The Nordström
Hospital for Plastic Surgery
Breast
Surgery
The First Consultation
During the first consultation the patient
will discuss the goals and expectations of the surgery together
with the operating surgeon. The surgeon will assess the nature
of the breasts, decide on the size and position of the implants
considering the patient's expectations and the breast to hip
ratio and explain the risks involved in the procedure. At
our hospital different size implants can be ordered for the
patient. The smallest breast implants are around 100 cc in
volume and the bigger ones can be over 500 cc. The size difference
between the implants is 30 cc.
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After the breast augmentation the
patient stays overnight at the hospital.
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Breast
Augmentation
For many women, breast size is an important
part of feeling good and desirable. Having a breast augmentation
can greatly improve self-esteem for many women.
Breast augmentation can dramatically enhance
the appearance of a woman's breasts. It can also improve the breast
to hip ratio important for a balanced body image. For example, hips
will look narrower after the breast enlargement making the figure
look more graceful and balancing the body contour.
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| Before the breast augmentation |
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After the breast augmentation |
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Having children, the loss of a significant
amount of weight and ageing all contribute to the loss of volume
and tone in the breasts. Breast size and shape depends upon various
factors such as breast gland size, skin tone and heredity. Implants
are used to enlarge small breasts. They can also be used to reconstruct
breasts after cancer, to correct underdeveloped or asymmetrical
breasts. There are several surgical approaches to reconstructing
a totally or partially missing breast, e.g. tissue expansion, implants,
and TRAM method. In some cases, for instance, it may be necessary
to replace local tissue from elsewhere in the body.
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| Before the breast augmentation |
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After the breast augmentation |
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Before the operation it is extremely
important to try different size implants to get an idea as
to the look you desire and to carefully go through all the
information about the surgery.
The operation lasts about an hour and
is done in general anesthesia. Before the operation the position
of the implants is carefully marked. The implant is placed
either above or below the muscle. The incision can be placed
along the crease underneath the breast; around the areola;
or in the armpit.
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| Silicone gel filled implants |
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Breast Reduction,
Breast Lift
Large, sagging breasts often cause back pain,
tense muscles, postural problems and skin rashes. Too big breasts
can also interfere with normal physical activities. The breast size
depends upon various factors such as heredity, amount of pregnancies,
age of the patient, amount of fat and overall weight of the patient.
Breast reduction can be done at any age but
on the very young patients should be performed only after careful
consideration.
During the consultation the breast size and
shape are discussed. The operation is done in general anesthesia
and lasts 2-3 hours. During the operation, over one kilo of excess
breast tissue can be removed, the excess skin is excised, the nipples
are relocated to a higher position and the remaining breast tissue
is reshaped.
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| Before the breast reduction and lift |
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After the breast reduction and lift |
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Breast reduction uses incisions that encircle
the areola and then extend vertically down the breast and horizontally
along the crease underneath the breast. In some cases, the incision
is placed just around the areola. There are other breast reduction
techniques using a different pattern of incisions. Breast reduction
does not usually prevent lactation and breast feeding but the nipples
sensitivity might temporarily decrease following the operation.
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Implant fillings
A silicone implant consists of an outer silicone
shell filled with a silicone gel. Some implants are filled with
gel so hard that when cut in two they do not leak a drop of gel.
Textured implants are more tissue friendly than smooth implants
minimizing capsule contraction or scarring around the implant to
a few percents. At our hospital we also use saline-filled implants.
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Silicone and Breast
Cancer
Lately the safety issues of silicone breast
implants have been extensively discussed in the mass media. There
is a great deal of scientific evidence supporting the long-term
safety of silicone breast implants. According to the multiple clinical
trials, the incidence of breast cancer in patients with silicone
breast implants is even smaller than in patients without implants.
This could be due to the fact that the patients who have undergone
breast enlargement often have less breast gland tissue and are therefore
at at lower risk to develop breast cancer.
Recent studies conducted in the USA, e.g.,
the study carried out at the University of Los Angeles supported
the safety of silicone breast implants. The study performed on the
patients operated 27 years ago had shown that the risk of breast
cancer in the patients with silicone implants is smaller than in
the patients without the implants.
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Silicone Gel and Autoimmune Diseases
In medicine silicone gel is considered to
be a suitable filling substance for use in the breast implants as
it does not get rejected by the body. Despite that, there is an
opinion suggesting an association between silicone gel and autoimmune
diseases such as rheumatoid arthritis and progressive systemic sclerosis
or scleroderma. One symptom of connective tissue disorder is a disturbance
of the autoimmune system. In autoimmune diseases the autoimmune
system turns against itself causing tissue damage. Heredity is a
frequent cause of connective tissue diseases and women are affected
much more frequently than men. The fact that among them are also
women with silicone-filled implants does not prove that silicone
causes autoimmune diseases. There are no clinical data proving an
increased incidence of connective tissue disorders in patients with
silicone gel breast implants. Statistically, connective tissue diseases
are as frequent in women with silicone-filled gel implants as in
the rest of the population.
In most European countries silicone gel is
approved as a filling substance for use in breast implants. In the
USA the use of silicone gel breast implants is prohibited till the
manufactures of these devices present the FDA (The Food and Drug
Administration) clear proofs that there is no connection between
silicone-filled breast implants and autoimmune diseases.
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Control in the
EU Countries
Silicone-filled implants are approved for
breast augmentation in all the Nordic countries and all the EU countries
except for France and Italy. In Finland silicone-filled implants
have been used for breast augmentation since 1970s. Although the
Medical Devices Unit of the National Agency for Medicines recommends
a careful examination of the patients prior to breast augmentation,
there are no limitations of the silicone gel implants use in Finland.
The patients with silicone-filled implants are advised to be examined
by a general physician every two years (the National Research and
Development Center for Wealth Fare and Health, 1994).
According to the official opinion of the
National Research and Development Canter for Wealth Fare and Health
(Impact 4/98), silicone gel is a safe filling substance for
use in breast implants and does not cause autoimmune diseases.
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