What it is a mammoplastika? Part 1
of Mammoplastik is a change of a form and volume of a breast with surgical intervention. Range of this intervention is rather big - it means adjustment of volume, a form, contours and/or separate parts of a breast (a nipple and an areola).
A surgery on increase in a breast, the so-called “augmentatsionny mammoplastika“, was specially developed for increase in the size of chest glands by means of implants.
In success of operation on increase and reconstruction of a breast quality of the used implants is of great importance, of course. The qualitative and reliable implant is established once - and then it is possible to carry it all life. Only in exceptional cases at patients the fibrous contracture can develop. Then it is recommended to make replacement of an implant and at the same time reconstructive operation of mammary glands.
The implants used now in plastic surgery have the cover made of a silicone elastomer are the most inert material in relation to our organism. Special layers - barrier and double elastomeric - do an implant extremely steady against damage. Physiological solution, silicone gel or hydrogel can be fillers of an implant.
In a mammoplastika two types of silicone implants are usually used: round or anatomic. Round are suitable for creation of effect of a high and full breast, the second imitate more natural forms. Density of silicone gel which filled implants for a breast is selected strictly individually. For modern artificial limbs in a mammoplastika very strong, three-layer cover, smooth or textured to the touch is used.
of the Indication to carrying out a mammoplastika:
- insufficient development of ferruterous tissue of breast;
- correction of symmetry of mammary glands in case they differ in a form and/or the size;
- restoration of a form and volume of a breast after feeding by a breast.
Preparation for a mammoplastika
Before carrying out operation the patient surely has to have preoperative training. Most often it is careful collecting the anamnesis - that is interview with the plastic surgeon and the anesthesiologist, and also all necessary tool and laboratory inspections. It means that patients make all standard tests, there take place consultations at experts and go for ultrasonography of mammary glands. In certain cases, if it is necessary, the doctor can also appoint ultrasonography of internals and conduct additional examinations.
Training of the patient for surgical intervention also consists in the termination of reception of any drugs which can affect coagulability of blood. Besides, some days before operation the woman is recommended to pass to reception of more easily acquired food (belkovo - a carbohydrate diet), and just before appointed date to refrain from a dinner. Before operation it is extremely desirable to leave off smoking and not to take some alcoholic beverages.
of the Technician of an augmentatsionny mammoplastika (increase in a breast)
Considering specific features of each patient, the surgeon can choose the following types of access for carrying out operation on increase in a breast:
- under a breast (submammarny access);
- in an armpit (axillary, axillary access);
- about a nipple (periareolyarny access), by
and also to choose the implant location:
- under a muscle (a submuskulyarny arrangement);
- over a muscle under its own fastion (a subfastsialny arrangement);
- under a mammary gland (a subglandulyarny arrangement);
- a combined method of an arrangement.
When carrying out this operation the next ways of anesthesia can be used:
- local anesthesia with an intravenous sedation;
- the general anesthesia with use of an intravenous anesthesia;
- the general anesthesia with use of an endotrakhealny anesthesia.
On average operation on a mammoplastika continues 30-40 minutes when using submammarny access, and till 60 minutes when using periareolyarny or axillary access. If increase in a mammary gland is combined with its tightening, then duration of operation can increase till two o`clock.
Is the most traditional and safe method of carrying out a mammoplastika. The section (length about 4 - x cm) is made around a natural fold directly under a mammary gland. Such form of access provides the easiest way of an insert of an implant and takes least of all time.
This way is optimum if at a mammary gland initially small volume, and at the same time soft fabrics are well expressed. In that case for increase in a breast use of soft and elastic implants is shown. A lack of this way of a mammoplastika is possible omission of an implant eventually. Besides, even at ideally performed operation it, most likely, all the same will be probed. Also it is possible to carry the fact that there is a visible hem to shortcomings of submammarny access, and it it is extremely difficult to arrange in a skin fold under a breast as the fold after correction of chest gland is displaced.
in case of the choice of this type of access should mean Axillary access that hems in axillary area are hardly noticeable. Also the implant is closed by a big pectoral muscle and a mammary gland therefore after carrying out a mammoplastika it is practically not probed, well fixed in fabrics and over time is not displaced. Only in one case the implant can be visible - it can move up at reduction of a big pectoral muscle (for example, during sports activities).
A lack of this method is that axillary access gives the worst formation of a cavity in fabrics for placement of an implant. In many cases it is possible to solve this problem with use of endoscopic equipment and special surgical tools. In addition, in this case it is rather difficult to create symmetrically located cavities for implants, and also there is a risk of damage of the nervous terminations.
At the choice of this method it must be kept in mind that at tendency to formation of hypertrophic hems the section can be visible in an axillary hollow at a raising of hands up.
In this case an implant is placed in a breast through the section made on border of pigmentation of an areola therefore after operation the hem is swept least up. However at such access it is slightly more difficult to create a cavity for an implant. The section of fabrics is made in a hypodermic or through tissues of the most mammary gland. In the postoperative period in both cases the risk of development of an inflammation, mikrokaltsinoz and formation of cysts is increased. Besides, during operation it must be kept in mind probability of injury of the fourth intercostal nerve which provides sensitivity of an okolososkovy zone.
the Combined access
At last, exists the combined access at operation on increase in a breast. The surgeon forms implantation cavities - pockets in two planes. At the same time the top part of an implant settles down under a muscle, and the lower part - under a mammary gland. Thanks to it the endoprosthesis remains reliably fixed in fabrics. In the postoperative period it does not move, and also is not probed on the one hand.