Mammaplasty – Woman’s attribute

When a man looks at a woman, he usually pays greater attention only to some specific parts of her body. Some men are attracted by long, slim and shapely legs, others by the buttocks and others by the size and shape of female breast. Unfortunately, the shape of female breast changes with age, and is also different after deliveries. The size of breast, however, in the case of women is different, and they do not have any influence on it.

Since the very young age, a lot of my female friends wanted to change some elements of their physical appearance. Many of them would lose a few or even a dozen or so kilos, whereas, I dreamt of my small breast being a little larger. During adolescence, after my sport classes or basketball trainings, I used to glanced furtively at my friends beautiful and firm breast while taking a shower. I tried to comfort myself thinking that I was still young and, finally, my breast would be as beautiful as theirs. But, it did not happen. I was a tall, slim and sportish girl with long legs. I treated lack of breast as physical immaturity and a kind of handicap. When I was a teenager boys used to laugh at me and call me flat-chested. When I looked very critically into the mirror, it was not so bad. I could notice some slight glands with areolas and mammillas. However, I felt ashamed while walking down the streets holding my head up high, and it seemed to me that if I was hunched, no one would notice my defect. I looked horrible. An image of a tall, slim and hunched girl with prominent shoulder blades, who looked down at the sidewalk made of tarmac, was disastrous. I have lots of bad memories from this period of my life. I often used to buy bras of a larger size of cups, and then I filled them with cotton wool or pieces of sponge. The effect, however, was rather miserable. Cotton wool usually changed into hard balls, and the sponge moved with every movement of my shoulders.

Mammaplasty

At the age of 18, my mother and I went together to the endocrinologist’s. The doctor calmed me down and did not detect any hormonal disorders. He advised me to put on some weight, as the BMI results reached the lower limit, and wait patiently. I followed every single instruction he gave me. I put on a few kilos and, consequently, my breast enlarged a little. At that time I also attended the gym regularly believing that well built chest muscles would replace lack of breast as such.

Finally, it was not until my studies that I changed my view on the problem. First of all, I had too little time to think about it and, secondly, there were a few young gentlemen who did not bother about my problem and dated me. After some time I had my beloved boyfriend and the jokes about my little ping-pong balls did not bother me any more. After the fourth year of my studies I got married and a few months later I got pregnant. Then, in the third trimester, my breast were just beautiful, the ones I had always dreamt about. They were not too big but plump, firm, smooth and sensitive. I give birth to a baby girl and as a typical mother I breastfed my daughter.

After my maternity leave, I came back to finish my studies. Then, I took up a job, although my husband earned well, and again my problem came back. Looking into the mirror I was scared seeing the breast of a mature and after delivery woman. Although I was in my twenties, my breast looked as if they belonged to a woman at the age of 40. It was a real tragedy.

I started seeking for help. I found in many magazines some articles on plastic surgery aimed at improving the look and shape of the breast. There were some articles on types of prostheses as well as pros and cons of such surgeries. After several weeks and hours spent on talking with my husband I, finally, decided to visit a doctor specializing at plastic surgery. My husband and I went together to the doctor’s and while paying such a visit I learnt the details of the surgery itself as well as the treatment afterwards. I did not know anything about possible complications before. One our visit was a real food for thought. My husband’s support was most important for me, however, the decision I needed to take on my own. Although I had dreamt for many years about beautiful breast, I took up my mind after a few weeks of sleepless nights.

The day of the surgery itself was, on the one hand, extremely stressful for me, but, on the other hand, it belonged to one of the happiest days in my entire life. The results were visible right after the surgery. I came back home 24 hours after the surgery. I could feel the pain in my breast, back and arms few days after. The pain, however, was bearable especially while looking into the mirror when I could see beautiful new shapes of my body. One week later I had to pay another visit to my surgeon for some control examination and removal of the stitches. My breast, then, was very tumid, tender and extremely sensitive. Such symptoms were felt for the following days, however, after the period of four weeks all of them went away and I felt wonderfully. It has been two years since the surgery took place. Its traces are slightly visible. Delicate three-centimeter-long scars in the subpectoral fold are invisible even if I sunbathe topless. I do not regret having undergone the surgery. I am a tall woman with beautiful, plump breast. Now, I can walk with my head up and throw out the chest. Moreover, right now I know it from my experience that small breast are very often not a small problem.

Marta

My second natural breast

At the end of November last year, being at the age of 44, I underwent another mammography control examination. It mapped out some changes in my left breast. Oncologists decided to remove the tumor. Histopathological examination revealed the presence of cancer cells, so further treatment required the amputation of the whole breast as well as the removal of the first part of the lymph glands.

I was surprised as never in my entire life had I expected suffering from cancer. During my stay in hospital, in the oncology unit, I came across many women after breast amputation. I even met a woman for whom the fact of having breast amputated was so embarrassing that she preferred to remain anonymous. However, she was not the only one. Many of them felt depressed, but still the majority tried to face such a difficult situation. After all, it was life that counted most. I was also paralyzed bearing in my mind the vision of living without my breast. Nevertheless, I assumed I would defeat the disease, and my body as well as my psyche would also defy it no matter how far the disease developed. There was, however, an aesthetic problem left.

Mammaplasty

I came across the issue of plastic surgery earlier. Many years before I had my child treated in the hospital of Polanica Zdrój. „There is still Polanica”, I tried to comfort myself. The oncologists helped me. It turned out that it would not be necessary to go to Polanica because there was one plastic surgery specialist in my hometown.

Two weeks after the first surgery, I was operated on once again. Apart from the oncologists who performed my operation, there was also a plastic surgeon whom I told what my problem was. He even imported from the Netherlands the best breast prosthesis available on the market. But honestly speaking, he offers only the best prostheses. So, after the surgery I woke up with a new breast. At first, it was quite flat, but I knew that it would be gradually filled in with a special liquid until it had a proper size. So did it happen. After several months I underwent another surgery in the clinic where my plastic surgeon worked, but this time the surgery was performed due to aesthetic factors. I had my nipple reconstructed on the artificial breast and my fine breast was raised and adjusted to the measures of the new one. My physical appearance changed definitely. Well, I gave birth to three children and breastfed them afterwards, but still my neckline and the whole figure, in comparison to the ones before the operation, both looked even better.

It could be said that the overall balance of my experience is positive. It is the very truth, however, not due to my appearance. The lesson of humility I had allows me to learn my own strong points and just think over those values that really count in life. Taking advantage of the possibilities offered by plastic surgery never made me feel like an Amazon. I treated my disease, cancer at least, as a transitional period, as pneumonia which dangerous as it is it is still curable. Five weeks after the amputation I got back to work. I even worked harder than before. I simply needed to catch up on my neglected duties. I got used to my prosthesis. Right now, it is just a part of me, my second natural breast.

Anna

Breast prostheses – a responsible decision

Breast augmentation and reconstruction is most often performed by means of prostheses, and these are the prostheses that evoke most controversies among people. The views on them are usually shaped by media which concentrates mainly on some breaking news. However, this type of news is not the one a woman needs to take a decision whether to undergo the surgery of breast augmentation or not. If she asks for help a specialist on plastic surgery, she may also expect detailed information on the topic. It is advisable, however, to have some views on breast prostheses earlier because, then, the consultation is of greater value and allows to make a good choice.

What types of prostheses are currently used worldwide and in Poland? Silicon prostheses are the ones used for the longest period of time, i.e. since 1962 (by Cronin and Gerow), next sodium chloride prostheses were introduced and became popular after the year 1992, especially in the United States. A few years ago, in search of something more perfect, the British invented the prostheses filled with soy oil. Afterwards, the German introduced hydrogel prostheses. At the very beginning, all of them had a smooth surface, however, for the last ten years textured prostheses have been used.

So, can we finally enjoy the possibility of having one ideal type of prostheses after 40 years of using them?

Unfortunately, we cannot. Let us take a brief look on types of prostheses as well as their advantages and disadvantages.

It should be emphasized at the very beginning that the covering of breast prostheses is usually made up of constant silicon, so the difference between prostheses lays in the filling. This is why, they are commonly known as silicon, saline or soy ones.

Silicon prostheses have been used for 40 years. At the very beginning they were the prostheses of first generation (1962-1970). They were characterized by a thick covering and dense consistency of silicon gel, so they were sufficiently airtight, however, they were much harder than natural breast. Within the years 1970-1980, the prostheses of the second generation were used having a thin covering. Consequently, they had better consistency, however, their tightness was not of the best quality. This was the type of prostheses that met such a frenzy of publicity due to numerous problems which, finally, led to their prohibition in the United States in 1992. Since 1980 the prostheses of the third generation have been used. They have multi-layer covering thanks to which their tightness is extremely huge and, at the same time, they are thin enough to have natural consistency. These are the prostheses that are widely used nowadays. Their only disadvantage, however, is lack of transparency for X-rays that makes mammography difficult to perform. Moreover, silicon is a nonabsorbable substance in the human body. So, if there is any leak from the prosthesis, then, silicon gathers in the breast which requires its operational removal. Nonetheless, it should be remembered that silicon is a neutral substance for the human organism. It is not a toxin poisoning our body. Besides, even if any prosthesis breaks, then it should be changed no matter what the filling is.

Sodium chloride prostheses are transparent for X-rays. Physiological solution that fills the prostheses is a neutral solution for the organism and totally absorbable in case of any leaking. They can be transplanted by means of little incision as well as by means of endoscope method. Their main disadvantage, however, is less natural consistency felt especially in the case of small breast which have insufficient amount of gland components. Also the tightness of these prostheses is much worse than in the former ones.

Much was expected as far as soy oil filling is concerned. The consistency of such prostheses resembled the consistency of natural breast very much. Moreover, they were transparent for X-rays. Unfortunately, after a few years, it turned out that soy oil resolves into free fatty acids which create an extremely unpleasant smell around a patient. For that reason doctors stopped using them.

So, what are women, who decide nowadays to undergo the surgery of breast augmentation, left with? Can they expect anything that would be safe and 100% reliable? Unfortunately, not. After 40 years we have not worked out absolutely safe prostheses. However, those 40 years resulted in reducing the risk connected with implanting breast prostheses to the minimum.

There is still the danger of developing connective tissue capsule around the prostheses. However, thanks to the producers efforts and advanced surgery techniques, the danger amounts today only to 2-4%. Also according to the research carried out all over the world, breast prostheses do not increase the development of breast tumor, but may even reduce the risk of cancer many times.

There is no ideal prosthesis nowadays, the one that could be suitable for every woman at every age.

Young women with small breast can be recommended silicon prostheses, whereas, women after 40 are advised to implant sodium chloride prostheses. If we correct dropping breast and implant the prostheses under the gland, then it is better to use the ones with silicon filling. In the case of women with a higher risk of cancer, it is more reasonable to use sodium chloride prostheses, which do not obstruct mammography examination in the future.

While deciding on the type of prostheses, such factors as health as well as aesthetics should be taken into consideration. It is extremely important to have the prostheses brought from a well-known source so that they have Polish certificates. It is strongly recommended to choose only those manufactured by well-known companies that give a guarantee of the highest quality products. Buying cheap and occasional prostheses is highly irresponsible. Unfortunately, quality is expensive. However, in the case of such a risky surgery as breast augmentation, there is no room left for risky cost cuts.

A proper decision allows to achieve the results that will become the source of happiness and satisfaction for many years.

It is worth remembering, especially when one considers seriously breast augmentation by means of prostheses.

Jerzy Kolasiński, M.D. Ph.D.

Gynaecomastia

A properly-developed breast of an adult man contains scant amount of adipose and gland tissue, whereas chest muscle, which is grown so much due to intensive physical exercises, is its basic ingredient.

Gynaecomastia is a pathological uni- or bilateral growth of breast glands in the case of men. The name itself derives from Greek gyne meaning a woman, and mastos, i.e. breast. 32-36% of adult men suffer from gynaecomastia to various extent. It is most often caused by hormones disorders in adolescence. It is one of the symptoms of the Klinefelter’s syndrome as well as other diseases related to gender hypoplasia (hypogonadism). It usually occurs between the age of 13 and 17. Moreover, it may be accompanied by an excessive production of adipose tissue in the region of the chest. Gynaecomastia can also occur while persistent taking of steroids which is extremely popular in the case of sportsmen and bodybuilders. At the adult age the development of breast is the consequence of reduced production of testosterone, and by the same token, the dominance of female hormones. Gynaecomastia can also occur while various liver diseases. One should always undergo detailed hormonal examinations before taking up surgical treatment and look for other possible causes of the illness. In the microscope study of the overgrown breast gland, the growth of leading out lymph duck as well as fibrin fibers predominate. However, if gynaecomastia is accompanied by obesity, in the histological study, adipose tissue constitutes the majority. It is the proportion of breast tissue to adipose tissue that is the basis of classification for such cases as hyperplasia. However, histological study is possible only after the surgery.

Mammaplasty

The cases of treating gynaecomastia were first mentioned in 17th century. In the first half of 20th century, all surgical methods of its treatment left unaesthetic scars around the areola and skin irregularities. In the year 1928 Dufourmentel proposed the cut on the border of the areola and the surrounding skin which resulted in a better aesthetic effect. A few years later, Webster promoted the technique of a half-round cut inside the areola leaving quite a thick layer of the tissues under the areola and the mammilla, preventing from hollows and irregularities, whereas, Balch, in order to avoid any scars in the region of the chest, proposed surgical approach from under the armpit. Taking into consideration the fact that adipose tissue constitutes a part of the breast, for the last few years, liposuction is also used in the case of surgical treatment of gynaecomastia. If gynaecomastia is complex, then the method of simultaneous suction of adipose tissue is supported, by removal of gland tissue from a slight cut in the subpectoral fold (Cohen, Pozez and Mckeown) or the areola (Pitmann). This surgical technique prevents from creating a hollow of the areola and breast dropping, and at the same time, allows to remove the excessive amount of skin when the changes are huge.

The surgery is usually performed under a general anesthetic. It is also recommended to wear a special pressure suit for 4 or 5 weeks after the surgery. The final results are often very good.

Małgorzata Kolenda, M.D. Ph.D.

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