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Pros and cons of complex breast surgery

Augmentation and breast modeling mammoplasty in other words breast enlargement and reduction, is a complex procedure. This procedure represents a solution for saggy breast, atrophic mammary glands, loosened skin and when the breasts size is small.



Breast modeling mammoplasty and augmentation in one procedure?

Augmentation and breast modeling mammoplasty in other words breast enlargement and reduction, is a complex procedure. This procedure represents a solution for saggy breast, atrophic mammary glands, loosened skin and when the breasts size is small.

Therefore, modeling and augmentation is necessary in order to achieve the required look. This means that the breasts are remodeled – get the right shape, firmness and their size is increased during one procedure. The benefits of such procedure are described here.


Breast modeling procedure

When only modeling breasts, the surgeon adjusts their shape, which sometimes involves decreasing the breasts size, and this is called reducing – modeling mammoplasty. The aim of the procedure is to remove extended skin tissue and sometimes the mammary tissue as well. Subsequently, the mammary gland (the breast) and the skin tissue are folded and joined together in a new, good looking and firm shape.


This procedure can be explained and simplified using a Lego model. Let’s imagine a Lego breast model which is loosened. Once you want to adjust the shape, you must dissemble all bricks, remodel them and assemble a “new breast”. This is what happens during the procedure.


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The breast is cut into several pieces, the pieces not useful or needed, mostly in large breasts, are taken away and the rest of them are put together into the required shape and stitched together. Of course, venous drainage and nerve supply of breast structure is taken into account and fully recovered depending on the technique used at the procedure.

There are several techniques and they differ in the manner of which part of the breast is the accessible part and which tissue around the nipple and areola remains unaffected and provides their nutrition. The scope and appearance of the scar tissue left after the procedure is also a decisive factor. One of the factors is the level of breast sagging. The larger the sagging is, the more complex is the procedure. These factors have impact on the number and position of surgical incisions and thus the scars.

There are three types of the breast modeling based on the incisions.

  • The gentlest one, however indicated in only a few cases, is when the scar is positioned only around the areola. This technique is called periareolar mammoplasty (doughnut method).
  • Secondly and indicated more frequently is vertical mammoplasty (lollipop method). The scar is positioned around the areola and continues down to the inframammary furrow (area under the breast).
  • The third technique is the most extensive and requires the largest amount of scars. The scar is positioned around the areola, continuous down to inframammary area and then deep inside the inframammary furrow (anchor or reversed T method).

A successful procedure and stunning result of the breast shape require good blood supply of the breast tissue, stitching with minimum tension and enough time for recovery. When planning breast modeling procedure it is very important to visualize how much of the skin tissue and breast tissue will be removed in order to achieve a good looking, firm shape and size of the breasts.


What is Breast augmentation


Classic augmentation involves increasing the breast size using breast implants. An implant can be made by various producers; it can have an oval or anatomic shape and different projections.

The range of the implant size is various too and it depends on the client’s expectations, the anatomy of client’s chest and the breasts themselves. The implants can be inserted via armpit, around the areola or via inframammary furrow and they are positioned under the mammary muscle or under the mammary gland.

The procedure is always performed as sensitively as possible in order to cause minimal breast trauma and its surroundings. This is very important for recovery process and a firm positioning of the implant and avoiding implant area inflammation.

A successful procedure and stunning result of the breast shape require good blood supply of the breast tissue, stitching with minimum tension and enough time for recovery.

When planning breast augmentation it is important to have a clear image of the future breast size and shape. This can be achieved by a precise medical examination of the shape and symmetry of the client’s chest and breasts and selecting the size of the implants using special underwear pads, called “sizers”.


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Fat auto-transplantation is not a suitable technique when breast modeling

Fat auto-transplantation or fat injection, so called lipo-grafting is not a suitable technique for breast augmentation when breast modeling. Although this question is proposed quite often, it is not possible to perform such procedure.

Fat auto-transplantation (lipo-grafting) is only suitable when the breast tissue is unwounded, in good health condition so that the fat cells – fatty tissue has good conditions for embracing and healing. Fat auto-transplantation technique is only possible when a gentle periareolar mammoplasty is performed and the augmentation is of a small range.


Breast augmentation modeling mammoplasty in practice

When comparing conditions for breast augmentation and breast modeling mammoplasty regarding healing processes and achieving required results, we find out that these are fairly similar and thus combining the two procedures appears as logical and without contradictions. However, this is not correct.

As mentioned above, good blood supply of the breast tissue, stitching with minimum tension and enough time for recovery is essential for achieving required results. Nevertheless, it is not possible to maintain low tension of stitching of modeled breasts and good blood supply of augmented breasts with implants.

The implants put pressure and extend the breast tissues which impacts the level of tension of stiches, at the same time the pressure exerted in the tissues limits blood supply. The weight of the implant is unable to keep the modeled breast together as it is heavier and larger.


On top of that it is very demanding to keep the implant in a firm and correct position as the modeled breast tissue is loosened, cut into several pieces and subsequently joined together. All these factors influence negatively blood supply and the recovery as well as healing process.

Therefore the conditions for planning such procedure are contradictious. It is very difficult to estimate the final size of augmented breasts when certain amount of breast tissues is taken away during modeling.

The amount of the skin and breast tissue that is necessary to be taken away is difficult to predict so that there is enough skin and tissue left for stitching. Selecting the optimal implants size is also difficult once we know that the breasts will be slightly smaller and their shape will be different and modified due to the modeling procedure.


20% risk of unsatisfactory effect after combined procedure

Breast augmentation mammoplasty is set in these up mentioned contradictions and it is obvious that planning and healing phases are opposing. Professional literature states 15% to 20% risk level of unsatisfactory effects at breast augmentation mammoplasty – combination of breast augmentation and modeling.

This means that each 7th to 5th client can have unsatisfactory or less satisfactory results of the procedure. Such result can be highly influenced by the client’s physical features and surgeon’s experiences too.


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Two divisions of Professionals’ opinion

There is, as usually, not one and only opinion on how to proceed with the procedure of both, breast augmentation and breast modeling mammoplasty at once. One group of surgeons never performs both procedures at the same time. First, they perform breast modeling mammoplasty and after the recovery period, they proceed with breast augmentation of the modeled breasts.

The second group of surgeons does both procedures at the same time if the risk level is not high and conditions are suitable and moderate. However, if there are not suitable conditions, they do each procedure separately, in two sessions. Fortunately there are only a few surgeons who do not consider the conditions and perform both procedures at the same time and so these do not represent a significant percentage of professionals.

As a conclusion, there is no absolute advice or suggestion for clients on how to make a decision and which way to go. However, professionals can provide an expert talk to the client so that the client is able to make the right decision.


What to take into account before making the decision?

Always consider the scope of the procedure. The more complex it is going to be, the more extensive the sagging is, the larger the implant size is, the higher is the level of risk and probability of unsatisfactory result.

The recovery and healing period is longer as well as the level of risks connected to such procedure is higher. On the other hand, the client must consider the fact that two separate procedures mean twice as much time off work responsibilities and being disabled for longer time from everyday life activities and on top of that, having two general anesthesia, two recovery and healing periods and the risks connected with such procedures.


The final advice

The most important and decisive aspect, which is essential and general, is to have chosen reliable medical center and experienced surgeon. The surgeon himself is the key element as there must be a close, intimate and reliable relationship evolved. Trust and belief in between the client and the surgeon is necessary.

Once the relationship is as described, the surgeon gains the trust by his acting and approach, pays attention to every detail, examines the client precisely, explains each and every question or hesitation, including risk factors and negative side effects, then the client has no other choice than to have the procedure done by her surgeon and fully believe in the judgment and opinion provided.



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