Women’s breasts are synonymous with femininity which is why, in breast surgery, special care and attention is devoted to their aesthetic appearance. The shape of breasts following surgical intervention needs to be in harmony with a patient’s body. This presents the greatest challenge for a surgeon involved in breast surgery, because the achievement of ideal shape and size of the breast to a large degree depends on the patient’s constitution, but also on the cultural characteristics of the patient’s environment.
The great significance of reconstructive and aesthetic surgery of the breast is connected to the impact of such a surgical procedure on the psychological state and wellbeing of the patient. The aim of reconstructive breast surgery is to aesthetically correct breast deformities which women are unhappy with, regardless of whether these deficiencies are a product of genetic anomalies (hypoplasia, asymmetry, over-voluminosity), injuries or surgical treatment of breast cancer. The purpose of such operative treatment is to achieve the appearance of breasts which matches the patient’s wishes, or which returns it to its original state, before changes started happening, and in doing so, restore for the patient both her physical and spiritual integrity and dignity.
Breast Enlargement – Augmentation
Breast enlargement is the most commonly performed operative procedure both locally and across the globe. It involves the correction of the shape and volume of breasts using prosthetic materials or in combination with corrective surgery of excess skin and reshaping of the relaxed glandular tissue of the breast.
Pre-operative preparation comprises: an oncological check-up, ultrasound or mammography of the breast, depending on the patient’s age and thickness of the breast tissue, general internist assessment and laboratory (blood and similar tests) results.
Breast Reduction
From its inception, the main purpose of cosmetic surgery has been to enhance different regions of the body or a tissue area so that the correct function and shape is maintained, using the patient’s tissue or in combination with prosthetic materials. However, frequent occurrences even in younger women are disproportionally large breasts, which cause neck pain and back pain as well as psychological problems. In such cases the reduction of breast volume is the only option and choice of surgery which brings women great relief, both physical and psychological.
Breast Reconstruction Following a Mastectomy
A mastectomy is a relatively simple surgical procedure, most frequently used in treatment of breast cancer, after which the patients’ physical health is recovered swiftly. After a mastectomy, several functional deficits can occur, for instance breastfeeding is impossible, breasts are asymmetrical, they do not look aesthetically appealing and there is also a reduction in sensitivity of the skin of the chest area. However, the most important is the psychological impact as a consequence of physical and aesthetic deformity, which includes development of anxiety, depression, low self-esteem, reduction in, and even at times the complete loss of, sexual libido. The purpose of breast reconstruction is not purely to replace the removed breast but also to secure new quality of life.
For patients with breast deformities needing reconstructive surgeries, it is not uncommon for several operations to be required, so it is incredibly important to determine an operative plan. Before such a plan, a thorough assessment and a consultation will have taken place. For these reasons precisely, a good plastic surgeon has to be aware of the most up-to-date surgical techniques and materials so that that patients’ wishes, needs and expectations can be fully met. Given that these will differ from patient to patient, the need for a tailor-made individual approach is one of the challenges of contemporary plastic surgery.
Correction of Congenital Breast Anomalies
Poland syndrome is a very rare congenital malformation (genetic defect) characterised by a lack of pectoral muscle, breast tissue and occasionally the nipple on one side of the body, together with a hand anomaly in the form of syndactyly (fused fingers), with associated skeletal or muscular anomalies.
It can be successfully corrected through augmentation of one or both breasts with endoprosthesis together with muscle tissue implants (lats/the large back muscle instead of the large pectoral muscle) in order to achieve symmetry.
Inverted Nipples
Inverted nipple is another example of a congenital breast anomaly. It is formed when the milk ducts are too short. Most commonly it occurs on both breasts, less frequently just on the one side. In cases when the nipple becomes inverted where it is normally everted, it can be an early indicative sign of breast disease such as cancer.
It is corrected within an inpatient environment and local anaesthetic using various techniques which allow for nipple eversion, by placing either internal or external stitches. It is possible that nipples become retracted following the operation, so a repeat procedure can be undertaken no sooner than six months following the previous intervention.
Gynecomastia
Male breast enlargement occurs when there are developmental problems or when there are changes in male hormonal balance (tu testis, prostate). Occasionally they can be caused by the use of certain medication for prolonged periods of time or because of excessive weight gain.
Enlargement of breast tissue in men happens either because there is an increase in glandular or fat tissues of the breast.
Patients with Gynecomastia often report associated psychological problems.
The operation is undertaken under total anaesthetic following a full clinical assessment of the causation of male breast enlargement which includes, together with breast mammography (depending on the age of the patient), urology assessment, oncology assessment, and endocrinology assessment. The technique used depends on the composition of enlarged breasts: either liposuction or surgical removal of the breast tissue together with a pathohistological analysis of the removed tissue.