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BREAST AUGMENTATION

Breast enlargement

Women desire enlargement of their breasts for a variety of reasons. Some individuals feel that their small breasts limit their fashion choices. Others are dissatisfied with the changes in the shape, size, and feel of their breasts after undergoing weight fluctuations, pregnancies, and aging. Whatever your reasons for wanting breast enlargement, breast implant surgery can enhance your self-image and restore your confidence. Breast augmentation enlarges a woman’s breasts through the surgical placement of breast implants. Breast implants improve fullness and projection of the breasts and restore symmetry. The most common incisions used for breast augmentation by Dr. Baros is inframammary fold (near the crease under the breast). (Figure A) but it is possible to used periareolar incision to (the edge of the areola or the pigmented skin surrounding the nipple). The implants are placed in a pocket either underneath the breast gland or beneath the pectoral muscle. (Figure B) The positioning of the implants in either of these pockets is dependent on patient desire, anatomy, and surgeon’s preference. The results are immediate. The implants will “ride high” early in the postoperative period and settle to their more natural and permanent position in the weeks to follow.

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The results are immediate. The implants will “ride high” early in the postoperative period and settle to their more natural and permanent position in the weeks to follow.



Dr. Baros postoperative instructions for breast augmentation:
  • 1. Your breasts are wrapped with an ACE wrap. Leave the wrap on for 72 hours. If the wrap is too tight, you can undo the ACE bandage and rewrap it more loosely. But, the ACE bandage should be snug and provide support for your new breasts. Also, the ACE bandage should cover the entire upper, middle, and lower breast. DO not wear it like a tube-top with cleavage showing up top. After 72 hours, you can take the ACE wrap off and shower. Your incisions should be covered with a water-tight, clear bandage. If water gets in underneath, take the entire bandage off and leave it open to air. There is surgical tape over the incision line and these should stay on even in the shower. After the shower, you should wrap your breasts with the ACE bandage again. Absolutely no baths or swimming for 3 weeks. Showering is OK after 72 hours.
  • 2. Take medications as directed. Do not take aspirin, anti-inflammatory medications (Motrin, Ibuprofen, Alleve) or Vitamin E supplements for 2 weeks after surgery.
  • 3. No driving while under narcotic medications for pain.
  • 4. Ask Dr. Baros in your first follow-up visit regarding going back to work.
  • 5. You should sleep on your back for 2 weeks following surgery.
  • 6. Avoid alcohol or cigarette smoking for at least 3 weeks following surgery.
  • 7. Call and make a follow-up appointment for 7 days following surgery.
  • 8. Do not raise your arms over the level of your shoulder for 3 weeks. Do not pick up objects heavier than a phone book.
  • 9. Bring a sports bra to your first follow-up visit. You will be able to wear a sports bra after Dr. Baros examines you in the office. NO underwire bras for 4 weeks.
  • 10. Your breasts will be high-riding, giving you lots of upper breast cleavage in the first 3 weeks, but the breast implants will settle over the first 3-6 weeks to a more natural position.
  • 11. Do not apply a heating pad over your breasts. Portions of your breasts will be numb and you may get a burn from the heating pad. Cold packs in the first 48 hours following surgery is OK and may help to keep the swelling down. Apply cold packs over the ACE wrap, not directly over the breasts and nipples.
  • 12. Scar therapy for your incisions will start at 2 weeks following surgery. Dr. Baros will instruct you regarding scar creams.
  • 13. Keep your incision out of the sun. Sun exposure will make your scars red, raised, and persistently irritated for a long period of time. Make every effort to avoid the sun for up to 1 year following surgery. You can cover up the incision with sun screen (SPF 15 or above) or clothing.
  • 14. You may return to normal activity and exercise at 4 weeks following surgery.
  • 15. You may feel “funny”, tingling sensations over your breasts a few weeks after surgery. It may affect one breast more than the other. This is normal recovery of some sensory nerves in your breasts.
  • 16. If you are constipated, take over-the-counter laxatives. You do not want to strain over the toilet. This may lead to your blood pressure rising and cause bleeding.
  • 17. Call with any questions or concerns. Dr. Baros is available through the office phone number 24/7. Don’t ever feel badly about calling.
  • 18. Report to Dr. Baros immediately if: A temperature of 100 degrees or above, excessive bleeding, excessive pain, enlargement of one breast associated with increased pain, bruising, and/or tightness. Should you experience any of these symptoms after normal business hours, call Dr. Baros immediately.

BREAST ASSYMMETRY CORRECTION

Correction of the difference in size and position of the breasts for achieving symmetry.

Depending on the degree of difference between the breasts, as well as on the type of deformity, there are several operative techniques. If the difference is not extreme, the symmetry is achieved by inserting implants of various sizes by means of the same operative technique as in breast enlargement operation. In case of major unevenness, as well as when one breast is more loose comparing to the other, it is necessary, besides inserting the implants in the smaller breast, to perform a lifting of the looser breast as well. A special case of asymmetry is represented by Poland syndrome, characterised by a unilateral absence or underdevelopment of the pectoral muscle, absence of glandular tissue and smaller nipple, as well as changes on the fingers. The cause of this syndrome is still unknown, as well as the reason for its more frequent occurrence on the right side. It is corrected very successfully with the implant that corresponds to the size of the other breast, but often after the previous expanding the skin with the so-called tissue expander, as the existing space cannot receive a big enough implant.

The procedure lasts some 2 hours and is performed in total anaesthesia.

The patient remains at the hospital 24 hours after the surgery, and a gradual return to normal activities is recommended. The sutures are removed after two weeks, and wearing of bra is mandatory. In case of placing the expander in Poland syndrome, its gradual filling is performed over several months, and then it is replaced with the permanent silicone prosthesis.

Swelling, sense of tension, transitory nipple sensitivity disorder, incomplete symmetry.

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GYNAECOMASTIA

Reduction of male breasts due to enlarged glandular or fat tissue.

The mammary gland is removed through a small incision around the nipple. In obese persons, the aspiration of the fat tissue that impregnates the mammary gland is often indicated, with or without the gland removal.

The surgery is performed in total anaesthesia and lasts around 1 hour.

The drains are removed after 24 hours, and the sutures after two weeks. A compressive elastic bandage is worn for several days.

Swelling, blood suffusions and prolonged creation of seroma.

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BREAST REDUCTION AND BREASTLIFTING

Reduction, lifting and re-shaping of large and sagging breasts.

Depending on the size and shape, there are many operative techniques. The following are the most frequent: an inverted T technique that implies a circular scar around the nipple, one vertical and one horizontal scar, the latter in the fold under the breast; a vertical technique with a circular scar around the nipple and only a vertical scar from the nipple downwards, which in the first two months has small creases around it that vanish in time; periareolar technique leaving only a circular scar around the nipple that in the beginning also has creases around it, which gradually vanish under the pressure of the gland from the inside. This technique is not suitable for very large breast.

The procedure lasts from 2.5 to 3.5 hours and is performed in total anaesthesia.

Return to normal activities after 5-7 days. The sutures are removed after two weeks. Wearing of bra is recommended.

Transitory nipple sensitivity disorder, mild swelling that withdraws within 1-2 weeks, possible appearance of small cysts in the glandular tissue. There is no guarantee that the breastfeeding function will remain preserved.

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BREAST RECONSTRUCTION

Reconstruction or compensation of the non-existing breast tissue after amputation or in the congenitally underdeveloped breast.

The amputated breast can be reconstructed in to ways, by means of silicone implant or with the own tissue. The application of implants is easier and simpler way, but as lack in skin is almost always present, first it has to be expanded with the expansion in the first act, by application of the so-called tissue expander. In the next several weeks, the patient comes every 5 – 7 days when small amounts of physiological solution are inserted through a special spot on the skin, so that the implant gets gradually filled in up to the desired volume. The application of the own tissue from the abdomen or the back is also very much present in the breast reconstruction. However, the modern treatment of malignant diseases today also implies a primary reconstruction when the patient gets a compensation of the lost breast right after the amputation. Several months after the surgery, a possible additional correction may be performed, in terms of increasing the symmetry with the other breast (reduction and lifting of the other breast).

Both operative techniques are performed in total anaesthesia, the first lasts around 1 – 1.5 hour, and the second much longer.

Very short in inserting the prosthesis – expander, except that one should come several weeks for gradual volume increase. In reconstruction with the own tissue, or skin-muscle lobes, the recovery lasts much longer, as it is a large operative intervention.

Swelling, appearance of seroma which is drained longer, mild breast asymmetry, and in the reconstruction with the abdominal tissue, also a rare occurrence of abdominal hernia

RECONSTRUCTION OF THE NIPPLE AND AREOLA

To reconstruct the nipple and areola ( darkened area around the nipple ) in a female patient whom the breast disappeared after mastectomies. Reconstruction NAC complex ( nipple areola complex) is individual and represents the final reconstruction.

Reconstruction of the nipple is done with the new created breast tissue on the principle of crossing local skin flaps. Reconstruction of the areola is done by the method of tattooing .

Operative procedures are performed under local anesthesia and the procedure takes about 1 hour.

Very short , daily chores after three / four days, stitches are removed after 12 days.

Mild swelling, partial necrosis of the nipple , inadequate position of NAC complex.