup size and after the surgery your cup size gets bigger. 34 or 85 shows your skeleton circumference over breasts, and it is measured either exactly around armpits, or around lower part of breasts. If you don’t do this measurement on yourself, you will keep seeing different bra sizes of yours depending on different brands you buy it from.

What is waiting for me during post- breast enlargement surgery?

Breast enlargement surgery takes around 1-1.5 hours and performed under general anesthesia. You will wake up with accompany of a serious medical dressing, or a bra. I don’t use drain. You will not have significant pain in subfascial technique. Your arm movements will not give pain like in under muscle technique. If I perform breast enlargement surgery early in the morning, you can be discharged in the evening of the same day. I let patients who come from distant places like another city or abroad to stay in the hospital that night. I recommend patients to use sports bra for 1 month after the surgery. If I place prothesis through armpit, I recommend patients to use a wraparound elastic bandage on breasts for 2 months. No need for removal of stiches. You can start swimming in 3 weeks.

Do I need to do massage after breast enlargement surgery?

After 2.week of breast enlargement surgery, I recommend you for 3 months to apply the simple massage I teach you. Most of my patients don’t take this recommendation serious and don’t use the massage. But, none of them had a problem regarding massage so far. Even I am not sure about the necessity of this massage. I guess my patients also feel the same way. It is just an old habit to say “massage is good” after the surgery.

Is there a risk of cancer resulting from silicone prothesis?

Yes, there is. But, at least your corpse will have big and good looking boobs. Just kidding! Of course there is no such risk. If there was, no one would have this surgery. Unlikely to other medical practices, silicone implants had undergone serious attacks thanks to these rumors. For years, a lot of study was conducted on it. The result is “silicone implants do not cause cancer”. As you may guess, this result is valid only for the ones which are produced in accordance with international medical devices and products regulations, and which are produced by internationally accepted high quality brands.

What are the worst case scenarios in post-breast enlargement surgery period?

I perform breast enlargement surgery rarely under sedation or local anesthesia, and usually under general anesthesia. All the risks regarding anesthesia, infection risk regarding surgical intervention, bleeding, and recovery problems are possible. Rarely, special problems due to silicone implant such as capsule contracture, or leak due to perforation on implants during the surgery may occur. Asymmetry between two breasts is rarely seen. Loss of sensation on nipples are rare and generally temporary. I can easily tell you that percentage of those complications is really low. Breast enlargement surgery is generally pleasant and makes you smile after.

Wish you a fast recovery!

If you have a different questions regarding breast enlargement surgery, please fill in the form. Wish you a healthy life.

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Op. Dr. Ozan Balık

Ozan Balık, M.D. was born in 1975. After he graduated from Adana Karşıyaka Highschool in 1992, he started Electronic Engineering major in Istanbul University. While he was having a series of operations he realized his tendency to medicine. In order to say “Don’t worry, they will be safe in here.”

Contact Op.Dr. Ozan Balık Levent Mah. Çilekli Cad. No:10 Beşiktaş İSTANBUL Tel: 0212 215 53 33 - Whatsapp: +90532 609 08 73 Mail: ozan.balik@gmail.com
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