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Breast Surgery

Breast surgery is one of our most common and perhaps most gratifying operations, since the breast constitutes an important and sensitive part of a woman’s body. For many different reasons, many women experience problems with their breasts – problems that we at the Institute of Plastic Surgery can usually attend to. Our goal is natural breasts with invisible or almost no scars!

Women experience problems with small, large, sagging, heavy, asymmetrical, deformed or tubular (pointed breasts) – problems that we can solve at the Institute of Plastic Surgery. We perform breast augmentation (including the use of the latest and safest silicone gel implants, normally inserted via the axillary skin), breast reduction, correction of breast deformities, asymmetries (congenital or developmental) and we reconstruct breasts after cancer. We have a good method for “prevention” of breast cancer that leaves you with natural breasts and few scars. This is a type of prophylactic mastectomy which is useful to prevent hereditary cancer.

More Beautiful Breasts without Scars.

Our method of breast augmentation, using the axillary skin and the newer silicone implants, gives the woman beautiful and more natural breasts with much fewer complications.

An important part of this technique is tissue expansion i.e. a balloon is placed either under the breast muscle or above it, but below the breast gland. The expander is enlarged to appropriate size and somewhat over-expanded in order to create the implant pocket in the breast. Using expansion, we carefully create the size and shape of the breast, and thus we can also compare with the size of the other breast. This is important, since many breasts are asymmetrical. The final volume of the implant can then be decided according to the wish of the patient. The space below or above the breast muscle is virtually bloodless and thus there is very little bleeding. This technique, using tissue expansion, also enables a degree of areola-plasty or mastopexy in pointed or tubular breasts, as well as in cases where breast reduction would be inappropriate. Over-expansion during surgery gives less pain afterwards.

When performing breast surgery, we use a valuable tool: The Wieslander’s Breast Dissector. The tissue expansion helps us to gain implant pockets and to increase the volume of the breast. The expanded tissue is immediately preserved because of the inserted implant. The degree of skin reduction needed, or nipple areola movement, is sometimes difficult to judge prior to the operation. In those cases we perform the tissue expansion and place the expander through an axillary incision. We can then judge, not only the size and shape of the implant needed, but also the degree of nipple areola movement and the required amount of skin reduction. A decision about the location of the sub-mammary fold is also important.

The incision is always closed with long-acting suture material (recently Maxon) and then the skin edges are taped together. A compression bra is finally applied. In all breast augmentation surgery, the upper breast pole is post-operatively compressed downwards while the sub-mammary fold is thoroughly fixed in the new position. Further improvements of scars are achieved by the use of silicone gel to suppress scar reaction.

Technique

Our technique, using the intra-operative tissue expansion described above, is applicable to all types of small and/or deformed or asymmetrical breasts. When appropriate, we also use this technique for the insertion of expanders and implants in the sub-mammary fold area and in the areola.

We normally use the three-layered silicone gel implant or the drop-shaped “anatomical” implant, since the latter have recently been made softer. The interior of all these implants is a gel, but the round implants have a more natural cohesion and move in a more natural fashion. There are however sometimes indications for drop-shaped implants, even though today, the numbers used are much lower than they were only a few years ago. Extensive research has shown that these implants do not harm the patient. Furthermore, repeated major investigations have shown that there is no connection between implants and immunological reactions. The breast cancer rate is approximately 30 % less in women with implants than in the general population. Current calculations suggest that these new implants will be safe for 25-30 years. Our implants come with an insurance that guarantees their quality and gives protection against capsular contraction for 10 – 12 years. There is no additional cost for this insurance. The rate of capsular contraction in our material (Perthese/Mentor) is, according to our latest follow-up, 1/701 – the risk is small!

Doctor’s Comment

The best shape of the breast is achieved through the use of a special technique, developed by Doctor Jan B. Wieslander: the gradual enlargement of the pocket during expansion combined with the use of especially designed instruments. This gives us the possibility to determine the size, the symmetry and the shape on the operating table.

The technique creates the desired lower breast pole and thereby also an optimal shape of the upper breast pole. The disadvantage with the so-called anatomical breast shape is often the hard edges and ridges, which also require longer incisions for insertion. The border of the implant can sometimes be seen. The cohesive drop-shaped gel implant is frequently placed above the muscle, which can create many disadvantages. When we expect difficulties with the shape, for example in a very thin person, sometimes in a previously operated patient or after cancer treatment, a drop-shaped implant could have advantages. Then we often place the implant under the muscle, if this is preferred. The greatest disadvantage of the anatomical drop-shaped implants is that they lead to scars on the front of the breast. When there are scars already, the situation is different. However, even the drop-shaped (anatomical) implants have nowadays become much softer (3rd generation) and implants of 250/325cc volume can therefore also be inserted through an axillary skin incision. 

Advantages with Implants under the Muscle

There are many advantages in placing implants under the breast muscle. You never risk sagging breasts caused by the weight of the implant, and the sensibility in the breast is not much affected. Besides this, the risk of capsular formation that causes unnaturally hard breasts diminishes. Recently we had 1/500 and now only 1/701 capsular contraction. Implants under the muscles are rarely felt, but implants above the muscle can often be both felt and seen. Also, implants under the muscles cause the least disturbance to mammography.

The new three-layered silicone gel implants are so far the most natural ones. When they have been inserted through an incision in the axillary skin, as we do in 90 % of cases, it is quite difficult to see or to feel that any surgery has been performed. Extensive research over the last ten years has not proved any connection between illness (e.g. rheumatic diseases) and silicone implants. As noted above, breast cancer is significantly less frequent in women with implants. This has been confirmed by several major investigations.

Silicone is part of 2-3000 different products in our environment, and all of us therefore have silicone in the body, but women with silicone implants do not show any higher concentration in their tissues. They are the most natural implants available. Saline implants also have silicone in their shells, but they are harder than normal breast tissue. They also create folds (rippling) and they do break!

Our method preserves sensibility in the nipple and areola, even though a temporary reduction or hyper-sensibility sometimes occurs. With our implants, it is possible to breast-feed (if the ability was there before) and we leave virtually invisible scars.

In conclusion, our technique enables us to use round silicone gel implants of many different sizes and profiles. Drop-shaped implants can also be used up to the size of 350cc by axillary skin incision. We do of course never enter the axilla itself. The scars are placed in the hair-bearing part of the axilla and follow a wrinkle, so they become virtually undetectable.

Breast surgery is performed at the Institute of Plastic Surgery, Malmö, Sweden.