COSMETIC SURGERY OF THE BREAST

Any woman has the right to decide on issues regarding her own breasts.

Many women have a bad body image about the size; shape etc. of her breasts and it could influence her life and sexual image.

Having accepted that as a given, there are certain facts about cosmetic surgery that she should keep in mind. Often only the desired results is explained and not the possible complications.

Some facts are as follows:

  • Surgery can enlarge (augment). Make smaller (reduction) or lift (Pexion).
  • The breast is not a piece of wood that can be carved, chiseled, or sandpapered to perfection.
  • The bodies healing processes are different and cannot be anticipated.
  • The women lies on her back during surgery and the position of breast and nipple is difficult to judge in this position(although we plan carefully before the operation)
  • Complications often follow. Bleeding, fat necroses, fibroses, scarring, uneven size and height can cause good intentions to be nullified, and results could often not be what the women desired.
  • She should always be aware of this and should question the surgeon about possible complications.

Breast Augmentation

Prosthetic implants are used. The prostheses can be implanted in the breast or behind the pectoralis muscle.

From a breast health perspective, the following comments should be made:

·         Depending on the breast type and cosmetic considerations, it is preferable to place the prostheses behind the muscle. This position is less of a handicap for future mammography. Placing the prostheses in the breast, reduce our ability to do a good mammogram and the total breast cannot be visualized. Cancers are often larger when detected in these breasts and the mammographer finds the examination difficult to do. She often has to do more views than the usual and radiation exposure to the breast is doubled. Because the prostheses is in the way and vulnerable, the radiologist is reluctant to place needles to make a simple diagnoses. This leads to much anxiety and unnecessary costs and surgery.

·         Prostheses augmentation is not a permanent once off procedure. It often needs to be replaced later on as the silicon sac perishes, can leak and the body hardens the capsule around the prostheses. The feeling of a once soft breast is often lost and the shape becomes round and unacceptable over years.

·         The weight of the prostheses pulls the breast down and the cleavage becomes deep and drops lower.

·         The procedure cannot be reverted in future as the breast tissue is stretched and hangs flabby. Pexion procedures become necessary to correct this and new prostheses must be placed, often larger.

·         I find that many women are not permanently satisfied and many want the prostheses out in later life.

·         Women should consider augmentation in a lifetime sense and not only for 10-15 yrs.

·         She should seek her spouse’s approval and support before embarking on augmentation, as she needs his support whenever something goes wrong.

Breast reduction and Pexion

·         The breast is made smaller or lifted. This could improve her body image significantly.

·         Remember that there will be scarring of skin incisions depending on the bodies reaction.

·         The nipple-areola must be moved upwards and this could cause loss of nipple sensation.

·         The size and shape and nipple position is difficult to get symmetric on both sides.

·         Fat necroses with resulting hard lumps in the breast can be confusing in future when these might be mistaken for cancer.

Breast reconstruction

A new breast is shaped after mastectomy. Various methods are used including prostheses placing, and swinging a skin/fat/muscle flat to make up breast volume.

If all our efforts to save a breast fail, we are strongly in favor of breast reconstruction. If the reconstructive surgeon is comfortable that all cancer cells are removed and recurrence should be unlikely, an immediate reconstruction after mastectomy is favored. He then works with soft pliable tissue and cosmetic results are better.

Late reconstructions after mastectomy are often difficult as the tissue is stiff and hard with fibroses.

The plastic surgeon is often called in before we decide on surgical treatment, so that his role is defined before start of treatment.

ALL WOMEN SHOULD HAVE A MAMMOGRAM BEFORE COSMETIC SURGERY. IT IS ALWAYS A TRAGEDY WHEN SHE HAS A SMALL UNDETECTED CANCER, AND ALL THE WORK AND MONY IS LOST WHEN IT IS FOUND MONTHS LATER. AND THE CANCER IS THEN SPREAD THROUGH THE BREAST AND SKIN.