Learn about breast enlargement in Prague, breast augmentation abroad and various types of silicone breast implants. Breast enlargement or breast implants are an ideal solution for many women with small breasts.

Breast augmentation abroad, also known as breast enlargement, involves the surgical placement of an implant behind each breast to increase its volume and enhance the breast’s shape. Breast augmentation is requested by women who perceive their breasts to be too small or sagging.

Types of breast implants

Basic types of breast implants by shape:

Basic types of breast implants by filler:

Nowadays novelties in the implant fillings field occur regularly. Various substances are being tried and used as fillings, including soya-gel and hydrogel. These new types of implants aren’t in regular use yet.

Basic types of breast implants by surface:

Basic types by profile:

• moderate
• high

The size of the breast implants is indicated in mililitres. The choice doesn’t depend on size but on dimension. The selection depends on many factors, such as the woman’s figure, height, width of her chest, figure proportion, size of pelvis, size of mammary gland and of course, the patient’s wishes. The most popular sizes in the Czech Republic are 200 – 300ml. (Implants from about 100ml to 1000ml are available.)

To see what size might be right for you, use a plastic bag that can be filled with liquid or boiled rice. Put it into your bra to help you choose the correct implant size.

Most commonly used brands of silicon breast implants are:

• McGhan/Inamed

• Mentor
• Polytech

• Eurosilicon

All implants have their own passport – a document that states the number and size of the implant. This passport is given to every patient after the surgery.

What does the breast implant look like?

The implant is formed with an outer pocket made from polymerized silicone gum, which is very firm and elastic. The pocket contains one more inner layer, which guarantees a higher resistance to rupture and the minimum permeability of particles. The surface can be smooth, although at present implants with textured surface are preferred. They have pores of a certain size and depth and now also have a smaller risk of capsular contracture creation. A titanium film may be on the surface of the implant (which lends itself to good tolerance with the body) or polyurethane. Inside the pocket there is soft cohesive silicone gel, saline, combination of both or even one of the other substances mentioned above. The cohesiveness of silicone gel particles enables the implant to keep its shape, lowers the risk of permeability of silicone micro-particles through the pocket and avoids the possible leakage of silicone in the event the cover ruptures. The silicone gel filled implant is used most often because of the reduced harmfulness risk on the body from silicone.

Price of breast implants

The price of breast implants ranges from about 18,000 to 50,000 CZK depending on the type of implant and the producer. For round shapes, the price ranges from 18,000 to 28,000 CZK and from 40,000 to 50,000 CZK for anatomic shapes. Prices are independent of size.

Breast augmentation abroad

When choosing a surgical procedure consider the following options.

The placement of the incision:

The choice depends on the desire and preference of the patient and on the usual practice of the clinic.

The placement of the implant:

Both methods (under the muscle and under the mammary gland) have their advantages and disadvantages. The choice depends on the quality and size of the gland, the quality of the skin and the subcutis, as well as the strength and quality of the muscle. The implant coverage has to be sufficient. If it is not sufficient, the implant can be visible and won’t look aesthetically pleasing. The pre-surgery consultation is intended to harmonize the patient’s ideas with real possibilities in regards to their body proportion, and with the advice of the surgeon.

For more information about breast enlargement abroad or breast augmentation in Prague please take a look at the linked pages.

The process of breast augmentation

In most cases, breast augmentation will be performed under general anesthesia. The surgery usually takes one to two hours and one to two days stay in hospital may be needed.

The method of inserting and positioning your implant will depend on your anatomy and your surgeon’s recommendation.
The three-four cm long incision can be made either in the crease where the breast meets the chest, through the dark skin surrounding the nipple or in the armpit. Every incision is made carefully so resulting scars will be as inconspicuous as possible.

A pocket in which the implant is inserted is created through blunt tissue preparation.

Some of the clinics abroad even use endoscopic technique by augmentation. The access for this technique is through an incision in the armpit or in the navel area.

The pocket will be filled with the implant either directly behind the breast tissue or underneath the chest wall muscle.

The size of implants must be carefully chosen in order to be fully covered by the breast tissue. Otherwise the edges of the implants can be easily seen and makes for a very unnatural look.

The cessation of bleeding is very important to avoid further complications – an undesirable capsule, a scar or poor coverage of the implant.

Drainage tubes may be used for several days following the surgery; it depends on the practice of the clinic and on the surgeon.

To close the wound, different sutures are used (mostly intradermal, eventually separate;) they are removed seven to 10 days after the surgery.

How the wound is covered is also up to the practice of the clinic. After the surgery, the breasts are fixed day and night with a special bra. It is recommended to wear this bra four to eight weeks after the surgery. For one month after the surgery, sleeping on your back and limiting sport activities is also recommended.

Are you a good candidate for breast augmentation?

Breast enlargement by means of implants is a very effective procedure. It is suitable for women with insufficiently developed breasts or when the mammary gland system is shrinking, as may be the case following breast feeding or a significant weight loss.

The optimal age limit for surgery varies. It is generally done after the development of the mammary glands is complete, which is usually after the age of 16.

It is certainly better to insert the implants into breasts that won’t change by potential breast feeding. Although it doesn’t eliminate the possibility to undergo breast augmentation before pregnancy; you have to take into account that lactation and pregnancy will change the size and quality of the mammary gland and therefore the surgery will probably need to be redone. It is better to undergo breast augmentation at least one year after the delivery and breast feeding.

Breast implants have no influence on the fetus and they do not expose it to any danger. The presence of implants does not hinder the ability to breast-feed. Studies done worldwide have not found an increased content of silicone in breast milk.

Some women request the implants to be placed as close to each other as possible to create a sexy line between the breasts. Unfortunately this effect is caused by the body’s constitutionand by the distance between the mammary glands therefore it is not possible to create it on demand.

Before breast enlargement

During your initial consultation, your surgeon will explain the surgery in detail. He will explain which surgical technique is most appropriate for you based on the condition of your breasts and skin tension. He/she will also show you before and after pictures and different types of implants.

If your breasts are sagging, the surgeon may also additionally recommend a breast lift. The surgeon will also inform you which implants he or she will use and which size is appropriate for you to achieve the best result.

Because it is a surgery performed under general anesthesia a pre-surgical examination including a laboratory examination and EKG by a general doctor or internal specialist is necessary. The exam should also include a detailed health history i.e. family diseases, diseases that you have had, allergies etc. At some clinics it is possible to have these examinations done in the morning the same day of the surgery.

Before the surgery it is also necessary to eliminate the possibility of breast illness by ultrasound (sonogram) or mammogram examination depending on the patient’s age. They are performed by special oncological and gynecological clinics. This is mostly done if you are a high risk patient due to a family history of breast cancer.

Your surgeon will give you instructions to prepare for surgery. You should avoid drinking and eating 6 hours before the planned surgery. Any medication containing acetylsalicylic acid (such as Aspirin, Acylpyrin, Alnagon, Mironal etc.) can increase bleeding during and after surgery They therefore shouldn’t be taken for about a week before the planned surgery. It is not good to undergo the surgery during menstruation, although it is not a reason to postpone the surgery. It is appropriate to consult your gynecologist concerning quitting birth control. Today’s opinion is to keep taking birth control pills and preventively taking medication against blood coagulation – low molecular heparin (e.g. Fraxiparin, Clexan, Fragmin.)

It is assumed that no acute illness (viral illness, cold, etc.) will have occurred in the period at least three weeks before the planned operation. Report any illness to your doctor.

If you smoke, plan to quit at least one or two weeks before your surgery and do not resume for at least two weeks after your surgery.

The day of the surgery you should come with your armpits shaved, if the surgical method has been agreed upon.  Bring any medication that you take with you for 2-3 days, hygienic items, shoes, pyjamas, ID papers, and an elastic bra without wire support that’s the same size as the chosen implants. Some clinics have them for sale. Clothes that need to be put on over the head are not suitable for the hospital stay. Putting on such clothes after the procedure might be very painful.

While making preparations, be sure to arrange for someone to drive you home after the surgery and to help you out for a day or two if needed.

The costs of the surgery are usually paid for on the day of arrival, before the procedure. An advance deposit is paid at the booking date. Everything depends on the rules of each particular clinic. Since it is an elective surgery, it’s not covered by insurance companies. It is also necessary to take some days off of work because it is not possible to receive a sickness leave.

After breast enlargement

You are likely to feel pain for a few days following your surgery. The pain is more intense when the implant is placed under the muscle. You will take painkillers for two to five days following the surgery; the pain will slowly recede.

You will probably be released from the clinic after one or two days. Before you leave, the bandages may be changed and the drains removed. That will depend on the clinic and your surgeon. The sutures are usually removed during the check-up in seven to ten days.

It is recommended to wear an elastic bra. You will usually get it at the clinic where the procedure is performed. The length of time to wear it is decided by the surgeon. It is usually 4-8 weeks after the surgery and following that, during sport activities. The surgeon may sometimes recommend a medical belt. It is usually used if the implant was inserted through the armpit, and so it squeezes the formed canal. It can also be used if placement of the implant was under the muscle, so that it pushes it downwards, and generally in other situations when the bra is insufficient. The need and length of time to wear it is again set by the surgeon.

The recommendations of breast massages after the surgery vary, depending on the clinic and the type of implant. Some surgeons don’t recommend them at all. On the contrary long lasting pressure massages of the scars are recommended. It is recommended to wash the breasts only after the wound is healed.

Stay relaxed and quiet during the first week following surgery. Have someone help you with the house and kids for the first few days.

You can resume routine activities and lighter house work in 10-14 days. It also depends on the feeling of pain. Avoid lifting your arms over a horizontal line for 6 weeks.

Heavier work, lifting heavy loads, exercising, weightlifting and other sport activities are recommended gradually after two months following the surgery and while wearing the elastic bra. Intimate intercourse should be done very carefully within the first month after the surgery.

It is possible to visit a solarium or sun tan 14 days after the surgery, it is better though not to rush these activities too much. The scars must be covered with plaster or treated with a high SPF sunscreen for a minimum half a year following the procedure.

You should be able to return to work within 10-14 days, depending on the level of activity required for your job.

The result of the augmentation is considered permanent after three months.

If the breast skin is dry after the surgery, you can apply hydrating creme several times a day. Be careful not to tighten the skin while doing any specific movements and avoid contact with the stitched area.

You should see your surgeon immediately if your breast shape changes, the consistency changes (your breast becomes hard) or any inflammation appears. A visit to your surgeon is also recommended after any severe trauma to your breasts (car accident, fall etc.) Regular check-ups are done after one month, after three months and after one year. A check-up after 10 years also includes an ultrasound examination. The check-up system depends on each clinic. Some clinics have no check-ups at all.

Always be sure to follow your doctor´s instructions.

The implant covers approximately 20% of the mammary gland tissue during a mammogram. That’s why it is a good idea to consider another examination technique such as a sonogram (ultrasound) or magnetic resonance.

Patients that have undergone breast augmentation with implant placement must not undergo diathermy (medical organ heating through high frequency electric current.) The implant could become extremely hot and could cause inner burns and eventually the rupture of the implant.

General complications

Each surgical procedure has its possible complications and we have to consider them, although they appear in a low percentage of cases. General anesthesia has certain risks, which will be explained to you by your anesthesiologist before the planned procedure.

There are complications concerning the healing and possible infection of the wound around the area of the implant. There have been documented cases when the implant had to be removed because of infection.

Another surgical complication might be bleeding. That’s why a laboratory examination of blood clotting before the surgery is essential. Also staying in a calm environment after the procedure is important. Another problem can be scar healing.

A serious complication that can occur in any surgery in which the patient is under general anesthesia is a so-called pulmonary embolism – blocking of the pulmonary artery with a blood clot. For prevention, doctors use elastic bandages on the legs and movement soon after the surgery, the best is the first day. Hormonal birth control raises the risk of thrombosis, so it is possible to stop it or take medication against blood coagulation – low molecular heparin (e.g.Fraxiparin, Clexan, Fragmin.)

Some patients are more likely to receive so-called keloid or hypertrophic scars. Sometimes a correction may be necessary, which is relatively difficult in these types of scars.

Breast augmentation is performed with the arms stretched. Patients can sometimes feel pain shooting into the forearm and hands after the surgery. It is caused by the tension of nerves running from the armpit to the arms. These problems are temporary and fade away after few days or weeks.

Complications concerning the implant placement

Capsular contracture

It is the most often described and feared complication of breast augmentation. A fibrous cover – capsule is always formed around the implant. The tissue reacts naturally to the foreign element of the body. The capsules form in all patients and they can be thin or thick. Its creation is individual. In 5% of cases the capsule can start to shrink – this is capsular contracture around the implant. It is accompanied by pain and a firmness to hardening of the breast. This phenomenon can occur in one breast or both breasts. There are ways to avoid the forming of a capsule or at least minimize its creation. It is for example important to ensure a sufficient size of the cavity for implant placement. Also implants with a textured surface reduce the risk of capsular contracture. The shrinking capsule often has to be treated surgically. There have been documented repeated cases of capsular contractures around the implants and sometimes the rigidness can repeat so that the only possibility is the removal of the implant .

Prolapse (expulsion) of the implant

The skin is in permanent tension in the area of the wound. The size of the implant can also cause a progressive thinning to breakage of the skin and therefore the prolapse of the implant. This complication is more common in patients whose skin has been damaged in any way or scarred for example by irradiation from tumor disease.

Serom

This is the creation of liquid around the implant immediately after the surgery or later. It is manifested by pain and breast enlargement. The reason is most often physical strain after the surgical procedure, excessive sport activity or injury.

Blood coagulation around the implant – hematoma

A collection of blood around the implant is mainly caused by disobeying the relazation orders after the surgery or defective blood coagulation.

Burst and penetration of the implant

The approximate durability of an implant set by the producer is around 10-15 years. The implant slowly wears out and its surface thins, which can cause it to burst. The breast can change its shape and will hurt. In such case a change of the implant is necessary. A breast rupture can also be caused by injury, accident or extreme sport activity. Microscopic particles of silicone can penetrate through the  gel filled implant’s external cover. These particles have been found around the implant and even in other parts of body. No harmfulness has been proved.

Shrinkage of the implant

The shrinkage of the implant cover is manifested by small folds that can be touched under the skin. It can be painful and big folds can irritate the surrounding tissue. It is a problem for skinny patients with a thin skin layer, very small mammary gland and in cases of implant placement under the gland.

Sensitiveness of nipples

The change of sensitiveness of nipples, either increased or decreased is often described by women after the surgery. In most cases it gets back to normal in several months to one year. The change can be sometimes permanent.

Breasts asymmetry

Even breasts enlarged with an implant can droop or sag after some time. Also asymmetries may occur, when one side droops more than the other. It can be caused by disobeying instructions after the surgery but also for other reasons. The implant can change its position through the movement of breast muscle right after the surgery. A higher risk of such a shift is threatened by teardrop implants.

Calcification

Small particles of calcium may appear around the implant. They can be confused with a beginning stage of breast cancer.

Tiny thrombotic vessels

Tiny vessels in the armpits or under the abdominal wall blocked by thrombus may appear after the surgery. They disappear naturally within several months.

Can silicone implants be harmful for body?

There have been made many studies concerning the harmfulness of breasts implants. All the substances that form the implant have been gradually studied and examined. This includes silicone, polyurethane, which is part of the cover of some implants, and platinum, which is used by polymerization of silicone gel. None of these substances showed explicit carcinogenic effect, i.e. ithey don’t cause tumor malignancy. Further studies have been done for any relation between implants and rheumatic and autoimmune diseases, again none have been proved. Elementary silicone occurs normally in parts of the blood, breast milk, connective tissue and most organs. Its content in the body depends on a person’s diet, geographic conditions, quality of drinking water or beer consumption. Also mothers that breast feed with silicone implants do not present any risk to their babies. Silicon is part of nursing bottles, dummies, spoons and other medical products.

How long will the effects of breast augmentation last?

The final breast augmentation is permanent, if there is no change in weight and proportion of breasts (see the above mentioned pregnancy.) Regarding the change of quality of the implant after 10 to 15 yearsor the increased possibility of an implant rupture (burst), it is necessary to consider the possibility of implant replacement. Breast augmentation is a personal, serious decision, and a permanent one. If you have planned carefully, worked with your doctor and followed his instructions, then your surgery should be a successful one!

The future of implants

At Illinois University in Chicago stem cells isolated from bone marrow were stimulated to grow along the supportive skeleton, which is made out of biologically tolerant material. Due to this form the cells have reproduced into previously selected shapes. Such cultivated forms from fat tissue has already been tested on mice. It is assumed that these implants grown from stem cells will be a safe alternative to silicone implants.

Breast enlargement by filling it wiht a person’s own fat or by transplantation of their own muscle has already been performed at some clinics worldwide. There haven’t so far been any experiences with such a technique in the Czech Republic.

Women that had malign breast disease and who undertook the surgery of breast removal can undergo its reconstruction. Regaining the chest symmetry and the shape integrity can therefore help to get the womanhood feeling again and also to moderate a depression.

The loss or deformation of breast caused by the treatment of malign tumour touches the woman in two areas. Beside the fear of further destiny, treatment and state of health, women suffer from the fear from how will their life change after a loss of such a big womanhood symbol.

Its proof is also that during the first information about the character of the disease and the planned treatment at the office, a big percent of women react in more positive way, when they find out together with the information of the necessity of breast removal about the possibility of its reconstruction.

The care of women with malign tumour is inter-branched and the breast reconstruction is part of the plastic surgery. The decision whether and when to perform the surgery depends on the oncologist, psychologist and sometimes even the geneticist.

The timing of the surgery

One of the possible options is so-called immediate reconstruction. It is the case when during one anaesthesia the surgeon removes the tumour with a part or with the whole breast and he/she then immediately fills the formed defect. Most often this procedure is applied in so-called prophylactic surgeries. Those are procedures in which potentially dangerous tissues are removed. In such breasts most often subcutaneous mastectomy is performed. In this procedure only the mammary gland is removed and the skin and areola with the nipple retains. The reconstruction is then usually performed with the usage of silicone implants.

Another possibility is so-called delayed reconstruction. It is a situation when the reconstruction procedure is performed after the termination of all examination concerning the recognition of the state and character of the breast tumour, thus in weeks to months. Those are cases, when it is not necessary to follow the surgical procedure with oncological treatment and it is performed rarely.

Breast reconstruction is most often undertaken after the end of oncological treatment and the negative examination aimed for possible secondary spread of tumour. It is usually performed after more than one year after the primary procedure.

The procedure of breast reconstruction

In principal there are 3 options of breast reconstruction. Always it involves gaining of the tissue volume in the place of missing breast.

• The usage of own material (transfer of the skin, sub-dermis and possibly the muscle to the place of missing breast)
• The usage of synthetic material (silicone implant, implant filled with saline or implant combining silicone content with saline)
• The combination of own material with the implant (when the transfer of the skin and sub-dermis from the near area of missing breast and the following filling with the implant)

The use of own material

Most often used is so-called TRAM flap. It is a tissue that is transplanted from the woman’s lower abdomen. The major part consists of subcutaneous fat covered with skin. The result is an arcuate scar in the lower abdomen, the same as in cosmetic abdominoplasties.

It is possible to transfer this tissue to the area of the missing breast in several ways:

• With the application of one of the muscles that forms the abdominal wall. It is the oldest method used for breast reconstruction. It brings the need to solve the formed defect of abdominal wall to prevent the creation of hernia. That is why this part of the body is often covered with small net as in solving bigger hernia.

It is possible to perform this procedure in all clinics of plastic surgery where the breast reconstruction is performed.

• Another option is to separate totally this tissue from the vessels and to transplant it to the desired area as a so-called free flap; it is necessary to reconnect the vessels of the flap to the blood supply.

In this case the suturing of the vessels is made under the microscope. That is the reason why such surgeries can be performed just at the plastic clinics where microsurgical procedures are made.

The advantage of this procedure is that the defect in the abdominal muscles is not big or with the usage of DIEP flap no defect is created.

The disadvantage is in principal longer process of the surgery and more strenuous care after the surgery.

For transplantation of needed volume of the tissue it is possible to use also other parts, although they are applied much less.

The advantages of the usage of own material:

• It is not a foreign material
• The psychological moment
• Lesser risk in the irradiated terrain
• The correction of the second breast is not always needed
• Final cosmetic look of the donor place

The disadvantages of the own material:

• Longer surgical procedure
• The possibility of defect creation in the donor place
• More strenuous care after the surgery

The use of synthetic material

In very small breasts it is possible to perform breast reconstruction directly by inserting an implant to the area.

In bigger breasts it is possible to insert a special type of implant to the reconstructed place, so-called expander that is gradually after the surgery filled through skin by injection to the desired size. During that the skin above the expander is “stretched”. Like this we achieve to get enough tissue with which we can subsequently cover the implant of needed size. After that we can either leave the existing filled implant or we can change it with silicone filled implant.

Last option in this group is the breast reconstruction with the usage of so-called Becker implant. In principle it is an implant with two cells. One is filled with silicone and the other one is added to its desired size with saline. We can therefore call it expander-implant.

The combination of own and synthetic materials

During this procedure the excess of skin coverage, which is needed to cover the inserted implant, is transferred from the skin of near area. Most often so-called thoracodorsal flap is applied, when the skin from the surrounding side is transferred to the area of newly reconstructed breast.

Another, shorter time used method, is the transplantation of the skin from the adjacent area of abdomen. The advantage of this method is that no other scar is created during the surgery because the procedure is performed from the scar after the breast ablation.

The advantages of the use of synthetic material:

• Shorter surgical procedure
• Less strenuous care after the surgery
• Suitable for small breasts and skinny women
• No functional defect of abdominal wall is created

The disadvantages of synthetic material:

• The psychological moment in the usage of foreign material
• Problematic application in irradiated terrain
• The complications during the healing of the implant (the capsular contracture)
• The need to correct the other side in bigger breasts

Another phase of the breast reconstruction

Each breast reconstruction is a procedure that consists of several gradual surgeries.

In interval of several months a new nipple and areola is reconstructed. This topic has been already described in another article. At the same time, an additional change of size and shape of the other breast might be made.

And even after the reconstruction of the new breast with areola and nipple it is possible, especially in case of the reconstruction with implant, to expect several surgeries necessary for the correction of the final result.

The care of the patients with reconstructed breast is long-lasting and minimally the follow-up of the treated patient is for the whole life. In spite that, the breast reconstruction brings higher self-confidence and according to what they say, it improves significantly the quality of their private life and very often even the professional life.

Right choice of breast implant considerably influences short and long term results of breast augmentation. Complications caused by implants are the reason of 1/3 re-operations in first 5 years.

Implants differ by surface, cover, filler and form – shape.

Surface of implant

Most implants have surface made of silicone, with exception of implants covered by a thin titan layer (no more on the market) and implants with polyurethane surface. They are rarely used because they grow together with surrounding tissue so strongly that they are practically irremovable.

The surface can be smooth or rough. A whole range of studies affirm that implants with rough surface have lower appearance rate of capsules (Baker III and IV). Roughness of the surface is different at different manufacturers and all of them declare their surface to be the best protection against capsules.

Cover of implant

The cover of implant is always made of silicone. It can have one or more layers. Theoretical advantage of covers with more layers was not clinically approved.

Content of implant

Implants contain either silicone, physiological solution or hydrocoloid fluid. Implants with hydrocoloid fluid are rarely used and it is therefore not necessary to describe them in detail.

In Europe are used 96% of implants filled by silicone and approximately 3% by physiological solution. Aesthetic results of implants filled by physiological solution are always worse than implants filled by silicone.

Liquid silicone was used in the past, nowadays it is so called cohesive gel (silicone builds long chains). Advantage of this filling is its relative tough consistency – it does not leak if the cover is damaged (silicone bleeding). Disadvantage – very relative – it is necessary to make longer incisions because of its higher toughness. Implants are filled from 80 to 100%, those with lesser quality contain even smaller amount of silicone. Insufficiently filled implants, above all implants with rough surface represent the main reason of rippling on the skin under the implant. Original implants were round and even today mostly implants with this shape are used.

Shape of the implant

Implants with oval – anatomic shape appeared already in the last two decades of the last century, however without success. In the nineties, company named McGhan – now Inamed started a massive campaign aimed on using these implants. Nowadays this company offers 16 different shapes of implants.

Theoretical advantages of oval implants are obvious – more natural shape, it should form the breast better when the chest is longer or breasts slightly sagging. Disadvantage is their relatively high price, they must be placed exactly, the pocket created for the implant must not be too large – the implant could turn around. However in practice we see that even small pressure changes oval shape into round and the whole effect can be only minimal or even none.

The question of lasting quality of implants, so heavily discussed on these pages, can not be answered explicitly. It is not true that half of the implants must be replaced as early as after 5-8 years. But it is also not true that modern implants do not have to replaced at all. High quality implants last definitely longer than implants with interior quality. Material of implants wears off, same as any other material, and its durability depends above all on its mechanical stress. Implants of women who exercise, play sports and above all tennis, wear off faster. The cover thins unevenly and small cracks appear.

These cracks cause the silicone to flow out of the cover and the breast shape to change. This danger does not exist in case of cohesive gel. In my opinion, the real cause of the implant rupture is its damage during the operation. The biggest study concerning implants defines the implant rupture as the cause of reoperation in first 6 years at 1% of patients! Fa mentor – more than 80.000 patients).

Also the Inamed company provides 10-year guaranty for the implants with cohesive gel.

This short review shows how many technical factors influence the choice of implants. The most important of them is however the human factor – experience of surgeons and their aesthetic feeling.

Breast lift or mastopexy is requested by a woman who, for personal reasons want to raise and reshape sagging breasts. As no surgery can permanently delay the effects of gravity and time, the effect is not permanent.

What is breast lift (mastopexy)?

Over the years, factors such as pregnancy, nursing, and the force of gravity take their toll on a woman’s breasts. As the skin loses its elasticity, the breasts often lose their shape and firmness and begin to sag.

If your breast size is too small, if you want to correct the breast volume after pregnancy, to balance different breast size or you need a reconstructive technique following breast surgery or after substantial reduction of weight, the breast implants in conjunction with mastopexy may be solution for you.

By inserting an implant behind each breast, surgeons are able to increase a woman’s bustline by one or more bra cup sizes.

The process of breast lift surgery

Anesthesia

Breast lifts will be in most cases performed with a general anesthesia, so you’ll sleep through the entire operation. Typically, people are requested not to drink, eat and smoke for about 6 hours before the general anesthetic and may need overnight stay in hospital.

Breast lift- the surgery

Mastopexy usually takes one and a half to three and a half hours. Techniques vary, but the most common procedure involves an anchor-shaped incision following the natural contour of the breast.

The incision outlines the area from which breast skin will be removed and defines the new location for the nipple. When the excess skin has been removed, the nipple and areola are moved to the higher position. The skin surrounding the areola is then brought down and together to reshape the breast. Stitches are usually located around the areola, in a vertical line extending downwards from the nipple area, and along the lower crease of the breast.

Some patients, especially those with relatively small breasts and minimal sagging, may be candidates for modified procedures requiring less extensive incisions. One such procedure is the “doughnut (or concentric) mastopexy,” in which circular incisions are made around the areola, and a doughnut-shaped area of skin is removed.

If you’re having an implant inserted along with your breast lift, it will be placed in a pocket directly under the breast tissue, or deeper, under the muscle of the chest wall.

Are you the best candidate for breast lift mastopexy)?

A breast lift can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently.

The best candidates for mastopexy are healthy, emotionally-stable women who are realistic about what the surgery can accomplish. The best results are usually achieved in women with small, sagging breasts. Breasts of any size can be lifted, but the results may not last as long in heavy breasts.

Many women seek mastopexy because pregnancy and nursing have left them with stretched skin and less volume in their breasts. However, if you’re planning to have more children, it may be a good idea to postpone your breast lift. While there are no special risks that affect future pregnancies or breast-feeding, pregnancy is likely to stretch your breasts again and offset the results of the procedure.

Before your surgery

During your initial consultation, your surgeon will explain the surgery in detail, explaining which surgical techniques are most appropriate for you, based on the condition of your breasts, its shape and skin tone. The surgeon will examine your breasts and measure them while you’re sitting or standing.

He or she will discuss whether an implant is advisable. You should also discuss where the nipple and areola will be positioned. Depending on your age and family history, your surgeon may require you to have a mammogram (breast x-ray) before surgery.

Be sure to discuss your expectations frankly with your surgeon. He or she should be equally frank with you, describing your alternativesand the risks and limitations of each.

Your surgeon will give you instructions to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. You may be asked not to use any medications containing acetylsalicyclic acid (such as Acylpyrin, Aspirin, Alnogon, Mironal, etc.). It can increase bleeding during and after surgery.

It is assumed that no acute illnesses occurred in the period of at least three weeks before the planned operation (viral illness, cold, etc.). Report any illness to your doctor.

If you smoke, plan to quit at least one to two weeks before your surgery and not to resume for at least two weeks after your surgery.

While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.

After your surgery

You’re likely to feel tired and sore for a few daysfollowing your surgery. Your breasts will be bruised, swollen, and uncomfortable for a day or two. Most of your discomforts can your doctor control by the painkillers or other medication.

You will be released from the clinic the following morning. Before you leave, the bandages are changed.

For several days you are recommended to avoid physical strain.

The stitches are removed approximately by week after the surgery.

Within a few days, the bandages or surgical bra will be replaced by a soft support bra. You should wear it as directed by your surgeon.

Healing is a gradual process.

Although you may be up and about in a day or two, don’t plan on returning to work for a week or more, depending on how you feel. And avoid lifting anything over your head for three to four weeks.

If you have any unusual symptoms, don’t hesitate to call your surgeon.

You may resume routine activities after 7 to 10 days. After a six-month period, regular check-ups at a mammary clinic are recommended.

Swelling and bruising in your breasts may take three to five weeks to disappear. You should be able to return to work within a few days, depending on the level of activity required for your job.

Your breasts will probably be sensitive to direct stimulation for two to three weeks, so you should avoid much physical contact. After that, breast contact is fine once your breasts are no longer sore, usually three to four weeks after surgery. If your breast skin is very dry following surgery, you can apply a moisturizer several times a day. Be careful not to tug at your skin in the process, and keep the moisturizer away from the suture areas.

Your scars will be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely.

You should see your surgeon any time when your breast shape change, when the consistencychanges (your breast become hard) or any inflammation manifestation appears.

If you become pregnant, the operation should not affect your ability to breast-feed, since your milk ducts and nipples will be left intact.

How long the effect of breast lift will last?

Your surgeon will make every effort to make your scars as inconspicuous as possible. Still, it’s important to remember that mastopexy scars are extensive and permanent.

Duration of results is variable depending on size (effects of gravity), pregnancy, aging, and weight fluctuations. Women who have implants along with their breast lift may find the results last longer.

The cancer treatment of breast consists in surgical removal of the tumor, often including removal of sentinel ganglion with following radiotherapy or chemotherapy. During the tumor removal also a part of mammary gland is removed at the same time and often even the whole breast, which represents usually big handicap for a woman. Although within the plastic surgery it is possible to reconstruct a part or even the whole breast together with breast areola so that it resembles maximally the look of the real breast.

The breast reconstruction must be at first recommended by the oncologist, who will decide in what time period after the tumor removal it is possible to perform the breast reconstruction.

In breast reconstruction we can use either artificial implant or own tissue.

The choice of the method depends on the local finding and on the general patient’s condition.

In case there has remained a part of breast’s skin after the breast removal or if the breast was removed just partially, we can simply insert a silicon implant, mostly under the breast muscle. If the whole breast was removed and there is not enough skin, a skin graft from a surrounding area is used. We form a skin flap and transfer it to the place where we want to form a breast. In such formed skin fold we then insert an implant. It is possible to transfer the skin flap from the outer part of the chest (thoracodorsal flap) or from the place under the breast (skin advancement). These skin flaps are suitable for reconstruction of small breasts, when the inserted implant does not exert big pressure on the created skin fold.

If we want to reconstruct bigger breast it is more suitable to use own patient’s tissue instead of an implant, it is a tissue from the further place with its excess and better possibilities to form it to a natural shape. Own tissue has also another advantage compared to an implant, there is no risk of capsular contraction and there is no need to change it like in case of an implant. For breast reconstruction with own tissue a skin with subcutaneous tissue is removed from the abdominal area under the navel.

The whole tissue is transplanted to the place on the chest where we plan to reconstruct a new breast, and there it is formed into desired shape. This tissue needs to have its own vascular supply to survive, through which blood flows to the transplanted tissue and the flap is therefore healed into the new place. The abdominal tissue might be supplied by vessels passing rectus abdominis muscle that lies under the transferring tissue.

The flap is rotated to the chest with the part of the rectus abdominis muscle and the vessels that are attached to the tissue are not disconnected so it guarantees its survival. The disadvantage of this method might be the defect of the part of the rectus abdominis muscle and following weakening of the abdominal wall.

More favorable, although technically more intensive is the method of free transport of tissue with the help of microsurgical technique. A tissue is removed with the part of the rectus abdominis muscle and the vascular pedicle of the flap is disconnected. The whole tissue is transferred to the chest where the disconnected vessels are connected on the receiving vessels under the ribs, and the blood between them can start to flow. For such vessel connection special suturing is used that is not visible with the naked eye, and this part of the surgery is therefore performed under the microscope and with the usage of special instruments.

The technique of the free tissue transplantation is technically and time wise more consuming and it represents bigger exercise for the patient compared to the breast reconstruction with silicon implant.

The patient has to be therefore in a good health state to avoid more serious complications during and after the surgery.

After the surgery the patient stays at intensive care unit for several days and then is placed to the standard unit. Calm mode is recommended for about one month and then slowly the physical exercise is allowed.

After some time also the adjustment of the second breast is often made so that both breasts would look the same. Also reconstruction of the nipple with the help of small skin folds is performed from the local material on the reconstructed breast. For more real colour of the breast areola we can use colour tattoo.

The solution of breast disease with its following reconstruction needs the cooperation of the mammography specialist, oncologist and plastic surgeon. Plastic surgeon should choose according to the specialist’s recommendation the most suitable method of breast reconstruction regarding the best result of the surgery and also the minimum risks for the patient.

The breast reconstruction after their removal is covered by the health insurance company.

A breast lift or mastopexy is requested by women who wish to raise and/or reshape sagging breasts. As no surgery can permanently delay the effects of time and gravity the surgery is not permanent. To learn more about breast lifts and mastopexy abroad read the following information and then explore our site to see if breast lift surgery is right for you. The shape of female breasts is rather individual. The breasts are formed by the developed mammary gland, ligaments and fat. The upper border is only estimated as the chest wall changes into breast very slowly. Usually it is around the 3rd rib. The lower border is in the area of the inframammary fold, normally around the 6th rib. The breast development is concluded between 16 and 18 years of age and the shape changes due to the age, during a menstruation cycle and during important hormonal swings (puberty, climacteric, childbirth, lactation). In young women the nipple-areola complex is above the inframammary fold; however with the growing age it sinks to the level of this fold and below – breast ptosis. The breast lift is not usually performed before the age of 18; the only exception is a serious health condition. In such a case a legal representative of the patient must be present at the pre-operative consultation.

Elizabeth Anderson had to act fast when she learned she had advanced breast cancer in April 2009. Just one month after her diagnosis, she had a bilateral mastectomy, a surgery removing both of her breasts.

“With a Stage 3 diagnosis it was either breasts or life. There was no decision to be made. I had to take them off,” recalls Anderson, a 47-year-old fitness instructor from Naples, Florida.

Following the surgery, Anderson says, she had to mentally prepare before taking a first glimpse at her new body; she knew it would be difficult.

“I just stared at myself in the mirror for a few minutes saying, ‘It’s OK, it’s OK. This is what you had to do,’” she says. Anderson, who also had chemotherapy and radiation during the course of her treatment, was elated to finally be cancer-free, but says it was difficult to adjust to her new body.

She figured her days of having breasts were gone forever. She was not a good candidate for breast implants, not commonly recommended for women who have had radiation. Instead she wore breast prostheses, but found them to be cumbersome. Then, there was the emotional frustration.

“This is zero. This is scars on your chest. This is absolutely nothing,” Anderson explains. “As a woman, to look in that mirror and not see anything, it doesn’t feel right.”

During a chance visit to a different radiologist near the end of her treatment, Anderson was told about bilateral delayed breast reconstruction, a procedure pioneered within the last decade, where doctors re-create breasts using fatty tissue taken from other parts of the patient’s body, often from the buttocks, the abdomen or the back.

Anderson says neither her oncologist nor her regular radiologist mentioned this type of surgery while she was being treated, and none of the women in her survivor group had even heard of the procedure.

“They all looked at me like I had two heads,” Anderson says. “People were very surprised. They assume implants are the way to go.”

Seven in 10 breast cancer survivors may be unaware of reconstruction options

That’s actually pretty common, according to a survey from the American Society of Plastic Surgeons, which found that out of every 10 women who qualify for reconstructive breast surgery, only three are fully informed of their options.

Each year more than 254,000 American women learn they have breast cancer, according to recent estimates from the American Cancer Society, and many need a mastectomy to remove the cancer.

“Those who diagnose breast cancer and those who do mastectomy are separate from the plastic surgeons who do the reconstruction,” explains Dr. Frank DellaCroce, a surgeon at the Center for Restorative Breast Surgery in New Orleans, Louisiana, the place where Anderson’s breast reconstruction was performed.

“Integration of those two sides affords a global conversation with the patient before mastectomy,” he says.

“That is absolutely the case,” agrees Dr. Ann Partridge, clinical director of the Breast Oncology Center at the Dana-Farber Cancer Institute, who also does research on improving health care communication. “Medicine is not a solo-practitioner profession anymore; we need to work as teams for a better outcome.”

Partridge says there have been several new reconstructive breast therapies developed over the past several years, and though she agrees patients should be informed of them, she says in some cases if the patient doesn’t bring it up, the oncologist may wait to have this discussion, especially when radiation treatment is needed.

“Reconstruction, while important, is not a medical necessity,” she explains. “We as oncologists tend to focus on the treatment of the disease, and while in the throes of things, all [patients] care about is life or death.”

Partridge also notes that new therapies spring up in small pockets of the U.S., and if a therapy is not available in the city where the patient is being treated, it may not be considered a viable option by the oncologist. Anderson, for example, traveled from Naples to New Orleans for her procedure.

Partridge and DellaCroce agree that regardless of the circumstances, reconstruction should be discussed as soon as possible, because having the option is an important facet in the patient’s full recovery.

“When you lose some component of your physical self, you also lose some of your emotional self,” DellaCroce says. “To have the breast rebuilt erases some of the injury of a very difficult event, a diagnosis of breast cancer and the devastating deformities that can occur with mastectomy.”

‘I’ve got them back!’

Anderson says when she first learned about bilateral breast reconstruction, she turned to the web for more information and located a surgery center that could remove fat from her buttocks. She went for a consultation, and had to gain 23 pounds in order to have enough fat to form small C cups, one cup smaller than she had before cancer.

After living without breasts for 18 months, she finally got them back on October 21. Anderson will need one more surgery, a butt lift to close the gap where fat was removed, but for now she says her battle against cancer has come full circle.

“Gotcha cancer! You took them from me, but I’ve got them back!” Anderson says. “It’s amazing what doctors can do today. I’m absolutely thrilled I can just be normal. That’s all I want, is to be normal again.”

Where to find information on breast reconstruction ?

If you’re interested in learning more about breast reconstruction options and the risks associated with the various procedures, both the American Cancer Society and the  Susan G. Komen Foundation answer questions about breast reconstruction after mastectomy on their websites.

Breastcancer.org provides photo images to help explain how procedures like implants and flap reconstructions work.

The Department of Health and Human Services has a chart detailing the surgery choices for women with early-stage breast cancer.

You can also find a board-certified plastic surgeon in your state by visiting the American Society of Plastic Surgeons website.

Keep in mind that the Women’s Health and Cancer Rights Act includes protections requiring insurance companies who offer mastectomy coverage to also provide coverage for reconstructive surgery.

The American Society of Plastic Surgery has a list of state laws concerning breast reconstruction.

Interview with Dr. Petra Berger, board-certified plastic surgeon (Frankfurt am Main and Zurich), on implant removal.

Dr. Berger, after seeing a real boom in breast augmentation using silicone implants in recent years, it now seems the opposite trend is ocurring. More and more women are having their implants removed. Am I wrong? What is your experience in your practice?

Dr. Berger: It varies greatly. On the one hand, silicone implants are still a very good choice for women with smaller amounts of fatty tissue, who wish to fulfil their dream of having larger breasts. I have patients who weeks after surgery still stand in front of the mirror every day, congratulating themselves on their decision. On the other hand, there is also an increasing number of desperate women considering implant removal who are turning to me for advice.

And what do you advise these women?

Dr. Berger: That obviously depends on each individual case. Some women want to go too big and are then surprised by the obviously unnatural result. In this situation, one solution might be to change to a natural shaped implant. Then, there are also women where the breast augmentation appears successful and yet despite this they are completely unhappy.

What are the reasons for this?

Dr. Berger: The phenomenon behind this is the feeling of a foreign object in the body. Silicone – and let’s not kid ourselves here – is not a natural material. In some women, it causes a sensation of having a foreign object in the body, which doesn’t go away if you try to convince them otherwise or with time. You cannot predict which patient will suffer this effect. Some have no problem with it, others are troubled by it. When lying in bed on their silicone breasts, when going for a swim or doing some other kind of sport, their thoughts are always fixed on their implants. In this instance, only their removal will help. We’re actually participating in one study in order to learn more about this phenomenon.

Why might it be appropriate to remove the implants?

Dr. Berger: In some cases, implanted silicone gel causes pain, which has been described to me by some patients as similar to being pricked by a thousand small needles. It may be that there is pain in only one breast, while the other is perfectly fine. Another problem is capsular fibrosis (scarring and hardening of the tissue – Editor’s note), which can occur at any time after silicone breast augmentation.

There seems to be reason enough to argue for implant removal. Certainly a lot of women will try and avoid this step for fear of making things worse, but is this fear justified?

Dr. Berger: The result really depends on the initial state of the breasts, but of course it also depends on how they were operated on previously. Nevertheless, I can reassure the patient. Generally we can help make a big improvement with some minor breast remodelling –  sometimes even without it. Especially when used in conjuction with insertion of the person’s own fat you can sculpt beautiful breasts.

Does this mean that affected women can choose either a) continuing to live with artificial breasts and the feeling of a foreign object in the body or b) Going back to having small breasts that they were unhappy with before?

Dr. Berger: No, you can choose between a), b) or c).

That sounds promising. What does option C) entail?

Dr. Berger: Breast augmentation using natural materials – for example, Macrolane made with hyaluronic acid. This is a kind of natural sugar, which is broken down if it is not topped up at regular intervals. For women without their own fat stores, it is a method worth considering. For women with their own cushions of fat there is yet another rather innovative option for breast enlargement: lipocondensation.

Please could you explain that in more detail, Doctor?

Dr. Berger: Lipocondensation uses the patient’s adult stem cells as starting material, which then undergo a complex process of  enrichment and purification. With that we get very pure additional fatty tissue, which promises yields of 70-90% above average when compared to conventional practices. Certainly because it comes from the patient’s own body cells, the final product is not only suited to breast augmentation, but can be used anywhere on the body. This is so-called BioShaping we’re talking about here.

That sounds really innovative. Patients will certainly not then be able to complain about this sensation of a foreign object in the body. This will give new hope to all concerned.Thank you, Doctor, for your clarification on the subject of implant removal.

Breast augmentation is a surgical procedure and as any other surgical procedure, it has its risks. All the risks mentioned in this article are valid in this surgery in general but their danger is very different for each woman. The client should get the information about specific risk rate during so-called consultation.

Surgeon’s competence

The consideration about whether to undergo the surgery or not should start with the examination by plastic surgeon. The consultation can be paid, the prices range around 500CZK. It is usual if the client sees several plastic surgeons and after that she makes the decision which one and if even to undertake the surgery. The experience and specialist competence of the surgeon together with corresponding equipment and conditions of the clinic, where the surgery is performed, are also one of the decisive factors for the surgery’s result. Because it is very difficult for the ordinary person to judge these circumstances, specific guidance offers the Czech Society of Aesthetic Surgery that belongs to the Czech Medical Association of Jan Evangelista Purkyne where under link “Public information” you can find the List of Certified Members. All the surgeons mentioned in this list have to fulfil conditions (also stated on this page) to receive the certificate of specialist competence to perform aesthetic surgeries. It is not possible to say that the surgeons without this certificate are not specialized enough. Often they just did not undergo the administrative procedure connected with gaining this certificate by the Society. The consultation and your feeling or estimation can help you to decide if you can trust the surgeon that you chose. That’s why the consultation should be the first step to surgery.

The most frequent risks and risk factors in augmentation

There are in particular risks as follows:

The original breast shape

The original breast shape plays an essential role in the difficulty of reaching the optimum result. In principle, in small breasts without loose skin it is easier to achieve success than by sagging breasts with loose skin.

For the evaluation of the degree of loose skin (drooping of the breasts) the mutual position of skin fold under the breast (infra-mammary fold) and breast areola with the nipple is decisive. The drooping (ptosis) is divided into 4 grades:

Skin ptosis of first grade means that the infra-mammary fold is under the lower border of breast areola. In principle, it does not present breast drooping.

Ptosis of second grade means that the infra-mammary fold meets the lower border of the areola.

In ptosis of third grade, the infra-mammary fold meets below the nipple.

The ptosis of forth grade is characterized by the infra-mammary fold that meets above the nipple or upper border of the areola.

An ideal candidate for breast augmentation is a client with ptosis of first grade. If we simplify it, we can say that in this case it is possible to reach a satisfactory result through any method and with any type of implant. In ptosis of second and third grade, it is necessary to evaluate very carefully the technique of the surgery, the method of implant’s insertion and its size and shape. In all cases, it is not possible to avoid breast reshaping at the same time mainly in ptosis of third grade. In ptosis of forth grade it is hard to avoid breast reshaping at the same time during the augmentation.

Shift of the implant

If it is not possible from any reason to maintain the optimum position gained during the surgery, a good result can be damaged. For example, by inserting the implant under the muscle through the incision in the armpit, the breast muscle has the tendency to push the implant up. This risk can be reduced by creation of optimum space for the implant and especially by keeping the recommendation of shaping from the surgeon (shaping bra, band, bandaging) and calm mode after the surgery.

Capsular contracture

A capsule (a case in Latin) means forming of tight tissue cover around the implant. It presents a late complication that occurs minimum several months, rather years after the surgery. The tissue capsule begins to shrink and therefore deform the implant and the external shape of the breast. Due to external pressure, the implants are firm when touching them. The affected breast might be painful. The complications do not have to be that strong and the development of symptoms might cease. Then the situation does not have to be solved. Otherwise massaging or surgical solution, which is not easy and without any risks, is recommended. Opinions on the causes of creation of this complication differ. When forming the capsule, it is often detected that some complications appeared already in the early time after the surgery.

Rupture of the implant

The implants are mechanically very resistant. They are definitely more resistant than most tissues from human body. There have been described many cases of car accidents when it came to multiple rib fractures caused by the stroke from steering wheel but the implants stayed undamaged if they were not pierced with the edge of broken rib. Even during big crush or pressure to chest, the implant bursts rarely. During diving or flying on the plane it never bursts. The ruptured implant is very often diagnosed by ultrasound, mammography or even other examination. Overwhelming majority of these results is wrong. It is caused by examination with devices, when there appear folds on the implants and these folds are in principle not different from bursts. The leaked silicone content is the only one that is possible to be well diagnosed. Some implants are filled with so-called cohesive gel. This gel is not liquid and even after the rupture of the capsule of an implant it preserves its original shape. Therefore, it does not leak out. Theory that the silicone from implants can cause cancer or even other disease is overcome today. In spite of this, it is mostly recommended to revise the implant if there is a suspicion on the rupture.

In implants filled with saline the rupture or leakage are little bit more frequent because of leak in filling flap. The leaked saline cannot even theoretically present any medical risk. It is better in this case to replace this implant rather within a month.

Whistling of the implants on the plane

It is a superstition. The implants are not capable to whistle under any circumstances. Logical explanation to this myth could probably be the fact that specific types of implants for special usage contain metal element. It would probably be signalled by the detector at the gate at the airport. In implants that are partly or fully filled with saline, in which metal is part of the filling flap, it will cause whistling. The implants will not whistle but the signalization of metal detector will and it will not happen on the plane but at the check-in. The same happens with metal articular restoration, screws and likewise.

In implants filled with saline, a sound of water spilling might be heard.

Infection, bleeding, embolism, anaphylactic shock and other complications

These surgical or post-surgical complications might appear the same as in any other surgical procedure. Although in general, their risk is low.

The necessity to replace the implants after several years

In general, if the implants do not cause any problems and there is no reason to remove the implants, they can stay for life. It is true that most of the producers limit the guarantee period of the implant to 5 to 10 years. Although same as in other products, it does not mean that the implant cannot serve safely further. The implants are constructed so that they live longer than their carrier does. Present practical experiences with implants even in our country enable us to trust this fact. In practice, the problem of implant replacement is similar to the decision whether to replace a car after the expiration of the guarantee period of the producer. The difference is that the replacement of the implants presents comparable risks with the original surgery.

Dissatisfaction with the result of the surgery

It is not possible for the surgeon to guarantee the result to any surgical procedure. With the biggest effort, experience and responsibility on the side of the surgeon and the client, the good result is not guaranteed. Undertaking this risk is a necessity of every surgery. In some breasts, an optimum result is not possible to reach through any method. Sometimes the optimum result was achieved from the specialist point of view and objectively a better result could not be achieved but the client is not satisfied with it. The reason lies most often in the pre-surgical communication. Even that the reasons of possible dissatisfaction are routine part of every pre-surgical instructions and are mainly also generally known, the rule that a man hears what he wants to hear and vice versa works during the consultation.

Pre-surgical consultation should be the first step in decision making whether to consider the surgery or not. Although in practice it works more like that a woman herself at first decides hardly without any specialist information. Often she beats her brain out with problems that do not exist and at the time when she arrives for consultation with resolute decision to undertake the surgery, she finds out that there are other significant obstacles that she could not be aware of.