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Expert Opinion: Breast Surgery

Prof. asoc. Dr. MD Marian Ticlea Prof. asoc. Dr. MD Marian Ticlea

MD Marian Ticlea is not only a sought-after specialist, but also an active member of the international research community and leading associations for plastic and aesthetic surgery: the German Society of Plastic, Reconstructive and Aesthetic Surgery, the German Society for Aesthetic Botulinum Toxin Therapy and the American Society of Plastic Surgeons.

He contributes to international high-level conferences and is in constant contact with competent specialist colleagues around the world. He is also well acquainted with the current state of scientific development thanks to his teaching activities in the training of medical students and aspiring plastic surgeons and aesthetic surgeons. He publishes in the field of Plastic and Aesthetic Surgery and regularly takes part in further education events.

This in-depth scientific experience lays the foundation for more than 29 years of practical experience and thousands of successful operations.

There are such situations in medical practice, when surgery on the breast is necessary. The main indications for such procedures are mammary gland diseases and aesthetic problems.

The diseases requiring surgical treatment:

  • Purulent inflammatory processes (purulent mastitis, gland abscess);
  • oncological benign and malignant neoplasms;
  • trauma and injury of the breast.

There is a protocol of treatment and special techniques of surgical intervention for these pathologies.

A separate category of problems is related to issues of aesthetic perception of the breast. Surgical techniques aimed at changing the shape and size of the breast are called mammoplasty. Indications for mammoplasty are assessed by the plastic surgeon together with the patient. Thanks to modern achievements plastic surgery is able to help women with the following problems:

  • Asymmetry of mammary glands;
  • deformation or asymmetry of the mammary glands after resection and mastectomy for neoplasms;
  • mastoptosis (pendulous breasts);
  • decrease in the volume of the breasts after pregnancy and lactation;
  • evident breast enlargement (macrospatia);
  • hypomastia (small breast volume), amastia (absence of the breast);
  • gynecomastia ‒ enlargement of the breast tissue in men.

Breast plastic surgery is divided into:

  • Augmentation mammoplasty;
  • reduction mammoplasty;
  • breast lift;
  • alteration of the shape of the areola and nipple.

Before the operation on the breast a woman should get a consultation from a mammalogy oncologist, undergo mammography, ultrasound examination, an electrocardiogram and do a number of blood tests. Only after having examined the patient, the plastic surgeon has the right to perform the operation.

Contraindications for the breast reconstruction:

  • Severe course of chronic somatic diseases;
  • pathology of the blood coagulation system;
  • some mental illnesses;
  • under 18 years of age;
  • pregnancy and breastfeeding;
  • susceptibility to develop keloid scars;
  • oncological diseases;
  • mastitis and mastopathy.

It is recommended to carry out breast correction after childbirth and completion of lactation.

So many seductresses dream of a lush bust, that is why the queues for breast augmentation surgery do not decrease. In medical terminology, such breast reconstruction is called augmentation mammoplasty. The purpose of such an operation is to give elasticity to the breast and increase the volume. Besides, the operation is supposed to eliminate asymmetry and improve the shape. The operation involves the use of implants. The material of the implants should meet a number of requirements:

  • Resistance to pressure and stretching;
  • the material from which the implant is made should not cause a rejection reaction;
  • the material must have a consistence similar to that of the mammary gland.

The most common and suitable implants are silicone ones. The service life of modern endoprostheses is 15-20 years, and replacement is required after the expiry of this period. The shape of the implant may be round or teardrop. The operative access through which the prosthesis is installed is determined jointly by the surgeon and the patient. The incision can be along the inferior boarder of the areola or in the axillary region. The operative access is also possible under the mammary gland. Taking into consideration the anatomical features of the patient, the doctor inserts an implant under the pectoral muscle or between the muscle and the gland. In case of a normal surgical procedure, it ends with skin closure with cosmetic sutures, but sometimes a drainage system is required. When it is augmentation mammoplasty, absorbable suture material is usually used.

In the period of postoperative rehabilitation it is recommended to wear compression linen and limit physical exertion. You will have to forbear from saunas and baths. The finishing fixation of the endoprosthesis is performed only in a year.

The reduction of mammary glands is a surgical intervention with excision of glandular and adipose tissues of the breast. The formation of the breast glands is affected by the hormonal background, body weight and heredity. Some women suffer because the size of their bust is too large. This problem can be solved with the help of the reduction mammoplasty. Hypertrophy of the mammary glands is eliminated by removing a part of the gland tissue followed by the tightening of the skin. The objectives of this type of reconstruction are:

  • to reduce the volume of the glands;
  • to maintain normal innervation and blood supply;
  • to provide the ability to lactate;
  • to maintain a lasting result.

Tissues are usually removed in the lower sector of the breast. The remaining tissues are balanced and shaped with sutures. Then a skin flap is formed, and the surgical procedure ends with suturing. This type of operation is coupled with massive blood loss, so the excision is performed with electroscalpel. Deformation of the nipple after reduction mammoplasty occurs in half the cases and requires further correction.

Breast lift is recommended for mastoptosis, when the nipple falls below the level of the pectoral fold. Surgery for breast lift can be performed in conjunction with endoprosthesis of the mammary glands. Breast lift without implants is also possible. The main techniques to perform breast lift are:

  • vertical methodology;
  • mastopexy with an anchor incision;
  • endoscopic lift.

The techniques differ in the methods of incisions. The choice of the technique depends on the degree of mastoptosis. The least traumatic is the endoscopic method. The postoperative scar is almost invisible and the degree of hemorrhage is minimal after such access. In case of mastoptosis of 1 and 2 degrees vertical and endoscopic techniques are used. Anchor incision is necessary at a higher degree of mastoptosis. Recovery after plastic surgery takes from 1 week to 1 month, depending on the amount and complexity of the reduction mammoplasty.

As with any surgical intervention, complications are possible. They are divided into early and late postoperative complications. Complications after anesthesia are put into a separate group.

The most frequent early postoperative complication is the appearance of hematomas (about 2%). They usually appear in the first 24 hours and require evacuation with the help of drainage. When timely treatment is provided, hematoma does not have any negative consequences. When there is infection of the hematoma, antibiotic therapy is required. There may be cases of separation of sutures and suturing of tissues with suture material (such a situation arises with the wrong technique of suturing was used or in case of the slow healing of the wound). Deformation of the gland and nipple are late postoperative complications as a result of violation of surgical techniques.

In the postoperative period a woman is kept in hospital for 1-2 days. Then the patient is sent home, where she remains on the sick-list for another week or two.

During the first five days after plastic surgery, the woman is forbidden to raise her hands above the level of the chest, have sex, and drink alcohol. For 1.5-2 months she can not exercise, sunbathe and lift weights.

Other rules that reduce the risk of complications after the reconstruction of the breast:

  • During the first 2 weeks it is allowed to sleep only on the back, then you can turn on your side, and you can lie on your stomach a month after the operation.
  • You can take the first shower 2 days after the surgical procedure and with the doctor’s permission.
  • You need to use compression linen that reduces postoperative pain for 1.5 months after mammoplasty, which prevents separation of sutures and migration of implants.

If the rehabilitation is successful, the doctor removes the stitches on the 10-14 day after the operation.

Recovery involves taking medication, and it lasts from several months to a year under the supervision of a doctor. After this time, the scars should be completely healed, and the patient should acquire tactile sensation. Then it will be possible to evaluate the result of the performed surgical procedure and, if necessary, to remove the stitch marks with laser.

Author: Prof. asoc. Dr. MD Marian Ticlea on Google+, Facebook, Twitter, LinkedIn, Jameda.

2017-21-12 Breast Surgery GermanMedicalGroup + 49 (7221) 39-65-785 Flugstrasse 8a 76532 Baden-Baden Germany Breast Surgery Breast Surgery Breast Surgery
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