Among the complications of mammoplasty are those that not only affect the well-being, but significantly worsen the appearance of the breast. Some problems are rare, but they raise more questions. One of the complications that mammoplasty provokes is a double bubble. Women expect after the operation is by no means the result that is found during the development of the defect.

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What does a double bubble look like

The name of the complication fully reflects its essence - it is a double breast. After the installation of the implant, the mammary glands are deformed in such a way that their aesthetics are completely violated, the appearance does not correspond to the anatomical structure.

There are several options for the problem:

• the mammary glands look as if superimposed one on top of the other;

• the implant looks through the living tissues of each breast like another hemisphere;

• the bust is displaced downward relative to the endoprostheses.

Instead of improving the appearance, a defect is formed that cannot be hidden by clothing. The problem needs to be addressed.

Causes

There are several factors that can cause complications.

Depending on the causes of the occurrence, the complication manifests itself at an early postoperative stage or later. The first two factors can cause a defect almost immediately.

Women at risk for complications

With special attention to choose a clinic, an operating surgeon, all recommendations should be followed by women who are more likely to experience complications:

• Having. In this case, the mammary glands are characterized by a thin base, extensive areolas and an elevated submammary fold. Their lower pole is distinguished by a small volume of tissues, which may not hold the endoprosthesis.

• Cone chested. Its differences are a wide base, a thin nipple-areolar complex. That is, the problem is the same as in the previous case - a poorly developed lower chest.

• With naturally elevated submammary fold. This feature can provoke the development of complications in the normal shape of the breast.

Double bubble correction

The problem can only be fixed with a new intervention. But its character is chosen depending on the characteristics of the double bubble, the individual parameters of the patient. There are the following correction options:

• Minimal intervention. The skin of the mammary glands is dissected, the internal tissues are carefully straightened. Then the doctor forms a new fold under the breast and sutures it.

• Capsulotomy. If the thickened fibrous layer surrounding the implant became the reason for the formation of a double bubble, the capsule is dissected. The endoprosthesis itself is not removed in this case, but it needs to return to its normal shape.

• Removal of the implant. If the defect has developed due to its poor quality, it is necessary to replace the endoprosthesis with a new one. The same operation will require an allergy to the implant, which causes swelling of the mammary gland tissues. Indeed, in this case, a threat to the health of the patient is also created.

• Lipolifting. This is a procedure for introducing the patient's own adipose tissue into the area of ​​\u200b\u200bthe mammary glands. Such an exit is possible with its excess in some parts of the body, for example, the abdomen or thighs. The fat is cleaned and injected into the breast area.

To learn how the double bubble correction operation is performed, see this video:

Prevention

What is required from the patient to prevent complications:

• be operated on by a good doctor who is able to assess and eliminate all the risks of a doctor;

• choose high-quality implants;

• be healthy by the time of the intervention, making sure of this with the help of an examination;

• follow all doctor's recommendations.

A double bubble after mammoplasty will not occur if the surgeon chooses the correct technique of the operation even with a problematic breast in the patient. This is a combined method, in which only the upper part of the endoprosthesis is installed under the pectoralis major muscle. If you place it there completely, the lower pole will squeeze the implant up, forming two extra hemispheres. The correct choice of incision sites during intervention, the suturing technique are important for the result.

Requirements in the postoperative period that can get rid of the development of a double bubble:

• wear high-quality compression underwear (preferably seamless) for at least 2 months;

• limit physical activity, that is, do not bend over, do not pull your arms up, do not carry heavy loads, avoid sudden movements;

• take care of the seams and skin of the breast in accordance with the doctor's prescriptions;

• sleep the first 2 - 4 weeks only on the back;

• give up bad habits so as not to disrupt the process of tissue healing and adaptation to the implant.

If complications could not be avoided, do not be afraid of its correction. Re-intervention is easier to tolerate, recovery after it is faster. But still, prevention, starting from the stage of preparation for mammoplasty, is the best way out.

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The implant itself has no effect on the body, since it is chemically and biologically inert. This fact was confirmed by many years of research, which resulted in certification and permission for the use of implants in all countries of the world.

The reason for “rejection” can be health problems that the patient either kept silent about because of fear of being refused the operation (for example, endogenous infection, autoimmune and endocrine diseases), or if an insufficient preoperative examination was performed. Former patients of regional non-specialized centers, including foreign ones, most often come to our clinic with such complications. The probability of "rejection" of the breast implant is excluded with a thorough preoperative examination and impeccable sterility of the operating rooms. The main thing is to report all health problems, honestly answer any doctor's questions and choose only specialized plastic surgery clinics or reconstructive and plastic surgery departments of well-known state centers with a good reputation.

How not to get breasts in the shape of a nesting doll (or what is a "double-bubble")?

"Double-bubble" - an ugly "matryoshka" effect, in which it seems that one breast is planted on the other. The risk of a double fold occurs during surgery by an inexperienced plastic surgeon who does not take into account the initial features of the structure of the mammary gland. In the “special risk group” are women with tubular, cone-shaped breasts (“goat breasts”) and mammary glands of the “regular shape” with naturally elevated inframammary folds. In such patients, the operation is supplemented with special stages: the elimination of tubularity, plastic surgery of the lower pole of the gland, and lifting. Fortunately, this defect is easily fixed. If a “stranger” patient comes to us with a “double-bubble”, a second operation is performed: the breast tissue is carefully dissected and straightened on the implant, then a submammary fold is formed and fixed in an anatomically correct place.

Quote

According to statistics, 97% of patients are satisfied with the result of breast plastic surgery.

Is asymmetry a risk factor?

Almost every woman has a slight difference in the size or location of the breasts. With a small size, the asymmetry of the areola is almost imperceptible. However, with an increase in the size of the bust, these features can be aggravated, and the asymmetry will become apparent. An experienced plastic surgeon carefully measures all parameters and takes into account both the different diameters of the areolas and the differences in location relative to the dimple between the collarbones.

The doctor, of course, immediately sees the asymmetry and warns about it. In this case, a timely correction is carried out: with a large asymmetry, implants of different volumes are placed, “equalizing” the sizes of the right and left breasts, or the diameter of one areola is reduced.

How does the "ripple" appear on the chest

"Ripples" - visible folds on the skin, sometimes occurring in thin girls due to a lack of soft tissue volume on the implant.

The cause of the defect lies in improperly selected implants that do not correspond to the physiological parameters of the patient's chest. The doctor is obliged to explain to the patient that the maximum volume with a narrow chest and in the absence of a sufficient amount of own tissues will cause problems. Sometimes "ripples" appear with a sharp decrease in weight, since the implants were selected based on the current parameters. When gaining mass and restoring the initial situation, the ripple disappears.

What to do if one breast is higher after plastic surgery?

Different breast height is a temporary phenomenon due to uneven postoperative edema from different sides. It often goes away without the intervention of a doctor, but sometimes one implant is fixed slightly higher than the other.

In such a situation, elastic bandaging is sufficient in the first weeks after the operation. In a later period, a slight correction of the implant location is carried out without a subsequent stay in the hospital. To prevent this problem, it is important to visit the surgeon on time and follow his recommendations.

Despite the many horror stories on the Internet, the intractable consequences of breast augmentation are rare. According to statistics, 97% of patients are satisfied with the result of breast plastic surgery. But even a small risk can be minimized by choosing the “right” clinic and an experienced doctor, such as

Mammoplasty is a good way to restore the shape of the female breast. A woman who decides to have an operation must comply with all the prescriptions of doctors. In preparation for the operation, you need to pass all the tests and undergo an examination by a general practitioner and an anesthesiologist. If this is not done, there is a risk of complications or unsuccessful breast augmentation. According to statistics, this situation occurs in 4% of women.

Loss of sensation in the nipple and areola

Minor sensory disturbances may be associated with edema. Edema will subside and sensitivity will be restored.

Most often, the sensitivity of the nipple and areola with subbamarous (under the breast) and axillary access is not disturbed. It is violated during peri-ariolar access (the border of the areola and skin on the chest).

Numbness of the breast after plastic surgery

In most cases, this happens because the branches of the nerves were cut during the operation and it takes time for them to recover. The recovery period is different for everyone, on average about six months.

If this is not done in advance, then after mammoplasty, serious consequences, complications and scars can occur.

Purulent wounds around the implant

It is observed in 1 - 4% of patients. The reason may be:

• natural rejection breast implant;
• entry infections during the operation.

It may appear a year or more after the operation. They are treated with antibiotics, and in severe cases, the implant is removed.

Infection

Any operation is associated with infection. The first factor is the qualification of the surgeon and his professional experience. The second factor is the non-compliance with hygiene requirements by the patient after the operation.

Accompanied by a temperature above 38 degrees, redness and purulent discharge. Antibiotics and antiseptic drugs are prescribed, and in difficult cases, the endoprosthesis is removed or replaced.

Seroma and hematoma

Normally, when a small amount of fluid collects near the breast prosthesis, but the seroma after mammoplasty is a lot of clear serous fluid.

The more extensive the surgical intervention, the more likely seromas will appear. If the gray is ignored, it can persist for a long time and cause hardening. Surgically removed with a syringe.

Any irritant can cause gray:

• reaction the body on the prosthesis, when the capsule has not yet formed;
• physical load, trauma;
• early withdrawal compression underwear;
• non-compliance restorative period.

Compression garments must be worn for at least 6 weeks to prevent seroma formation.

A hematoma is an accumulation of clotted blood in sacs around a breast prosthesis. It is accompanied by severe swelling, fever, and inhibits muscle mobility. Treatment of a hematoma is mandatory.

tissue necrosis

Tissue necrosis - necrosis, occurs when the implant squeezes the blood supply in the chest due to the scar tissue (capsule) that has grown around it.

To prevent this from happening, in 1968 W.C. Dempsey and W.D. Latham suggested placing the breast implant subpectorally (under the pectoralis major muscle).

Scarring

Immediately after the operation, the surgeon sticks a special patch on the scar. It makes it possible for the first time to observe body hygiene.

Scars and scars in the first months, it is important to let them heal quietly. Surgeons recommend:

• not scratch scar, but let it heal and form;
• smear the formed scar with a special silicone gel;
• paste silicone strips that allow the skin to breathe and do not let water through, but also visually make the scar invisible;
• don't visit pools, postpone a trip to the sea;
• not load chest area, scars should not stretch.

After a few months, the incision line will not be visible at all. But if a woman's visible part will have an unaesthetic appearance and it will bother her, there are ways to fix it in plastic surgery:

• excision of a scar or scar;
• grinding.

There can not be the same terms until complete recovery. Therefore, if the scar is red, you need to wait until it turns white. Otherwise, you can earn a keloid.

Breast change

The breast after surgery may change shape and become more dense. This change is called capsular contracture.

In fact, a capsule of fibrous connective tissue is formed around the implant, which thickens and thickens over time. Normally, the capsule is very thin and is 1/10 of a millimeter. But with capsular contracture, the capsule grows to 2-3 mm or more.

It gradually squeezes and compresses the implant, which leads to its deformation, and hence to a change in the shape of the breast and to pain. In severe situations, it leads to atrophic changes in breast tissue.

If capsular contracture is detected, a corrective operation is performed. The implant is changed and the capsule is removed.

Temperature

In the first days, this is a natural reaction to a foreign body, the temperature after mammoplasty will be 37 and above. In the following days, a "hangover" state may occur. The surgeon will prescribe antibiotics and monitor the patient's condition.

Possible complications associated with implants

A capsule forms around the breast implant. With silicone implants, capsular contracture is more common. Capsular contracture, consisting of fibrous tissue, begins to compact the implant, which leads to pain. The aesthetic appearance of the breast also deteriorates.

The operation with a severe degree of capsular contracture allows you to remove the capsule itself and the endoprosthesis. Mild cases do not require surgery.

Implant rupture

High-quality implants go through many stages of testing at factories, which indicates their safety. They are filled with a state of the art cohesive gel and come with a lifetime warranty. Even if the implant ruptures, the gel will not leak into the soft tissues and will not harm the patient's health.

The rupture of the implant can be visually invisible. But it is detected on a mammogram or MRI.

Severe tears can spoil the appearance of the breast and cause inflammation, swelling and pain.

Deformation of the endoprosthesis

If after mammoplasty one breast has become larger than the other, this will disappear in the first months after the operation, when the swelling subsides.

In another case, with an incorrectly selected endoprosthesis or placement.

In the third case, deformation may have occurred:

• More prone to deformation saline implants.
• Has the meaning volume filling of the implant: normal and overfilled. When crowded, wrinkling is less.
• textured endoprostheses are more deformed and wrinkled than smooth ones.
• Implants "under the muscle" less deformed.
• A special type of deformation can also be attributed double bubble complication.

Implant displacement

It takes time for the breast implant to be firmly fixed in the tissues. To do this, immediately after the operation, the patient is dressed in compression underwear. To avoid asymmetry and displacement, it is recommended to completely abandon physical and power loads on the chest and upper abdomen for three months.

If, after three months, an adjustment is still needed, additional procedures are prescribed.

A moving chest muscle can cause discomfort in the postoperative period, but this disappears with time, when the muscle and the implant adjust to each other.

Salt implants are more likely to dislodge because they are heavier than silicone implants.

An implant placed over a muscle is more susceptible to displacement than an implant placed under a muscle.

Double fold (or double bubble)

Double bubble after mammoplasty is a serious aesthetic complication. The chest does not look like a single whole, but as if in a fold.

30% of women have a specific anatomical feature of Cooper's connective tissue ligaments. These ligaments are located under the breast and support the weight of the entire glandular part. After the operation, when the swelling subsides, a small percentage of women face such a problem. The surgeon suggests a correction.

During the correction, an incision is made, a part of the breast tissue is excised, carefully straightened and fixed in a new place to a new submammary fold.

The double fold after mammoplasty will still be noticeable for some time, but after a week this deformation will disappear. Patients after such a correction should wear compression underwear for two weeks.

Calcification

This is a specific complication of breast plastic surgery, which is associated with the individual characteristics of the body. There is a deformation of the mammary gland and the aesthetic appearance is lost.

Around the implant is formed the deposition of calcium salts - calcification. During examination and palpation, the surgeon identifies foci of calcification, and may suggest implant replacement or correction surgery.

There is no cure for this complication.

These deposits on mammography may be mistaken for tumors.

Simmastia

This is an aesthetic complication after mammoplasty, in which the implants are very close to each other. Visually, the mammary glands seem to have “grown together”.

The reason may be:

• choice too volumetric breast implants;
• anatomical location of the mammary glands.

In order to avoid simmastia, an experienced surgeon must select the correct volume of the breast implant, otherwise it will be necessary to make a correction for smaller implants.

skin ripples

Basically, such ripples occur on cheap breast implants. Ripples after mammoplasty can also appear when the capsule covering the implant has not been completed on one of the breasts. If the ripple does not go away, the surgeon suggests a correction.

With a small volume of the own breast tissue, breast implants are mainly installed “under the muscle”.

Decreased effectiveness of breast cancer diagnosis

Breast implants and silicone have not been proven to cause cancer. Endoprostheses are installed in patients who have had their gland removed due to cancer.

Sometimes it also happens that the patient came to mammoplasty, and an oncological disease was detected.

Experienced surgeons sometimes combine operations: during mammoplasty, for example, fibroadenoma is removed. And the removed material is sent for further examination.

Endoprostheses make it difficult to screen for mammography, which reduces the effectiveness of diagnosing cancer.

To prevent rupture of the implant during palpation and examination, it is necessary to warn the doctor about its presence.

Decreased ability to breastfeed

Breastfeeding issues are discussed with the surgeon in the preparatory period. Both saline and silicone endoprostheses do not adversely affect pregnancy and fetal development, even in the event of a rupture.

With peri-ariolar access (through the peripapillary incision), the ability to breastfeed is significantly reduced or completely lost, since the ducts are crossed.

With subbamarous (under the breast) and axillary access, the mammary gland is not injured. But if there were complications, the risk of impaired ability to breastfeed remains.

After breastfeeding, at least 6 months later, you can start preparing for mammoplasty.

Capsular contracture

In medicine, capsular contracture is a formation that consists of dense fibrous tissue. It is formed around the implanted implant, gradually squeezing it. But it is a normal reaction of the body to a foreign body.

But a doctor should be consulted when signs of capsular contracture begin to bother. Among them, the hardening of the neoplasm and its increase in size are noted.

The reasons for the formation of contractures are:

1. Accumulation serous fluid around the implant, which leads to its detachment.
2. Inflammation.
3. non-compliance recommendations specialist during the rehabilitation period.
4. hematomas, formed after surgery.
5. Wrong size implant.
6. hit silicone between the implant and the fibrous formation as a result of the rupture of the first.

In the case when the capsular contracture is large, a repeated surgical intervention is performed to remove it.

In order to prevent the development of such a complication, it is necessary to follow all the recommendations of a specialist during the rehabilitation period, use implants with a textured surface, wear special compression underwear, and visit a specialist regularly.

If the chest itches, there is a seal in the area of ​​​​the implant, you should consult a doctor.

Pain

Often after mammoplasty, patients complain that their chest hurts. Unpleasant sensations disturb 2-3 days after the operation, subject to the normal course of the healing process and compliance with all doctor's recommendations. But you should know that the duration of the recovery period in each case is individual.

After mammoplasty, the nipples may hurt, which is also not a deviation, provided that the pain does not increase, but gradually disappears.

The causes of pain are trauma to the soft tissues during the operation and their stretching during the recovery period.

Swelling of the abdomen

Swelling is a normal reaction of the body to surgery.

But swelling of the abdomen after mammoplasty is not observed in all patients. Often, an unpleasant symptom occurs when access during surgery is carried out under the breast.

It appears gradually. Puffiness immediately after the procedure for breast augmentation is observed only on the mammary glands. After 1-3 days, she falls on her stomach. In appearance, it is swollen, with pressure, traces may remain.

The color of the skin changes only when there is bleeding. In this case, bruises and hematomas appear on the abdomen.

Unsuccessful plastic surgery of the mammary glands can lead to the occurrence of puffiness. In this case, the symptoms will be pronounced brightly, will constantly increase, worsen.

To relieve swelling, it is recommended to apply cold on the stomach, wear compression underwear after surgery, and eat right. In the first days after surgery, you should not take a hot bath, shower, go to the sauna or bath. In severe cases, it is necessary to use homeopathic remedies in the form of creams to relieve swelling.

Measures to prevent and reduce the risk of complications

After any plastic surgery, you must:

• Do not visit swimming pool, sauna, bath, solarium, from 4-6 weeks.
• Do not take hot baths.
• Homemade aquatic procedures should be taken only with a special silicone strip on the incision, and not earlier than a week later.
• In the first 7-10 days sleep on the back with a raised head, so that swelling sleeps faster and discomfort decreases. Two weeks later - on the side. Not earlier than a month later - on the stomach.
• Even if the patient is compression underwear, do not lift weights. This threatens with complications and new operations.
• Do not practice sports. Intensive training on the chest and upper abdomen and back can displace the thoracic endoprosthesis from its location, which again threatens with complications and correction.
• Do not exercise for the first time after surgery sex. This may cause the seams to come apart. Pregnancy planning is recommended to start no earlier than one year after mammoplasty.
• Don't fly to airplane in the first few weeks after surgery.
• Accept medicinal drugs prescribed by the surgeon.

Mammoplasty in our time from an exotic and risky operation has turned into almost an ordinary cosmetic procedure. Despite this, breast plastic surgery raises no less questions, and perhaps even more than 10 or 20 years ago: medical technologies are changing rapidly, doctors offer more and more options for correcting aesthetic defects.

We shared the thoughts and doubts of our sibmas with the specialist in mammoplasty, plastic surgeon of the Euromed Clinic multidisciplinary medical center, Candidate of Medical Sciences Olga KULIKOVA and asked her to answer the most burning questions.

Anatomy of the chest: a small educational program

So, at the base of our chest lies the pectoral muscle. These are two peculiar muscle "fans" going from the sternum to the left and right - to the large tubercles of the humerus. Above the muscle is located ( and attached to it) mammary gland - it is there that milk is produced, which we feed babies. Its size is approximately the same in most women, and we owe the differences in the size and shape of the breast to the fatty layer that surrounds the gland.

Not all women are happy with their breasts; some she seems too small, "boyish", and their full-breasted girlfriends eventually begin to suffer from the effects of heartless gravity, uncompromisingly pulling the mammary glands to the ground. So there are probably no women who are not interested in mammoplasty in principle.

Fine silicone: another little educational program

When a potential owner of a luxurious silicone breast becomes interested in the prospects for her future happiness, she discovers that "everything is complicated." Silicone implants can have an anatomical shape of a drop or a perky hemisphere. They differ in filling - they can be “stuffed” with silicone gel to the eyeballs or only 85%. And also the width and height of the base ( width and projection), as well as the height above the level of the chest ( profile). An implant can be installed under your own mammary gland, under the pectoral muscle, under the fascia ( "inside" the pectoral muscle), as well as under part of the muscle. Finally, the surgeon must decide where to make the incision: under the breast (in the submammary fold), under the armpit, or along the contour of the nipple ( periareolar access).

There are so many options that my head is spinning - which is better? What will bring you closer to the desired result? What will you (and not the surgeon?) like?

Where to cut and where to put

Symbum's opinion:

A friend made breasts through the armpit, bent over from pain for a month, could not do anything and was so surprised that I (access under the breast) didn’t hurt anything, that’s what different access means.

Olga Vladimirovna, does the access point really play a fundamental role in the pain and duration of the rehabilitation period?

No, it's not. The main role is played by the place of implant installation - under the mammary gland or under the muscle. Placement under the pectoral muscle is always painful, and it does not matter whether we place the implant through the nipple, under the breast or under the arm. Just axillary access is designed specifically to "dive" under the head of the pectoral muscle, so it always causes discomfort.

- So is it worth it to suffer and put an implant under the muscle?

Indeed, when installing an implant under the mammary gland, everything heals quickly, often after a day there are no pain sensations - a very short rehabilitation period. The breast immediately becomes soft, looks very natural, but ... But the implant, especially the large size, has weight. And when installed under the gland, only your own skin will hold it. And no one has canceled the laws of gravity - is it artificial breasts, or natural ...

” - The larger the implant, the faster it descends. If we install it under the muscle, then it will go down 10 times slower.

Of course, a lot also depends on the tone of the muscles: for some, they will keep the implant until the age of 80, and for some, like a rag, there was no point in installing it under the muscle. In such cases, I always warn a woman that you can only go without underwear on major holidays.

Opinion sibmam

She put an implant-anatomist under the gland. Three years later, the chest is full, but sagged. It was necessary to choose access under the muscle!

The average profile is normal, high, they say, it is more likely that there will be sagging even with the installation under the muscle due to the fact that it bulges forward strongly, and the part will still hang.

- Is this the only reason for installing an implant under the muscle?

No, not the only one. The implant looks good when it is covered by the maximum amount of its own tissues. When a girl arrives, who, in fact, has nothing to cover it with, in fact, this is an absolute indication for installing an implant under the muscle - then it will not be contoured.

- That is, we put everyone under the muscle?

There is a group of women who, on the contrary, are better off installing an implant under the mammary gland. This applies primarily to athletes: body fitness, bodybuilding, powerlifting ... in a word, to girls who actively work with pectoral muscles. With heavy physical exertion, the muscle can contract and displace the implant.

” -On the other hand, in 18 years of practice, I have seen implant displacement only twice - this happens extremely rarely. I even had a patient - a world champion in bodybuilding. We put the implant under her muscle, because before the competition she “dries” so much that the muscle is drawn very clearly, the implant would be too noticeable. In preparation for the competition, she works with heavy weights, but, as she said, "the main thing is to do everything smoothly" and the implant stays in place!

But even if it shifts, nothing terribly happens. It is quickly put in place, the pocket, which has stretched, is sutured.

Your chest is still fluffy!

Opinion sibmam

It makes no sense to put a high profile under the muscle - it will flatten the muscle.

390 will not be enough, I say right away. The muscle will press and the chest is not very lush, it can turn out, and if you really put it, then from 450 ...

To stand, you need a high or extra high profile, and that's the only way. With the average and average + 450 will lie.

Olga Vladimirovna, but the muscle is compressed, is it possible to get a high and lush chest when installing an implant under the muscle?

The muscle really flattens the implant first, this is normal. Indeed, in its natural state, the pectoral muscle lies on the ribs, and when we put something under it, it contracts and resists. But over time, the muscle stretches, there is also such an expression - "the chest has fluffed up." The muscle, as it were, “releases” the implant and the breast takes its final shape. But this is to wait from two months to a year - we will definitely warn all the girls about this.

- And the installation of the implant under the fascia ( connective tissue membrane, forming a kind of "case" for the muscle) - what are the advantages of this method? Perhaps the process of "fluffing" will go faster?

I see no reason to separate the fascia and injure the gland. There was such an experiment, because this is a rather young science - mammoplasty has been practiced only since the fifties of the last century. Today, it seems to me, everyone has already abandoned fascia.

Opinion sibmam

The implant is attached somehow cunningly, I remember in the picture, it is difficult to describe. In general, the implant can move if it is completely hidden from top to bottom under the muscle, and if it is half attached to the muscle and the part is under the gland, then everything is ok. The implant adheres to the muscle as usual and holds without any displacement. In addition, the doctor also attaches it in two places additionally under the muscle there, so that everything will surely grow quietly and take root as ideally as possible.

- What about the partial installation under the muscle, which is now being talked about a lot?

The pectoral muscle never completely closes the implant - this is anatomically impossible. But there is a very wide pectoral muscle, when most of the implant is under it. To make the breast softer and more natural, we partially remove the implant from below above the muscle. At the same time, the muscle itself does not need to be cut - we simply push the fibers apart, making literally two or three cuts. But, as I mentioned, even if most of the implant is covered by muscle, over time it still straightens out.

- Is it necessary to wait for surprises in a year - maybe the chest will “fluff up” in the most unpredictable way?

No, the result is always exactly predictable. I have 4-5 mammoplasties a day, and when a girl comes into the office, I immediately remember patients with a similar anatomy, with the same costal hump, and show her photos: it was, it became - what do you like? This is such and such an implant, such and such a size. Sometimes, on the contrary, I ask the patient to bring a photo of the breast that she likes. And, looking at the photo, I can always say: this is an anatomical implant, installed under the muscle, high profile. This is a round implant placed under the gland... But I will never be able to do this to you, because you will not have enough skin or gland to cover the implant, it will look like a caricature. Such visualization gives a complete picture of the results of a future operation.

- Or maybe something goes wrong, for example, there will be a noticeable asymmetry of the nipples?

Because of the operation, asymmetry cannot arise - if a symmetrical person has come to us, where does she come from? But if there was asymmetry, then the installation of the implant emphasizes it. And this question must be discussed before the operation! After all, there are women who believe that they have lived with such nipples for many years, and will continue to live, they do not see anything wrong with this. And for others, it is important that the nipples are strictly symmetrical.

Doctor, put the balls in, don't be shy!

- Is there a fashion for the shape and size of the breast?

Now more often they ask for a natural form. Those who put “balls” in the 90s are now going and removing them, even doing a size reduction and tightening. Now they ask for the first size! There are very beautiful anatomically shaped implants that are carefully inserted through the areola under the muscle. The seam is then masked with a tattoo, and no one will ever guess that there is something “not their own”. The shape is just fantastic, well, it turns out very beautifully!

” - But, of course, there are still girls who say: “Doctor, forget about naturalness, I need balls! Do not be shy either in volumes or in sizes, as much as you like - in full! Everyone has their own idea of ​​aesthetics.

- That is, you can "order" any size?

No. There are very precise markings, calculation formulas, and if the surgeon says that more than 400 ( milliliters - they measure the volume of implants) does not fit, then you should not beg him, beg and wait for a miracle to happen. There are surgeons who are weak-willed... It seems to me that it is difficult to refuse male surgeons especially, beautiful girls come! Some bend, but this is fraught with problems for both the surgeon and the patient. I refuse those who do not hear me, and then, when someone is “bent”, they come to me with problems ...

Speaking of problems...

Well, since we are talking about this, let's talk about the possible complications. Many women would like to reduce the distance between the mammary glands as much as possible for the effect of a “seductive cleavage”. Is it possible?

Well, nothing is impossible if you have a sharp tool in your hands, but it's not physiological. The distance between the breasts is due to the fact that the muscle is fixed along the edges of the sternum. Sometimes patients are greedy, asking for an implant more than the body is able to accept. And then, instead of a seductive hollow, this platform rises, the pockets into which the implants are inserted merge into one. This complication is called synmastia. My patients didn’t have synmastia, but they came from another clinic and asked for a correction... I don’t like to correct other surgeons, and sometimes it’s impossible to fix everything.

- That is, no hollow?

You just need to be patient. The first time after the operation, it is impossible even to bring the breasts together with your hands, but then the muscle relaxes, stretches and “releases” the implant, the distance between the breasts is reduced. In a year you will reach the desired forms.

- And what about the “double-bubble” effect, when the implant stands out, as if a woman has a doubling of her breasts?

It occurs in two cases: the first option - the implant "slips" below the submammary fold, and the second option, when the surgeon deliberately underestimates the submammary fold. There is a so-called restrictive type of structure of the mammary gland, when the distance from the nipple to the submammary fold is small. If you insert the implant, then the nipple will be completely under the breast. Then (having discussed all the risks with the patient), a periareolar breast lift is performed, the nipple is raised as high as possible, the implant is placed as low as possible. There is a danger that the border between the implant and the own gland will stand out as a second submammary fold, but there is nothing more to be done here.

Opinion sibmam

My gland is slipping from the implant, the border is clearly visible. It was necessary to put under the muscle.

- The anatomist suggested a high profile and ... how to say it correctly ... in general, wide implants, that is, the base of the back - a diameter of 13 cm, counted on me. In order to “flatten” the chest in all directions and remove all sagging as much as possible, I have a part of my own material, the size is not zero.

- And if it is not the implant that “slips”, but the mammary gland?

And this is the “waterfall effect”. At risk are those who initially have ptosis ( prolapse of the mammary gland), such as after breastfeeding. In this case, the surgeon explains that without a facelift ( an incision around the areola and vertically down, from the nipple to the submammary fold) not enough. But ... "I'm not like that, I'll be fine, I don't need a lift." The surgeon puts the implant under the muscle, hoping that the mammary gland, contrary to the law of gravity, will happily climb onto this muscle. Sometimes, when a large implant is placed, this is possible. But, as a rule, with a pronounced degree of ptosis, we cannot set the volume to 600, but set, for example, an acceptable 300. They stretch the muscle, and the mammary gland sadly hangs down from it. Don't be afraid of braces!

Opinion sibmam

You can not insert a small implant under the breast, for example 300, especially if the breast is not spoiled by feeding several children. The chest will not close the mammary fold and the seam will be clearly visible.

It is best to insert through the armpit, where the skin is different, the seam heals the easiest and becomes invisible.

- Can stretch marks appear on the breast during mammoplasty?

Never! Stretch marks are always hormonal. They arise in the pubertal period, not only in girls, but also in boys, and not only on the chest, but also on the stomach, on the hips, under the arms ... And the second period is pregnancy. And not because the breasts are growing, but because the hormonal changes in the body are taking place!

” - There are women who have more elastic fibers than collagen, and stretch marks will inevitably appear, no matter what creams they use and no matter what cosmetic procedures they resort to. Alas, an entire industry is working to fool them!

But nature never takes without giving something in return. In such a patient, very inconspicuous sutures are always formed: it can be cut even along, even across, after a year you will no longer find any traces of the seam.

- And what about pain and swelling during the rehabilitation period - what is the norm, and what is already a complication?

Edema is a normal post-traumatic reaction. What is pain syndrome? Swollen tissues tighten the nerve endings, so this is also normal and physiological. Not only the chest swells: due to gravity, the edema descends through the cellular space down to the front wall of the abdomen - this is also normal. It lasts at least 10 days, but usually up to two months. Some have pastosity ( slight swelling) is stored for a year!

” - Moreover, patients after the operation are prone to swelling at the site of the operation. That is, if you drank alcohol the day before, the first thing that will swell in you in the morning is your chest, if you have operated on the chest, eyelids, if you have operated on the eyelids, and the stomach, if you have had tummy tuck.

And so for a year, while blood circulation is restored! You need to be careful - less salty, spicy and alcohol at this time.

Another complication that is often mentioned is contracture, the formation of a layer of dense connective tissue around the implant, due to which the breast becomes hard as a stone ...

Haven't come across this in a very long time! Contractures often happened earlier when the implants had a smooth surface. Since we started working with implants with textured ( "velvet") surface, this problem simply disappeared - fibroblast cells "cling" to such a surface, and the body does not perceive the implant as a foreign body, does not try to isolate it with a dense capsule of connective tissue ( and it can be as hard as cartilage, you can’t even cut it with scissors). It happens that patients come who put the implant somewhere at the dawn of the era of mammoplasty, 20 years ago, but in this case, nothing terrible happens. We remove the implant, remove the contracture, put a new implant, but of a larger size, since the contracture "eats" part of its own tissues.

And one more “horror story” is the rupture of the implant, when the silicone “scatters” throughout the body. Is it true that this happens with incompletely filled implants - wrinkles can form on their surface, which are easily “wiped”? Maybe a better filled implant?

We mainly use 85% filled implants. They are softer and look more natural. But it happens that a girl has so few integumentary tissues that even installation under a muscle does not save the situation. In this case, slight folds on the implant can contour - become visible even through the skin. In this case, it is better to opt for a fully filled implant.

” - As for the rupture of the implant, this is a very rare complication that I see once or twice a year. And the reason for it is not the folds, but the bending of the implant, when too small a pocket was formed under it, in which it could not completely unfold. It is this bent edge that can cause a rupture.

But even in this case, nothing terrible happens, since modern implants do not spread: the molecules are cross-linked by chemical bonds, and the filler resembles jelly. We just take out the old implant and insert the new one. By the way, for the patient it is free, because the guarantee for each implant is a lifetime!

Interviewed by Irina Ilyina

Many women dream of beautiful and large breasts, so they decide on such drastic measures as breast augmentation. But, often there is a complication called double bubble after mammoplasty. In addition, if the operation was performed by an unskilled plastic surgeon, various problems may arise. But even if mammoplasty was done by a first-class doctor, no one can guarantee that the postoperative period will pass without consequences. In any case, surgery is a serious burden on the body.

Pain after mammoplasty is normal. Tissues gradually begin to heal and return to normal. If the chest hurts for too long, then this is a reason to go for a consultation with a surgeon.

Some women complain that their back hurts. Most surgeons consider such a reaction of the body as the norm. After a while, the pain should go away.

Burning in the chest after mammoplasty can also be normal, but it's better not to risk it and see a doctor.

Plastic surgery has come a long way. Complications after surgery are quite rare if the procedure was performed by a qualified specialist. But no one is immune from failure. If the number of unpleasant symptoms after the procedure began to increase, you need to re-contact the doctor.

Sometimes a slight increase in body temperature after surgery is considered normal. Since the operation is a serious stress for the body. The temperature may persist for several days. In this case, you should not panic, after a while everything will return to normal.

Consequences of mammoplasty

Plastic surgery often leads to necrosis of the skin. As a result of gravity, the implant exerts strong pressure directly on the skin of the mammary glands. There is a violation of the blood supply and necrosis appears. The process can last 2-3 months, and it can stretch up to 5 years. You can eliminate the consequences after breast augmentation with the help of an additional operation and insertion of an implant under the pectoral muscle.

When the breast is enlarged through plastic surgery, the nipples may lose sensitivity. This is due to the fact that during the operation a nerve was affected. Often, sensitivity is restored after a while.

Complications after breast augmentation occur when sensitivity is not restored for a long time, or when a woman enlarged her breasts, hypersensitivity appeared, which was not there before.