Safety and understanding of breast surgery

Every surgical procedure carries a risk of complications, and this applies to breast surgery as well. For this reason, cooperation from the patient is essential; it may require making temporary sacrifices to facilitate the healing process or, at the very least, ensuring that nothing interferes with it. In fact, this cooperation must begin even before the surgery. In the preoperative period, an ultrasound is always necessary; if any suspicious lesions are detected, a biopsy must be performed, or further diagnostic steps—such as an MRI or mammography—are required. An exception is made for certain solid lesions, which I may be able to remove during the surgery itself.

When preparing for surgery, you should ask yourself: what compromises and sacrifices am I willing to accept? In the case of breast reduction or a breast lift, one such compromise is the presence of long, "inverted-T" shaped scars. While the horizontal scar is concealed within the inframammary fold (the crease under the breast), the vertical scar—running from that fold up to the nipple—will fade over time and become less noticeable. However, if you have a known tendency toward developing keloids or hypertrophic scars, please inform me or your surgeon; this helps avoid unpleasant surprises during the healing process. Furthermore, any procedure involving extensive incisions carries inherent risks—such as wound dehiscence (opening of the wound), localized scarring, infection, or irregularities—which could extend the recovery period by 2–3 weeks and may necessitate daily dressing changes.

In the early postoperative period, swelling or hematomas may develop. Temporary loss of sensation in the nipple can occur, though less frequently; fortunately, complete or partial necrosis of the nipple is an extremely rare complication. While the nipple can be reconstructed, a loss of sensation will persist. Because breast tissue and skin are living, hormone-sensitive tissues with unique characteristics in every patient, even the most skillfully performed surgery cannot guarantee that the breasts will not sag again in the future or that asymmetry will not recur. However, patients can influence the outcome through proper nutrition, appropriate physical exercise, the use of well-fitted bras (without push-up padding), and, most importantly, by maintaining a stable body weight. Should any deformity arise, there is no cause for concern, as it can always be addressed through a revision procedure—though this should not be performed sooner than 6–12 months after the initial healing process. This is why proper recovery is crucial following any breast surgery. Typically, a well-fitted sports or compression bra must be worn for the first 6 weeks, followed by an underwire bra for the next 6 months. In cases involving breast implants, a stabilization band (often referred to as a "Stuttgart belt") is also required, usually for a period of 8 weeks. It is also important to understand that, depending on the type of procedure, it may take 7–12 months for the breasts to reach their final shape and position. For this reason—and particularly in the case of breast-lifting procedures—I perform a so-called... Hypercorrection—placing the breasts unnaturally high, to the point where they might even look "plastic-fantastic"—is a deliberate step. During the healing process, the Newtonian force of gravity will bring them down to their proper position. It is also important to remember that we are not sculpting the breasts out of stone, but rather working within a living organism; human tissue, being sensitive to hormones, may react to a surgical procedure in various ways. Breasts sometimes heal at different rates, so temporary asymmetries during the recovery period are not at all unusual. Conversely, permanent asymmetries are fortunately rare, and even if they do occur, they can easily be corrected—for example, through lipofilling or by repositioning the nipple.

When it comes to breast implants, we must be particularly vigilant regarding the risk of infection. Although infections are extremely rare, they require immediate treatment; in the worst-case scenario, they may necessitate the removal of the implant. Another rare complication—occurring most frequently in smokers or individuals with thin skin—is the exposure of the implant through the incision site under the breast. This can happen if an implant that is too heavy exerts pressure on a fresh wound. This same mechanism can also lead to complications known as "bottoming out" or the "double bubble" effect. The risk of such issues can be minimized by using ultra-light implants or those with a polyurethane coating, which effectively adhere to the chest wall without placing excessive strain on the surrounding tissues. Fortunately, these problems are virtually non-existent with my preferred approach—the transaxillary (underarm) method—because the incision is located above the implant, meaning it is not subjected to pressure, and the integrity of the lower pole of the breast remains intact. An implant may also shift upward, a phenomenon often caused by "muscle animation." Essentially, the muscle—if not sufficiently stretched—can push the implant upward and laterally. There are several ways to prevent this; the most common approach is the creation of a "dual-plane" pocket for the implant. In this technique, the lower attachments of the pectoralis major muscle are released—a process that does not impair the functional movement of the shoulder or arm. The implant is then covered by the muscle from above, and by the skin and breast tissue from below, which prevents it from shifting upward.

Since an implant is a foreign body, the immune system reacts to it. As the body cannot remove it, it becomes isolated from the surrounding tissue by a capsule. In rare cases—especially if even minimal contamination has occurred—this capsule may contract and thicken. Over time, such capsular contracture can lead to implant deformation, chronic pain, or even rupture. In such instances, the prosthesis must be replaced or substituted with a fat graft. In extreme cases, an excessive immune response can lead to the development of a lymphoma known as BIA-ALCL. Although this condition is extremely rare—and was only identified relatively recently—it carries a good prognosis and is easily treatable; however, it does require the removal of the implant and the initiation of oncological therapy. To minimize these potential issues, manufacturers have developed various types of implant surfaces. It goes without saying that I minimize the risk of such complications by using products exclusively from the best manufacturers. It is also worth noting that these implants come with a lifetime warranty against rupture and a warranty of at least 10 years against capsular contracture.