Surgeon’s competence
The consideration about whether to undergo the surgery or not should start with the examination by plastic surgeon. The consultation can be paid, the prices range around 500CZK. It is usual if the client sees several plastic surgeons and after that she makes the decision which one and if even to undertake the surgery. The experience and specialist competence of the surgeon together with corresponding equipment and conditions of the clinic, where the surgery is performed, are also one of the decisive factors for the surgery’s result. Because it is very difficult for the ordinary person to judge these circumstances, specific guidance offers the Czech Society of Aesthetic Surgery that belongs to the Czech Medical Association of Jan Evangelista Purkyne where under link “Public information” you can find the List of Certified Members. All the surgeons mentioned in this list have to fulfil conditions (also stated on this page) to receive the certificate of specialist competence to perform aesthetic surgeries. It is not possible to say that the surgeons without this certificate are not specialized enough. Often they just did not undergo the administrative procedure connected with gaining this certificate by the Society. The consultation and your feeling or estimation can help you to decide if you can trust the surgeon that you chose. That’s why the consultation should be the first step to surgery.
The most frequent risks and risk factors in augmentation
There are in particular risks as follows:The original breast shape
The original breast shape plays an essential role in the difficulty of reaching the optimum result. In principle, in small breasts without loose skin it is easier to achieve success than by sagging breasts with loose skin.
For the evaluation of the degree of loose skin (drooping of the breasts) the mutual position of skin fold under the breast (infra-mammary fold) and breast areola with the nipple is decisive. The drooping (ptosis) is divided into 4 grades:
Skin ptosis of first grade means that the infra-mammary fold is under the lower border of breast areola. In principle, it does not present breast drooping.
Ptosis of second grade means that the infra-mammary fold meets the lower border of the areola.
In ptosis of third grade, the infra-mammary fold meets below the nipple.
The ptosis of forth grade is characterized by the infra-mammary fold that meets above the nipple or upper border of the areola.
An ideal candidate for breast augmentation is a client with ptosis of first grade. If we simplify it, we can say that in this case it is possible to reach a satisfactory result through any method and with any type of implant. In ptosis of second and third grade, it is necessary to evaluate very carefully the technique of the surgery, the method of implant’s insertion and its size and shape. In all cases, it is not possible to avoid breast reshaping at the same time mainly in ptosis of third grade. In ptosis of forth grade it is hard to avoid breast reshaping at the same time during the augmentation.
Shift of the implant
If it is not possible from any reason to maintain the optimum position gained during the surgery, a good result can be damaged. For example, by inserting the implant under the muscle through the incision in the armpit, the breast muscle has the tendency to push the implant up. This risk can be reduced by creation of optimum space for the implant and especially by keeping the recommendation of shaping from the surgeon (shaping bra, band, bandaging) and calm mode after the surgery.
Capsular contracture
A capsule (a case in Latin) means forming of tight tissue cover around the implant. It presents a late complication that occurs minimum several months, rather years after the surgery. The tissue capsule begins to shrink and therefore deform the implant and the external shape of the breast. Due to external pressure, the implants are firm when touching them. The affected breast might be painful. The complications do not have to be that strong and the development of symptoms might cease. Then the situation does not have to be solved. Otherwise massaging or surgical solution, which is not easy and without any risks, is recommended. Opinions on the causes of creation of this complication differ. When forming the capsule, it is often detected that some complications appeared already in the early time after the surgery.
Rupture of the implant
The implants are mechanically very resistant. They are definitely more resistant than most tissues from human body. There have been described many cases of car accidents when it came to multiple rib fractures caused by the stroke from steering wheel but the implants stayed undamaged if they were not pierced with the edge of broken rib. Even during big crush or pressure to chest, the implant bursts rarely. During diving or flying on the plane it never bursts. The ruptured implant is very often diagnosed by ultrasound, mammography or even other examination. Overwhelming majority of these results is wrong. It is caused by examination with devices, when there appear folds on the implants and these folds are in principle not different from bursts. The leaked silicone content is the only one that is possible to be well diagnosed. Some implants are filled with so-called cohesive gel. This gel is not liquid and even after the rupture of the capsule of an implant it preserves its original shape. Therefore, it does not leak out. Theory that the silicone from implants can cause cancer or even other disease is overcome today. In spite of this, it is mostly recommended to revise the implant if there is a suspicion on the rupture.
In implants filled with saline the rupture or leakage are little bit more frequent because of leak in filling flap. The leaked saline cannot even theoretically present any medical risk. It is better in this case to replace this implant rather within a month.Whistling of the implants on the plane
It is a superstition. The implants are not capable to whistle under any circumstances. Logical explanation to this myth could probably be the fact that specific types of implants for special usage contain metal element. It would probably be signalled by the detector at the gate at the airport. In implants that are partly or fully filled with saline, in which metal is part of the filling flap, it will cause whistling. The implants will not whistle but the signalization of metal detector will and it will not happen on the plane but at the check-in. The same happens with metal articular restoration, screws and likewise.
In implants filled with saline, a sound of water spilling might be heard.
Infection, bleeding, embolism, anaphylactic shock and other complications
These surgical or post-surgical complications might appear the same as in any other surgical procedure. Although in general, their risk is low.
The necessity to replace the implants after several years
In general, if the implants do not cause any problems and there is no reason to remove the implants, they can stay for life. It is true that most of the producers limit the guarantee period of the implant to 5 to 10 years. Although same as in other products, it does not mean that the implant cannot serve safely further. The implants are constructed so that they live longer than their carrier does. Present practical experiences with implants even in our country enable us to trust this fact. In practice, the problem of implant replacement is similar to the decision whether to replace a car after the expiration of the guarantee period of the producer. The difference is that the replacement of the implants presents comparable risks with the original surgery.
Dissatisfaction with the result of the surgery
It is not possible for the surgeon to guarantee the result to any surgical procedure. With the biggest effort, experience and responsibility on the side of the surgeon and the client, the good result is not guaranteed. Undertaking this risk is a necessity of every surgery. In some breasts, an optimum result is not possible to reach through any method. Sometimes the optimum result was achieved from the specialist point of view and objectively a better result could not be achieved but the client is not satisfied with it. The reason lies most often in the pre-surgical communication. Even that the reasons of possible dissatisfaction are routine part of every pre-surgical instructions and are mainly also generally known, the rule that a man hears what he wants to hear and vice versa works during the consultation.
Pre-surgical consultation should be the first step in decision making whether to consider the surgery or not. Although in practice it works more like that a woman herself at first decides hardly without any specialist information. Often she beats her brain out with problems that do not exist and at the time when she arrives for consultation with resolute decision to undertake the surgery, she finds out that there are other significant obstacles that she could not be aware of.