Introduction
For many women, a breast augmentation is very important for them to feel well, to perceive themselves as beautiful, seducing. The breast augmentation procedure substantially increases the self-confidence, and as this is a prerequisite for our health and success in life, it should be a priority for you.

Breast augmentation, also known as augmentation mammoplasty, concerns women who consider their breast size to be too small. It can mend a reduction of breast volume after pregnancy or after a significant loss of weight. By inserting an implant it is also possible to balance off a mammary asymmetry. Besides the surgery by which an implant is being inserted, there is no other method which can provide an obvious and significant breast size augmentation.

On implants
Implants are made of silicone, as it proves to be the most frequently used material in producing medical breast implants due to its biocompatibility. Except for this role, silicone is used with further more purposes, such as stitch covers, protective layers for the artificial heart valves, silicone implants for patients evincing orthopedic conditions. About 12 years ago it was claimed that there might be a connection between silicone implants and two particular diseases: breast cancer and the autoimmune disease. Scientific research was done on more than 2.000.000 women with breast implants all over the world. They showed no clear evidence according to which silicone could cause any type of cancer or autoimmune disease. These data were collected by South California University and made public in the "Journal of Plastic and Reconstructive Surgery", as well as at Calgary University - Canada in the "English Journal of Medicine" and by Mayo Clinic - USA, all of them providing clear proof of the fact that there had been no increase in the risk for breast cancer with women having silicone implants. The autoimmune disease is a general term used to describe an immune system that reacts defensively to substances which are part of one's own body. These complications may appear spontaneously with common people.

The theory according to which silicone might cause the autoimmune disease is totally wrong. It was clearly demonstrated by various tests done on several groups of women with breast implants. Clinical studies have found no clear link between silicone implants and connective tissue disorders. There are further ongoing studies that keep on verifying these results on large groups of women participating in such studies for a longer period of time.

Breast implants are either silicone shells previously filled with silicone gel or they are filled with salted serum during the operation. The use of gel-filled breast implants has recently been resumed in Europe and it has been also decided that starting with 2003 such implants may be used in the US, as well.

What patients could benefit from breast augmentation?
Any woman who is looking for improvement, not perfection, in the way she looks. If you are realistic in your expectations, then, you may be a good candidate for this surgery.

Surgery risks
There is no surgery without risks. The risks must be discussed in detail with the surgeon and the anesthesiologist before the surgery. Beside the risks common to any general anesthesia surgery, infections, hematomas and unaesthetic scars can appear.

Capsular contraction represents the most common problem concerning this surgical intervention (the conjunctive tissue forms a capsule around the implant which begins to tighten and, eventually, squeeze it). In a more advanced phase an intervention is needed and the removal of the implant may also be required (in case it has been placed in front of the pectoral muscle it is to be moved behind it). Sometimes the implant has to be replaced as well.

It is about a complication that does not depend on the surgeon's technique or on the quality of the implant but on the particular reactivity of each patient's body.

Some women claim a hyper or hypo sensitivity of their nipples (over or under sensitivity). You may also sense numbness patches near the incision area. Such symptoms usually disappear in time but with certain patients they also become permanent.

There is no evidence showing that breast implants may affect fertility, pregnancy or the patient's ability to breast - feed. In case one nursed babies one year before the surgery she may very well produce milk for a few days following the operation. This may cause discomfort but it can be treated with the medication we will prescribe for you. Occasionally the implants might break and leak. It might be the outcome of some accidents and very rarely such things might happen spontaneously.

If a saline implant breaks, it will deflate in a few hours and the serum will be absorbed by the patient's body without generating any complication. If a rupture occurs in a gel-filled implant, one or two things may happen. If the shell breaks but the capsule around the implant remains unscathed, there may be no change. In case the capsule also breaks, especially following great pressure, the silicone gel may seep into the surrounding tissues. Consequently, there may take place some modifications in the shape or firmness of the breasts. If such a thing happens, a second surgery is needed and the implant must be replaced.

Before surgery indications

• before the operation, you must undergo a mammogram or an ultrasound examination;
• do not eat and drink anything after midnight before the surgery;
• it is forbidden to take aspirin and other drugs that contain aspirin for 2 weeks before the surgery;
• you must tell the doctor or the anesthesiologist if you have medical problems (hypertension, vascular problems, heart failure, diabetes, lung problems, bleeding problems, epilepsy, neurological problems, allergies to certain drugs);
• you must tell the doctor if you wear dental prosthesis or contact lenses;
• if you smoke, plan to stop smoking for 1-2 weeks before the surgery and do not start smoking until at least 2 weeks have passed from the surgery;
• avoid extra exposure to sun before the surgery;
• do not keep a strict diet before the surgery because it can delay the healing;
• if you catch a cold or you have an infection of any kind, the surgery must be postponed;

The surgery
Breast augmentation, is usually performed under general anesthesia and it lasts for one or two hours. The incision can be made either in the submamar crease, inside the areola or in the armpit. The surgeon will do his best in order to make the incision as small and inconspicuous as possible. The saline implants can be introduced by a 2.5-3 cm incision while gel-filled breast implants need a 5-5.5 cm incision. As for the positioning the implant in relation to the pectoral muscle, we always insert saline-filled implants underneath the chest muscle and the gel-filled implants either pre - or retro - pectoral according to the initial aspect of the patient's breasts (skin tone, sagging breasts, the width of breast tissue and fatty tissues).

The advantages and disadvantages of these alternatives, concerning the insertion and the positioning of implants should be discussed in details before the surgery. A small tube may be placed in each breast to drain off blood and fluids for 24 hours.

Post surgery hospitalization
Hospitalization is of about 1-3 days, during which antibiotics are given to the patient. Placement behind the muscle may be more painful for a few days after surgery than placement directly under the breast tissue. You are likely to feel some unease discomfort for 24 to 48 hours following the surgery but it can be treated with the medication ( painkillers and miorelaxing )we will prescribe for you.

Post operative recovery
After you leave the clinic the stitches are removed 12 days after the surgery; this can also be done by you family doctor. During the next 2-3 months you must wear a surgical bra that should perfectly suit your new breast shape and size. You should avoid intense physical effort for the first two or three weeks. As for the scars, they will swell and turn red in the first six months and after 9 months - 1 year they begin to flatten out and fade away. You should avoid exposure to sun for one year in order to prevent the pigmentation of the scars. Still, scars will never disappear completely.

We do mention that routine mammograms should be continued after breast augmentation for women who belong to the age group evincing high breast cancer risk. When requesting a routine mammogram, you should go to an X-ray center where technicians are experienced in the special techniques required to get a reliable x-ray of breasts with an implant. Ultrasound examinations may also be requested.

Conclusions
The most important aspect concerning breast augmentation is one's personal wish and decision. For many women, the emotional and psychological benefits of breast augmentation are materialized in the enhancement of their self-confidence and appearance, creating a new"look"

With this surgery we have a big medical practice: more the 4000 cases operated on, so far.

Find out how you can benefit from this intervention.
Make an appointment for an examination at Dr.Mihail COJOCARU.