The aesthetic breast augmentation is one of the most common corrections in the aesthetic surgery. Many women think about the breast augmentation from the aesthetic and emotional aspects. The main reasons for the breast augmentation are: augmentating the size or shape of the breast (the cosmetic reasons), reconstruction after the removal of the breast because of the cancer, replacement of the existing old implants for medical or aesthetic reasons, and correction of the congenital deformities. In 99% of cases the augmentation is performed using the silicone mammary implants, while in only 1% of cases the implants are filled with the saline solution. The most modern types of silicone implants are filled with the cohesive silicone gel which is responsible for the lifelong stability of the implants shape (the “form stable implant”). The older types of implants were filled with the silicone oil, which is why the implants became deflated and changed the shape over the years, and had to be replaced after 10-15 years. Today’s modern implants, as we apply in our polyclinic, are lifelong. American companies such as “Natrelle” the manufacturer Allergan give lifelong guarantee on the quality of the silicone implants. Natrelle implants, as we usually apply in our polyclinic, are considered to be among the best in the world, and 60% of the total world implants market are Natrelle implants. The reason of wide usage of the above mentioned implants is the widest range of shapes and volumes of the silicone implants, then the most natural shape, and the smallest percentage of postoperative complications. The breast augmentation may be done earliest at 18 years of age. The ideal female candidate for the breast augmentation is older than 18 years, has the ideal or normal weight (the body mass index is between 20 and 25), the great tension and skin texture, the symmetrical smaller breasts whose nipples are oriented anteriorly (forward, when looking from the “en face” projection). There are 3 basic approaches to the breast augmentation:

–          Transaxillar (through the armpit)

–          Periareolar (through the lower half of the areola)

–          Inframammary (through the line which divides the lower pole of the breast and the anterior thoracic wall)

Transaxillar approach

It is the approach through the armpit area that contains many sweat glands which may contain numerous pathogenic bacteria, and which increases the possibility of the postoperative infection. The operational access is quite unpleasant for the operator because it disables good control of the formed pocket or possible bleeding. Most of the breasts that have been augmented by transaxillary approach look very unnatural, whereby the upper poles of the breasts are too prominent, and the nipples have an inferior or downward orientation. The scar from transaxillary approach is often hypertrophic and visible, and as such unacceptable. This approach is less used in the breast augmentation.

 

Periareolar approach

This approach is done through the semicircular incision around the lower pole of the areola. It is indicated with women who do not plan the pregnancy because it unavoidably transects certain laciferous ducts, which can disrupt the function of breastfeeding. If the areola is smaller in diameter, then the implants of greater volume can not be placed into the formed pocket. The disadvantage of this approach is a relatively high frequency of numbness or hypoesthesia of the nipples which are erogenous zones (statistically 10-15% of the cases). The scar is sometimes very little visible, and sometimes it is very impressive, and below it persists the permanent bulge of the breasts (the “double bubble deformity”).

 

Inframammary approach

The inframammary approach is the world’s most used (75% of the surgeons use this approach). The incision is located in the inframamary fold which is located at the turn of the lower pole of the breast to the anterior thoracic wall. This approach allows maximum visibility of the formed pocket, the easiest way to insert implants into the pocket, the best control of halting bleeding or hemostasis, and is characterized by raising or elevation of the nipples for a few centimeters compared to the preoperative position of the nipples. In our polyclinic we prefer this approach that, we think, gives the best aesthetic results. The scar must be precisely located in the newformed inframammary fold which is situated slightly lower than the position before the breast augmentation. The final scar is minimally visible and very well hidden in the inframammary fold.

 

Procedure

The first step is preoperative examination and consultation which includes a detailed discussion on patient’s desires, ie breast augmentation. Personal and family history and data about the general and cardiac health and illnesses in the family must be thoroughly examined. The next step is explaining the types of silicone implants. After that an examination has to be done: measuring the distance between the pit on the top of the sternal bone and the nipple (SN-N distance), then measuring the dimensions of the mammary area that compares with the dimensions of the implants which a patient prefers. A very important part of the examination is the so-called  clinical “pinch” test, which very accurately determines the location of the pockets in which the implants will be inserted. Any breast asymmetries, including the asymmetries of the volume, shape and position of the nipple, must be carefully recorded and shown to the patient. In the end, a thorough inspection of the anterior thoracic wall is required for the possible detecting of the bone and cartilage deformities of the ribs and/or the sternal bone. The breast palpation can detect any possible irregularities in the breast tissue. The breast USD or mammography are not required routinely, although it is recommended to do these tests as a part of preoperative treatment. The surgery is almost always performed under general anesthesia.

 

Surgical procedure

One of the most important factors for achieving the excellent aesthetic results is the proper selection of the silicone implant for each patient, considering her wishes, dimensions of the mammary areas and any abnormalities and/or irregularities in the bone-cartilage sceleton of the pectoral girdle. Also, it is important to identify the location of the pockets to insert the implants: whether the pocket will be formed above or below the pectoral maior muscle. For this purpose a practical clinical test, or the “pinch” test, is used. The test is performed in the projection of the upper pole of the breast by a special measuring instrument- calliper. The soft tissue of the upper pole of the breast is encompassed with the calliper legs and maximally pinched. If the measuring instrument indicates that the maximum width of the pinched upper pole of the breast is larger than 2 cm, then we decide to form the pocket above the pectoral maior muscle. If the width of the tissue is smaller than 2 cm, then the implants should be placed in the pocket formed beneath the pectoral maior muscle (the so-called “dual plane technique”).

In the picture left the implant is inserted into the subglandular pocket formed between the gland tissue of the breast and the pectoral maior muscle (the “pinch” test is more than 2 cm). In the picture right the silicone implant is inserted into the submuscular pocket formed between the maior and minor pectoral muscle (the “pinch” test is less than 2 cm).

  

The preoperative “marking” is extremely important. “Marking” includes marking of the distance from the nipple to the highest point of the sternal bone (the “sternal notch – nipple distance”), then the current position of the inframammary fold, dimensions of the implant and the pocket in which the implant will be inserted, the planned inframammary incision, the medial line of the pectoral girdle. The dimensions of the implant are set in the accompanying brochures. The required distance between the breasts is about 3 cm at the level of the nipples. The dimensions of the pocket must be somewhat larger than the dimensions of the implant (about 1-1.5 cm) to prevent rotation of the anatomical implants in the postoperative period. Most of the patients have mildly to moderately asymmetrical breasts. Any asymmetry must be preoperatively noted, photo documented and shown to the patient. In our polyclinic we successfully correct all preoperative asymmetries, either by forming the symmetrical pockets to insert the implants or by using different volumes of the implants.

The application of the saline solution with adrenaline and lidocaine in the mammary areas. The aim of this solution application is achieving the shrinkage or vasoconstriction of the blood vessels and allowing bloodless work during the procedure as well as excellent analgesia (lidocaine) or the absence of pain in the early postoperative period.

After the precise preoperative measuring, the initial inframammary incision is located about 1 cm below the real submammary line (the line where the lower pole of the breast passes onto the anterior thoracic wall) and is long from 4.5 cm to 5.5 cm, depending on the volume of the implant that is planned to be inserted. The location and length of the incision are very accurately marked on the basis of detailed measurements of the pectoral girdle dimension before the procedure.

After the precise preoperative measuring, the initial inframammary incision is located about 1 cm below the real submammary line (the line where the lower pole of the breast passes onto the anterior thoracic wall) and is long from 4.5 cm to 5.5 cm, depending on the volume of the implant that is planned to be inserted. The location and length of the incision are very accurately marked on the basis of detailed measurements of the pectoral girdle dimension before the procedure.

After the complete formation of the pockets, the moist sterile gauze is put into the pocket for the compression of the pocket walls and achieving satisfactory hemostasis or bleeding control. After that follows the preparing of the same pocket on the opposite side.

Before inserting an implant, we regularly wash the pockets with antibiotic solution. We use a combination of antibiotics which covers all possible causes of infection. We adopted this procedure after visiting the top hospitals in Bristol and Stockholm. The reason is very important: the prevention of the capsular contracture or creating the firm scar capsula like an envelope around the implant. In numerous researches the latent or subclinical infection with the bacterium Staphylococcus epidermidis (the normal skin saprophyte) in the cases of the capsular contracture development is confirmed.

On the pictures is displayed an implant in the original sterile packaging, which is opened just before inserting the implant into the formed pocket. Previously, the implant was soaked in the antiseptic solution for surgical skin disinfection to allow easier insertion of the implant and additional prevention of infection.

Inserting of the implant into the pocket. The role of an assistant is very important because the proper holding of the hooks allows a surgeon quick and easy implantation. Thereby it is important that the process of inserting the implant does not take longer than 15 to 20 seconds, because too large manual manipulation of the implant, such as squeezing, can furrow the surface of the implant, which is later manifested as the breast surface irregularity.

Before inserting the implants, a drainage tube is set into the pocket. We believe that it is necessary to set the drainage tube for draining the bloody and serous contents from the pocket, because this process allows shorter duration of postoperative swelling and hematomas, and reduces the possibility for the emergence of the capsular contracture. In addition, setting up a drain for the removal of the excessive content from the wound prevents the creation of larger asymmetry in the breasts and, given that redon drain produces the negative pressure inside the pocket, minimizes the possibility of the postoperative bleeding. After that, the implants are inserted into the pockets and follows the closing of the incisions by sewing the envelope or fasciae of the pectoral maior muscle with the underlying muscle using the resorptive thread. Such a method of sewing allows the precise location of the new inframammary line which is lower compared to the preoperative position of the line. If the incision is located precisely in the new inframammary line, it is minimally visible. On every implant there are special tags on the front and back surfaces that allow surgeons excellent orientation and proper installation of the implants.

On the pictures above sewing of the subcutaneous layer with the resorptive sutures where the suture knots are directed towards the depth of the wound is shown. We pay great attention to precise setting of the subcutaneous sutures for the sake of adaptation of the incision edges, which is particularly visible in the right picture.

The final sewing of the skin with the permanent suture, which is set intracutaneously, below the skin, so only the lateral parts of the suture are visible. It is noticeable that the edges of the incision are very precisely and correctly adapted to one another, which ensures the minimal, barely visible scar. The scar is exactly set in the new inframammary line (the line where the lower pole of the breast passes to the pectoral girdle), which will make it almost invisible. The suture is removed after 2 weeks. The remaining two layers of the resorptive sutures will be resorbed after a few months.

The final covering of the wound with the sterile bend. We tend to hold wounds closed during the first postoperative week, and then the wounds are left uncovered, in order to allow the patient normal showering (the children’s baths are recommended because they do not irritate the incisions).

 

Postoperative period

After the surgery a patient is moved to the recovery room where she stays for the  next 24 hours. Antibiotic is applied intravenously 8 and 16 hours after the procedure, and perorally the next few days. In this way the postoperative infection possibilities are maximally reduced. A patient does not feel any postoperative pain, because the intramuscular injections of analgetics are being applied, while the painkillers can be taken during the next few days. Moistening the wound should be avoided during the first postoperative week. Bending the wound is done every two to three days during which the sterile bend is changed and the antibiotic spray or powder is locally applied. In the first few postoperative days a slightly raised temperature can occur (to 38°C– it is a common postoperative, resorption raised temperature), which is not necessary to cure. A patient should sleep on her back with a slightly hightened pillow during the next month. Immediately after discharging from the polyclinic, the patient sets a special bra which excelently stabilizes breasts and protects them from the external trauma. It is necessary to wear the bra during 24 hours in the next 4 weeks. We recommend strict avoidance of physical activity and/or physical manipulation of the breasts for at least 4 weeks. The patient has to beware the accidental kicks in the area of the breasts. Hematomas and swelling of the breasts and surrounding areas of the pectoral girdle can be most visible 2-4 days after the procedure, and they usually last for 2-4 weeks. We recommend taking the pills on the basis of pineapple during the first 4 postoperative weeks because they significantly accelerate the swelling and hematomas resorption. The sutures are removed after two postoperative weeks. The patients should not take aspirin during the first two postoperative weeks because aspirin encourages the creation of hematomas.

A special bra is shown that is used to stabilize and fix the mammary implants during the first postoperative month. The straps on the front of the bra must be placed in the projection of the upper poles of the breasts so that a natural pear-shaped form of the augmented breasts would be subsequently formed. The bra is especially designed to respond to all needs of fixation and protection of the breasts in the early postoperative period.

 

Complications

The aesthetic breast augmentation complications are quite rare. Possible complications include:

  • infection (we did not have a single case so far)
  • bleeding
  • capsular contraction or creation of the firm scar envelope around the implant (possibillity smaller than 2 %)
  • implant rejection possibillity (we never had such a case in our practice)
  • breast asymmetry (it is possible to correct it later, except in the case of a big preoperative asymmetry)
  • hypertrophic scars and keloids (very rarely, they can occur with people prone to creating hypertrophic scars and keloids; we did not have a single case so far)

 

APPENDIX

 

Silicone implants

The aesthetic breast augmentation is one of the most common corrections in the aesthetic surgery today. On the silicone implants market there are 2 basic types:

  1. round
  2. anatomical

We use almost exclusively American Natrelle implants the manufacturer Allergan. The aforementioned implants have the largest selection of different shapes and sizes and the smallest percentage of complications, and are therefore the most represented in the world (according to some statistics, 60% of all the implants embedded in the world are Natrelle implants . Both companies provide a lifelong guarantee on the quality of the implants. It specifically means that the implants do not change their original shape (they are “form stable”), that the structure of the implants is entirely the same today and in about 30 years. The latest generations of the silicone implants are filled with the cohesive silicone gel, containing a microcoarse, textured envelope, where the diameter of pores on the surface of the implant is different, which provides the organism with excellent adhesion of the implants. This means that the implants are very biocompatible. Natrelle implants are legally registered and available in the Republic of Croatia.

  

Round implants

The round implants fill the upper pole of the breast more, so the breast looks round during the first few postoperative years. During the process of aging, as a result of gravity and aging of the skin, the upper pole of the breasts becomes emptier, because the implants descend. The great advantage of the round implants in relation to the anatomical implants is that the possible spinning or rotation of the round implants in the pocket does not cause the breast to change the shape. Spinning of the anatomical implant in the pocket is a postoperative complication because the shape of the breast drastically changes and seems unnatural. Luckily, spinning of the anatomical implant is very rare and can be easily prevented by the proper configuration of the pockets, wearing a special bra and avoiding the rough manipulation of the breasts in the first two postoperative months.

Operacija povećanja grudi pomoću implantata može se izvršiti na tri načina: kroz pazuh, kroz donju polovnu areole, kroz brazdu koja dijeli prednji zid prsnog koša i donji pol dojke.

U ”Ordinaciji Ostojić” estetska operacija grudi najčešće se izvodi inframamarnom metodom gdje se implantat umeće kroz rez na brazdi između donjeg pola dojke i prednjeg zida prsnog koša (inframamarna brazda). Inframamarni pristup operacije povećanja grudi omogućuje najbolju preglednost formiranog džepa, najlakše umetanje implantata u džep i izuzetnu kontrolu zaustavljanje krvarenja i ostalih komplikacija pri zahvatu.

Prednosti ove metode su izuzetno nizak rizik od mogućih komplikacija za vrijeme operacije povećanja grudi kao i u postoperativnom periodu, podizanje bradavica za nekoliko centimetara u odnosu na preoperativni položaj, minimalna vidljivost, tj. odlična prikrivenost ožiljka u inframamarnoj brazdi i općenito vrhunski estetski rezultati i zadovoljstvo klijentica. Iz ovih razloga preferiramo inframamarni pristup.

Periareolarni pristup vrši se kroz polukružni rez oko donje polovine aureole. Ovaj pristup daje dobre rezultate, no postoje određeni nedostaci. Prije svega, periareolarna operacija povećanja grudi nije primjenjiva na pacijenticama koje planiraju trudnoću (ili žele ostaviti tu opciju otvorenu nakon operacije) jer se pri zahvatu ne može izbjeći presijecanje određenih mliječnih kanalića (samim time može se poremetiti funkcija dojenja). Nadalje, implantati većeg volumena ne mogu se umetnuti kroz rez ukoliko je areola manjeg promjera, dok je ožiljak od reza ponekad neprimjetan, a u nekim slučajevima izrazito vidljiv. Isto tako, u 10% – 15% slučajeva moguća je učestalost utrnulosti ili hipoestezije bradavica.

Transaksilarni pristup povećanja grudi implantatima vrši se kroz rez u pazušnoj regiji. Ovaj pristup povećanju grudi koristi se sve rjeđe. Ožiljak je vrlo često vidljiv, a često grudi koje su povećane ovim pristupom izgledaju neprirodno – gornji polovi dojke su previše naglašeni, a bradavice orijentiraju prema dolje. Veliki nedostatak pristupa je i činjenica da se u pazušnoj regiji nalaze brojne žlijezde znojnice koje mogu sadržavati patogene bakterije što povećava rizik od postoperativnih infekcija. Uz to, sam zahvat operateru otežava kontrolu formiranog džepa i eventualnog krvarenja.

Odabir vrste zahvata radi se kod preoperativnog pregleda povećanja grudi, gdje se pacijenticu dodatno detaljno informira o svim prednostima i manama pojedinog pristupa.

Breast enlargement or correction is one of the most common and most popular procedures in aesthetic surgery. A thousand women decide each year to enlarge and correct their breasts, thus improving their appearance and gaining additional confidence.

The main reasons for breast enlargement are:

  • returning of a beautiful looking chest after birth or due to loss of weight (breasts often become depleted and hung),
  • achieving a harmonious, proportionate body figure on which clothes look better,
  • achieving symmetry and generally better looking chest (which can be disrupted by previous operations for health reasons),
  • sense of satisfaction in one’s own body,
  • increase self-confidence and feelings of femininity.

Whatever the reason, it is normal for each woman to look good, that is, to be satisfied with her appearance and to feel better. Breast enlargement is certainly one of the best ways to achieve this, given the relative accessibility and extremely low risk of complications.

In addition to breast enlargement, aesthetic procedures can also correct asymmetry of the breast as well as surgical reconstruction of the breast after mastectomy, that is, removal of the breast.

It should also be noted that the aesthetic procedure of breast enlargement is the only way to permanently and effectively increase breast. “Natural” ways of breast enlargement work only in rare individuals with specific genetic predispositions, various creams and preparations rarely give the desired results.

Choosing the right size and shape of the implants is extremely important and is done in a preoparative examination with our expert help and advice, while respecting the wishes and expectations of the patient. Selection of oversized implants in relation to breast tissue can result in the imaging of the implant through the skin and enhancing the earlier breast sagging by increasing the influence of gravity.

Breast enlargement surgery itself is performed in general anesthesia and lasts on average one hour to an hour and a half. There are three basic ways of implanting – transaxillary (through the armpit), periareolar (through the bottom part of the aureola) and inframammary (through the mammary furrow dividing the lower half of the breast and the front wall of the thorax).

The safest way is inframammary and generally gives the best results. The scar is minimally visible because it is very well hidden in the inframammary furrow, allows the easiest and most precise insertion of the implants and the best control of the risk of infection, bleeding, and the like. Precisely this approach is preferred in the “Ostojić Practice”.

As already mentioned, the complications of aesthetic breast enlargement are extremely rare. Throughout the operation, we take all precautions that minimize the risk of complications. In the postoperative period it is necessary to wear a special bra and avoid any physical chest manipulation over a certain period. With regular examinations and maximum support, recovery after surgery is painless and safe.

Breast enlargement among the most popular aesthetic procedures

Aesthetic surgery is no longer an exclusively luxurious “sport” for the rich. The advancement of technology and the development of new techniques has enabled “ordinary” people to look younger and better when exercises, diet and various cosmetic products do not help. Aesthetic surgery allows a safe and often painless correction of body defects. If patients have a valid reason and realistic expectations, aesthetic surgery can have extremely positive effects not only on physical appearance but also on mental health.

It doesn’t surprise that breast enlargement is one of the most popular surgical procedures for aesthetic surgery. Breasts are probably the most prominent feature of femininity, and many women have at least once thought about enlarging or correcting their breasts. According to the American Society of Plastic Surgeons, about 286,000 women underwent this aesthetic procedure in 2012.

The most advanced techniques and implants make this procedure extremely safe and relatively painless. In “Ostojić Practice” we use only the highest quality breast implants that practically retain the shape for a lifetime. Although there are multiple methods of breast enlargement – most implants nowadays are implanted in the chest by an inframamary method, i.e. by insertion of the implants through a cut on the furrow between the front chest wall and the lower half of the breast – the so-called inframameral furrow. Periareolar and transaxillar approach are options, but there are certain limitations and deficiencies that make surgeons avoid them, that is, the advantage is given to the inframaral approach.

Rhinoplasty (aesthetic nose surgery) has been of the most popular methods of cosmetic surgery in the past few years. In 2012, 243 000 people, of which about 67% of women underwent this type of surgery. Rhinoplasty is followed by correction of lids (204 000 surgeries), liposuction (202 000 surgeries) and facelift (126 000 surgeries). Source: American Society of Plastic Surgeons.

 

Breast enlargement should be strictly your choice

Correction of the breast, especially breast enlargement is one of the most popular aesthetic procedures and most women probably have thought at least once to undergo breast surgery. Striving to look good is a natural thing, especially today when looks are extremely important. Sometimes we can not achieve the desired appearance naturally, and then the aesthetic procedures such as breast enlargement are the only solution.

Correction or breast enlargement can have many positive effects not only on the appearance, but also on the woman’s psyche. The ultimate goal is, as with any aesthetic procedure, to make the person truly happy with his or hers appearance, to increase self-esteem and thus make him/her happier. However, in order to achieve this, the motives of undergoing aesthetic procedure, specifically in this case breast enlargement, must be clear and valid. First of all, breast enlargement should be done only if it is your choice.

If you are intending to undergo breast enlargement or correction solely to satisfy others’ desires, you should probably consider your decision. Agreeing to everything, among other things, artificial breast enlargement, in order to please the loved one is certainly not a good indicator of a healthy relationship. Breast enlargement should not be subject to the desire to be eventually accepted in a particular society or make friends and acquaintances envious. If you decide to undertake this step, do it for yourself – that your favorite clothes fit just like you always wanted, that every vacation is a real enjoyment, because you look great in a swimsuit, that your view in the mirror will give away a smile of satisfaction. Only when you are truly satisfied with yourself and full of confidence will others truly appreciate and love you.

Today’s standards of beauty are very high, and sometimes a bit “crazy”. Some breasts are never large enough or “standing” well enough. Similar to anorexia, women sometimes have a distorted image of their body, in this case their breasts. Therefore, it is extremely important that the aesthetic surgeon provides counsel and objective thinking in a conversation with the patient, taking into account her wishes.

Sometimes a person is dissatisfied or lacks self-confidence for completely different reasons unrelated to the breast itself. In such cases, a person sometimes expects a change in the body (more beautiful, larger breasts) to solve these problems. Unfortunately, in such cases breast enlargement is not justified, that is, larger breasts will not make life better.

In some cases, aesthetic procedures on the chest are inevitably justified. Breast correction has very positive psychological effects in reconstruction after breast cancer surgery. Positive effects are very noticeable after a short time. People who after this unpleasant and often traumatic experience drastically lost their confidence after aesthetic intervention of breast reconstruction often experience positive psychological effects very quickly.

For these reasons, any renowned aesthetic surgeon should require a psychological analysis at the preoperative examination stage to gain insight into the patient’s motives of undergoing breast enlargement. If everything is OK with the psyche and the motives are sincere and valid, breast enlargement can have phenomenal effects on the self-confidence and satisfaction of the woman.

What are the most common reasons for aesthetic breast enlargement?

The main reasons for breast enlargement are cosmetic reasons (increase or correction of breast form), correction of congenital deformations, reconstruction after breast cancer removal and replacement of existing old implants.

How long do silicone implants last, i.e. when do they need to be changed?

The older types of implants were filled with silicone oil, resulting in deflation of the implants, and the shape would change over the years. They therefore had to be changed after ten to fifteen years. Contemporary implants used in the “Ostojić Practice” last for a lifetime.

What is the difference between anatomic and round implants?

Anatomical implants are naturally shaped and they follow the natural lines of the body. We use anatomical implants with a polyurethane membrane of the German manufacturer Polytech Health & Aesthetics.

Round implants fill the upper half of the breast more abundantly, and therefore the breast looks round during the first few postoperative years. During the aging process, as a result of the gravity and aging of the skin, the upper half of the breast becomes obsolete, as the implants are lowered down. The great advantage of round implants in relation to anatomical implants is that eventual rotation or rotation of the round implant in the pocket does not cause a change in the shape of the breast. Turning an anatomical implant into the pocket is a possible postoperative complication because the shape of the breast drastically changes and acts unnaturally. Fortunately, the rotation of the anatomical implant is very rare and is easily prevented by properly shaping the pocket, wearing a special bra and avoiding rough chest manipulations in the first two postoperative months.

What is the minimum age for breast enlargement? Breast enlargement can be done at the age of 18.

How much does breast enlargement cost?

Breast enlargement rates vary depending on the type of silicone implants that are implanted and the complexity of the procedure.

Are there more ways / approaches for breast enlargement?

Yes, there are three basic approaches: inframammary (the implant moves through the furrow dividing the lower half of the breast and the front wall of the thorax), periareolary (through the lower half of the aureola) and transaxillar (through the armpit).

What breast enlargement approach is most popular (which one do you recommend)?

In the “Ostojić Practice” we prefer an inframamous approach. In general it gives the best aesthetic results, facilitates insertion of the implants into the pocket, transparency of the formed pocket and control of bleeding stopping. The inframamous approach is also characterized by the lifting of nipples by several centimeters compared to the preoperative position of the nipples. The scar after surgery is minimally visible and very well hidden in the inframameral furrow (a fissure between the lower half of the breast and the chest wall). Approximately 75% of the surgeons uses an inframamous approach.

What are the disadvantages of transaxillar and peri-linear approach?

Transaxillary access makes it difficult to control the formation of the pocket and eventual bleeding, which is why it is often very uncomfortable for the operator. The armpit region contains numerous sweat glands that often contain pathogenic bacteria, which increases the risk of an operative infection. Breasts enlarged by this method often seem unnatural, nipples have inferior orientation (downwards), the upper parts of the breasts are too prominent, and the scar is often clearly visible (which is unacceptable to today’s standards). The method of transaxylation is being used more and more frequently.

Periareolar access is performed through a semicircular cut of the lower half of the aureola and necessarily crosses certain milk canals, which means that it should not be used in women planning a pregnancy after surgery, as it may impair the function of breastfeeding. The problem may arise even if the aureola is of a smaller diameter, which prevents the insertion of large volume implants into the formed pocket. Another disadvantage of this approach that occurs in 10% – 15% of cases is nipple numbness. As far as the scar is concerned, its visibility varies, sometimes it can be remarkably visible and beneath it persists the permanent protuberance of the breast.

 

What does breast enlargement procedure look like?

The first step is a preoperative examination that involves a detailed interview with the patient, the wishes and expectations of the operation are being heard, i.e. breast enlargement. The types of silicone implants and approach to the procedure are explained. Data on general and cardiac health condition of the patient as well as diseases in the family are thoroughly examined. Then an overview is performed – the SN – N distance is measured, i.e. the distance between the hollow at the top of the chest and nipple. The dimensions of the milk or mammary region are also measured, which are compared with the dimensions of the implants that the patient wants.

An important part of the examination is the so-called clinical „pinch“ test, which accurately determines the location of the pocket in which the implant will be inserted. All possible asymmetries of the breasts must be recorded and presented to the patient. Breast ultrasound or mammograms are required as part of a routine preoperative medical checkup. In the end, a thorough inspection of the chest wall and palpation of the breast is necessary.

What are the possible complications?

The possible breast enlargement complications are infections, bleeding, the formation of a solid membrane around the implant, the possibility of implant rejection, breast asymmetry, and hypertrophic scars. It should be noted that complications are extremely rare, for example, in the “Ostojić Practice” we did not have any cases of infection and rejection of implants, as well as keloid scars. Complications:

 

  • infection (so far we have not yet had any case of infections),
  • bleeding,
  • capsular contracture or the formation of a solid scar membrane around the implant (the possibility is less than 2%),
  • the possibility of implant rejection (we never had such a case in practice),
  • breast asymmetry (it can be corrected afterwards, unless there was a major preoperative asymmetry),
  • hypertrophic scars and keloids (very rare, and can only occur in people who are prone to hypertrophic scarring and keloid formation; so far, we have not had such a case),
  • turning or rotation of an anatomic implant,
  • gathering or “rippling” of implants,
  • rupture or puncture of implants,
  • late accumulation of fluid in your pocket or seroma.

 

How long does it take and what the postoperative period looks like?

After surgery, the patient is in a recovery room for the next 6 hours. In order to minimize the risk of postoperative infection, an antibiotic is administered intravenously, and then orally for the next few days. Wound dressing is done after a week. During the first few days after surgery, there may be a mild elevated temperature that does not need to be treated, as this is the usual postoperative resorption temperature. In the next month, the patient must sleep on her back.

When discharging from the practice, the patient is given a special bra that ideally fixes the breasts and protects them from external trauma. This bra must be worn during 24 hours in the next 2 – 3 weeks. The patient should at all costs avoid bodily activity and physical chest manipulation at least four weeks after surgery. Hematoms and swelling of the breasts last for two to four weeks, and are most pronounced two to four days after surgery. In the period of two weeks after surgery, the patient should not take aspirin (potentiates hematoma).

Breast Enlargement with Mesmo Microtextured Implants (Meme and Replicon Models): 24.000,00 kn

Breast Enlargement with Mesmo Opticon implants: 26.000,00 kn

Preoperative examination: 200,00 kn

Breast Enlargement with polyurethane implants from Polytech Health & Aesthetics (Meme and Replicon models): 25.000 kn

Breast Enlargement with polyurethane implants Opticon model: 26.000,00 kn

Lifting of the lowered breasts or mastopexy: 24.000,00 kn

Decrease of large breasts or reduction: 24.000,00 kn

Lifting of the lowered breasts with an increase in silicone implants: 28.000,00 – 37.000,00 kn

Correction of twisted or inverse nipples: 6.000,00 kn

Decrease or reduction of wide areolas: 8000,00 kn

 

The quoted prices apply to payments made in cash. It is possible to pay in 2 – 12 installments with all credits cards including the ones issued by Zagrebačka banka, Privredna banka Zagreb (including American) and Erste Bank (including Diners). Payment by debit cards issued from these banks makes the price 6% higher, and the payment by credit cards issued from these banks makes the price more than 10% higher. In addition, with the Diners credit card you can pay in 36 installments, but it is more expensive by 10% plus annual interest rate of around 7%. One-time payment is possible with the credit cards of all other banks in the world, but it is more expensive by 10%.