Most women find that their breasts begin to sag and fall as they age. Weight loss, pregnancy and breastfeeding, gravity and natural aging process can cause a decrease in height and of ‘elasticity of the skin, causing an excess. In essence, the mammary gland is to find in a container excess skin, particularly unpleasant.
A lifting of the breast, known as mastopexy, is an operation that removes excess skin, reposition the nipple-areola complex in the correct location and uplifts the riplasmandolo breast. Too large areolas may be reduced in diameter and symmetrized between them. In cases where, in addition to the stretching of the skin has also verified the decrease of the volume of the mammary gland and the fat connected to it, you can also insert a breast implant to give back projection to the udder. Dr. Grassetti, where possible, prefer to use of same for breast tissue flaps give volume and projection to the sagging breast, using the technique commonly known as “with autoprotesi” in time to ensure a more natural result.
Indice dei Contenuti
Preparing to intervention
The surgery should not be performed in pregnant or breast-feeding and it is preferable to avoid the period of the menstrual cycle.
Before the operation you will be asked for the reports of mammography or breast ultrasound: for they have the dual purpose of ascertaining the ‘presence of mammary tumors and to get a useful comparison for future diagnostic tests that will be carried out in the years to ‘intervention.
They should not be taken for two weeks prior to surgery or medications containing aspirin or acetylsalicylic acid, as well as taking oral anticoagulants should be adequately replaced with low molecular weight heparins agreeing everything with the patient’s GP. A month before the intervention must be suspended progestogen therapy (birth control pills) in patients who use it: this to further decrease the risk of deep vein thrombosis in the legs.
If you smoke, you should stop for at least one month before surgery to reduce the chance of post-operative complications on skin vascularization and bleeding.
And ‘it recommended getting right now a bra elastic-compressive with front opening high-end, making sure to agree with the health the opportunity to change it if the size purchased was not perfectly adapted to the “new breasts”.
The night before must be done carefully cleaning shower, shaved with a razor completely the axillary region, removed the nail polish for hands and feet.
Observe the fast of at least 8 hours before the ‘intervention.
The surgical breast lift is performed under general anesthesia and usually stays in the hospital for one or two nights. It lasts for 2 to 3 hours depending of the ‘extent of the reduction and the technique used.
During a breast lift Dr Grassetti removes excess skin, reshapes the gland and repositions the nipple-areola complex.
The scars depending on the technique used, may be localized around the areola, along the vertical which goes from the bottom edge of the areola to the inframammary fold, along the inframammary fold same, more or less extensive depending dell ‘of the removal of the entity and able to drop (ptosis) of the breast. It must be said that the techniques which remove the skin and the excess tissue only around the areola (round block), compared to only a areolar scar determine a shape of the breasts rather flattened. Otherwise, removing the excess skin even in the lower quadrant of the breast, resulting more extensive scarring, but breasts conical much more pleasant, and often even more thanks to the projected construction of un’autoprotesi as you just said.
In some cases, to obtain a better result, it may be necessary also an increase of volume of the breast through the preparation of ghiandolo adipose flaps to inferior pedicle known as “prothesis”, then using the same tissue of the patient where this is available. Alternatively it should be positioned a silicone implants under the mammary gland if it is well-represented, or under the pectoral muscle in lean subjects with little or glands represented (see. Chap. Breast augmentation).
The sutures are usually made with all internal points which do not require removal.
At the end of intervention it is placed a drain for each operated side, a armpit level, which will be removed after 24-48 hours.
You may feel a slight pain in the pectoral region, easily kept at bay with standard analgesics. It regresses in any case within a few days.
You need to wear a sports bra without underwire elastic compression within 8 weeks after surgery to support the breasts while the remodeled breasts cicatrizzando settle in their new form, in the first 4 weeks day and night, in 4 successive weeks only during the day.
A bed should rest on two pillows to keep your head and shoulders elevated.
For the first 4 days after the ‘intervention is recommended complete rest of the pectoral muscles: do not force the arms to get out of bed, do not lift weights, do not make large movements with his arms.
For the first week it will be forbidden to drive a car. Likewise, it is absolutely recommended the abstaining from smoking for at least a week: it may be responsible for bleeding, necrosis of the nipple areola complex and acute exacerbation of pain. In case some cutaneous points have been positioned, these will be removed after a week. At this point it will be possible to perform the first shower (not the bathroom!).
For the first 10 days it will be recommended instead a home resting, always avoiding efforts to pectoral muscles, refraining from ‘sexual activity and making walking even to’ open air.
The work can be resumed after 10 days, except in case of major manual effort.
For about a month will have to be avoided any kind of sports activity and exposure to the sun or heat (sauna, sun lamps, etc.). It must also be avoided prone position (face down) overnight.
For about six months it is good to avoid pregnancy.
Report the successful execution of ‘mastopexy during subsequent senologiche investigations.
POTENTIAL COMPLICATIONS GENERAL
As with any surgery, albeit modest and performed on patients in good health, you may encounter:
A modest bleeding wound is normal. If important entities may require surgical reintervention.
wound infection. It is manifested by pain, swelling, warmth and redness of the skin, whether or not accompanied by fever. Any infection can usually be treated with antibiotics and local wound dressings, but may result in poor quality scars.
The appearance of a hematoma in the first hours after the surgery is rare and is treated with immediate or suction drainage (whence the ‘importance of the positioning of a safety drainage). However, it can occur up to a week after surgery. Is manifested by severe pain and sudden increase in volume and hardness of the breast should be reported immediately to the surgeon, as well as bruising on the overlying skin in the following days. If modest it reabsorbed spontaneously. If larger may require the evacuation including by reopening the wound in the operating room.
The formation of seromas consists in accumulation around the prosthesis of a yellow and transparent liquid called serum, entirely similar to that which forms in blisters and bubbles of burn victims. Small amounts are absorbed spontaneously, while gathered more conspicuous that should form when the drains are no longer present may require aspiration or surgical drainage as in the case of major hematoma.
Dehiscence (reopening) of the wound is very rare and may occur in particular at crossroads of the sutures, where is more tension. Usually it heals spontaneously with outpatient medication; more rarely it may require a new suture. And ‘more common in diabetics, smokers and obese.
Although very rare, phlebitis and pulmonary embolism: the ‘incidence increases if the patient is not mobilized early.
POTENTIAL COMPLICATIONS SPECIFICATIONS
skin necrosis and the nipple areola complex. It ‘a very rare circumstance, but fearsome and due mostly to problems not reported at the time of the visit as previous surgery on the breasts or in patients who smoke heavily or very large breasts and perishable. They can also result in a remote surgical treatment for the reconstruction of the nipple areola complex.
Decreased sensitivity of the nipple areola complex is planned between the sequelae of surgery.
Necrosis of part of the adipose tissue (liponecrosi) may occur prematurely with leakage of oily liquid from the wound, or at a distance of time with possible formation of fibrous nodules, indurations and calcifications often asymptomatic.
Impossibility of breastfeeding after surgery, because many milk ducts are damaged.
In case also it has been placed a breast implant have to add the specific complications of breast augmentation surgery and, unfortunately, consider that the incidence of such complications is higher than that of the interventions performed individually. In particular it should be noted that the ‘mastopexy associated with breast augmentation can present complications in turn specifications such as the failure to achieve a balance between topographic gland and breast implant with double profile appearance (double bubble); skin surface undulations for inadequate coverage of the implant with the raised gland (wrinkling and rippling); possibility of visibility of the prosthesis especially if positioned subglandular, when over time the gland by gravity back graduamente to descend on the chest.
The improvement effect is immediately evident especially in patients with breast not too large, although the breasts appear quite full at the upper pole and will tend to assume a more natural look only after two months. The final result must be evaluated after six months, as well as any “tweaks”: it must be said that a perfect symmetry in the volume of the breasts and in ‘teat orientation is realistically impossible to obtain.
The augmentation does not stop the normal aging process, therefore it is inevitable that with the ‘age the skin is still relax, especially if the breast is large, or it results in an increase of breast size for the deposition of adipose tissue in the case of pregnancy or weight gain. However, even without subsequent retouching, the appearance of the breast will still be better than you would if the ‘intervention was not performed.
Inevitably the intervention produces permanent scarring that improve over time. The horizontal scar in the inframammary fold, as needed in case of very large breasts, can go to the axillary region and toward the sternum, overflowing beyond the breast limits and resulting partially visible pertando. In addition some patients, due to excessive skin reactivity can develop reddened scars, enlarged or hypertrophic and therefore easily visible. They are treatable by surgery or require revision surgery after one year.