In fact, we need to start the cooperation even before the surgery. In the pre-operative period, an ultrasound is always necessary and, if suspicious lesions are detected, a biopsy must be taken or the diagnosis must be extended with an MRI or mammography. The exceptions are some solid lesions, which I can remove already during the surgery itself.
When preparing for surgery, ask yourself what compromises and sacrifices are acceptable to me? In the case of a reduction or lift, the compromise is to accept long scars in the shape of an 'inverted T’. Of course, the horizontal scar hides in the subpectoral fold and the vertical one, running from the fold to the nipple, will fade over time anyway, so will not be irritating. However, if you are known to have a tendency towards keloids or hypertrophic scarring, you should inform me or your surgeon to avoid any unpleasant surprises during the healing period. Anyway, procedures where we have long wounds always carry the risk of dehiscence, local hypertrophy, infection and neovascularity, which will prolong healing by 2-3 weeks and require daily dressings.
In this early postoperative period, swelling or haematomas may still develop. Rarely, there is a temporary loss of sensation in the nipple and even full or partial necrosis of the nipple. Of course, the nipple can be reconstructed, but in that case the sensory loss will remain.
As the mammary glands and skin are living tissue and have individual characteristics in each patient, even the best-performed operation cannot guarantee that the breast will not droop again in the future or that the asymmetry will not return. However, the patient also has an influence on this, through proper nutrition, proper physical training and, above all, maintaining a constant body weight. Even if a deformity does occur, there is no need to worry, as it can always be corrected with a revision surgery, but not before 6-12 months after healing.
This is why proper recovery is crucial after any breast surgery. Usually a well-fitting sports or compression bra should be worn for the first 6 weeks, which is then changed to an underwired bra and worn for 6 months. In the case of breast implants, a Stuttgart belt is also included, usually for a period of 8 weeks.
It is also important to realise that, depending on the type of surgery, the breasts may need up to 7-12 months to reach their final shape and position. For this reason, and especially in the case of breast lift procedures, I perform a so-called hypercorrection, i.e. I lift the breasts unnaturally high so that they appear „plastic fantastic”. During healing, the Newtonian force of gravity will bring them lower, into the right place. We also need to remember that we are not sculpting breasts in stone but in a living organism, and hormone-sensitive human tissue can react differently to surgery. Breasts sometimes heal at an uneven rate, so temporary asymmetries during the recovery period are not unusual. On the contrary, permanent asymmetries are fortunately rare, but can still be easily compensated for, for example, by lipofilling or nipple displacement.
With breast implants, we need to be particularly sensitive to the issue of infections. These occur extremely rarely, but require immediate treatment as, in the worst case scenario, they can result in the implant having to be removed. Another rare complication, occurring most often in smokers or those with thin skin, is exposure of the implant through a wound under the breast. This happens if an implant that is too heavy presses on a fresh wound. The same mechanism can lead to complications called 'bottoming out’ or 'double bubble’. It is possible to minimise the risk of these events by using ultralight or polyurethane-coated implants, which literally glue themselves to the chest without putting strain on the tissues. Fortunately, all these problems are almost non-existent with my favourite transpectoral method, as the wound is above the implant and therefore not pressed, while the integrity of the lower pole of the breast is intact.
The implant can also move upwards and this happens as a result of the so-called 'animation’ of the muscle. Simply, the unstretched muscle moves the implant upwards and to the side. There are several methods to prevent this and the most popular one is to create a 'dual-plane’ implant pocket. In this technique, the lower attachments of the pectoralis major muscle are undercut without causing functional-mobility problems in the shoulder and arm. The implant is then covered from above by the muscle and from below by the skin and gland, so it is not moved upwards.
As the implant is a foreign body, the immune system reacts to it. Our body is unable to remove it, so it becomes isolated from the rest of the body by a sac. In rare cases, the capsule can contract and thicken, especially if even minimal contamination has occurred. Shrinkage of the capsule in the long term causes deformation of the implant, chronic pain and even rupture. The prosthesis then needs to be replaced or replaced with a fat graft. On the other hand, an excessive immune system response can, in an extreme situation, lead to lymphoma (BIA-ALCL). This disease is extremely rare and has only recently been recognised, has a good prognosis and is easy to treat, but requires removal of the implant and implementation of cancer therapy. To minimise all of the above problems, manufacturers have created a variety of implant surface types. Needless to say, I minimise any risk of the above events by using products from only the best companies. It is worth mentioning here that the guarantee on implants is given for life against rupture and at least 10 years against capsular contracture.