The aim of cosmetic breast surgery is to create beautiful and symmetrical breast.
What define beautiful breast shape depends on the individual patients body stature and what she consider attractive ,as well as on her particular cultural concepts of beauty.
What are cosmetic breast surgery?
Augmentation is procedure to increase in size of breast.
This can be done with
1.Autologus tissue like fat grafting
2. Breast Implants.
All implants on the market today are made of two separate components, outer silicon shell and inner filling that can be of Saline or Silicone.
The outer shell of breast implant are either smooth or textured .
|2. Free rotation within the capsule||2. Tethered to capsule|
|3.May bottom out||3. More rippling|
|4.Loss of superior pole||4.Better retention of shape|
|5.Possibly higher contracture rate||5. Possibly low contracture rate|
What are shapes of Implant?
Breast implant may be round or anatomical shape.
The newest generation of implants –the cohesive silicon gel implant-promises increased gel integrity and a more natural appearance.
That are the approaches for breast agumentation?
There are four approaches
Commonly dual plane breast augmentation is done in which implant is placed under both muscle and breast tissue.
Advantages of dual plane implant placement
1.Minimal capsular contracture
2.Implamt is not visible hence no rippling
3.No alteration in normal breast function as breast feeding
What are complication?
1 Most common complication is capsular contracture.
2. Implant malposition
4. Infection and implant removal.
Breast Augmentation with FAT GARAFTING
Fat grafting to enlarge the breast can be performed for cosmetic reasons, for correction of asymmetry ,and for reconstruction of deformity.
Advantages of fat grafting
Donor area for fat harvest
The most common donor siteare
Procedure is performed under general or regional anaesthesia.
Fat is aspitratedmanualy with liposuction cannula attached to syringe or vaccume pump.
Lipospirated is washed with 0.9 % normal saline solution
Centrifugation is done at 1000 rpm for 2 minutes.
Then this purified fat is injected in to breast.
It is recoomonded that patient should wear a supportive bra day and night for 7 days after breast augmentation with fat grafting.
Oral antibiotics areadmistered for 3 days postoperatively.
Compression garments for donor area for 3 months.
Mastopexy is asthetic breast surgery in which breast is lifted and reshaped without increasing size of breast to look aesthetically pleasing and more youthful.
In modern mastopexy ,restoration of upper pole fullness with possible parenchyma rearrangement can be an essential part of the procedure, even without implant augmentation.
Indication and Selection of Procedure
Ptosis of beast is main indication for mastopexy
Mastopexy can be combined with breast augmentation with implant.
There are basically two technique of Masxtopexy
Why breast reconstruction
The presence of breast is a defining feature of adult mammalian gender.
It must therefore be considered an essential element of human feminity, and the role it play in female psychology cannot be understated.
Hence reconstruction of breast is almost exclusively consequent on surgery for breast cancer.
What are aims of breast reconstruction
Creating a symmetrical ptotic conus precisely positioned on the breast footprint embodies the art of breast reconstructive sculpture.
The ultimate goal of breast reconstruction is to create symmetrical,natural-looking breast and not necessarily a specific shape or volume.
Indication for breast reconstruction
Immediate Versus delayed Reconstruction
Immediate Delayed Reconstruction
This is indicated when patient may require adjuvant therapy as radiotherapy. In this reconstruction an expander is placed in skin envelop which helps in maintain suitable subcutaneous cavity to accommodate implant or tissue of reconstruction at later stage.
What are Type of reconstruction
Which are flaps are used for breast reconstruction
Gynaecomastia and tuberous breast
Gynaecomastia: Gynaecomastia is commonly described as benign ( Noncancer) proliferation of male breast tissue or persistant enlargement of male breast tissue.
32 to 36% of males suffer from gynaecomastia, and as high as 65% in adolescent boys.
Bilateral disease is reported to occur in 25-75% of cases
Causes of Gynaecomastia
1.Idiopatic- exact cause is not known.
Oestrogen,androgens ad their receptors are thought to play a major role in the development of the condition
An imbalance in the concentrations of the hormone’s, with a relative increase in ostrogen, is thought to bring about breast tissue proliferation.
A relative increase in plasma estradiol compared to testosterone is thought to cause pubertal gynecomastia.
In addition ,weight gain increases conversion of testosterone to ostrogen.
Due to various metabolic and endocrine disorders
Aquired and congenital hypogonadal states leading to an increased overall estrogen state.
Drugs are major etiological factor
It occurs due to direct increase in ostrogen and decreased testosterone
Bannayan and Hajdu
Cordova and Moschella
Opinion of Endocrinologist
Evaluation of liver,renal and thyroid function
Tumourmarkersfot testicular such as bhCG,alphaferoprotein and basal prolactin level(Prolactinoma)
X-ray chest to rule out ca lung
Mammmography: To rule out ca breast
CT head to rule out pituitary tumours.
Medical: Tab Tamoxifen(anti-oestrogen), TabClomiphen( act on hypothalamic pituitary axis to increase LH & FSH) and Tab Danazole( acts on by suppressing pituitary –ovarian axis by inhibiting the out put of both LH & FSH) can be used for spontaneous regression.
The aim of surgical treatmentare volume reduction with or without retailoring of redundant skin.
Liposuction and Excision of gland: Minimal invasive surgery through periareoral incision.
Excision of Skin: May require when there is excessive skin that would not be retracted after liposuction.
Patient have to wear pressure garments for 3 to 4 months.
Liposuction and Liposclupture
In women,the creation of smooth and well defined curves will always improves their figures. As surgeons, we aims to improve the shape of our patients,but the results of our effort are closely linked to the expectations of each patients being realistic rather than unrealizable.
In male , a more angular and muscular shape is sought ,paying attention to the definition of abdomen and chest wall muscularity.
Improvement in shape and figure generally makes patients feel more comfortable about themselves ,enabling more versatility wearingdifferentsclothes,sporting fashions and/or swimwear.
Liposuction has estabilished itself as the most valuable body –contouring plastic surgergical procedures available and the demand for it is not abating.
Improved instrumentation and anesthetic techniques have facilitated better and upgraded results since the introduction of technique 30 year ago.
What is safe liposuction?
It is generally accepted that large -volume liposuction is anything over 5000 mL of fat removal and that greater volumes of aspiration are associated with increasing complication rates.
Normal suction machine which generates about 30 mmHg negative pressure.
Ultrasonic liposuction Machines
Power assisted liposuction machine
Manually with syringe cannula
There are various cannulas of different sizes varying from 1 mm to 6 mm and in different shapes with varying tips.
Liposuction can be done undergeneral ,regional or local infiltration with IV sedation.
Dressing,Compresion and postoperative management
After closure of all access ports with an absorbable suture, a guaze dressing applied
There will be some fluid leakage from the incisions overnight.
Patient have to wear pressure garments for 2 to 3 months.
Adjunctive measures postoperatively
Lymph drainage, massage and ultrasound treatment by a qualified physiotherapist are recommended for persistent swelling and tissue that are woody, indurated or bruised.