What causes double bubble after mammoplasty. Complication of double bubble mammoplasty: causes, options for solving the problem, prevention Double fold after mammoplasty whose fault is it?

A double fold after mammoplasty is one of the undesirable side effects that occurs infrequently, but negates the results of the operation.

This defect requires repeated surgical correction; there is no other way to correct it.

What does it look like

It is believed that a double fold after bust enlargement occurs, as a rule, in women whose breasts initially have a cone-shaped or tubular shape.

However, recent studies and comparative analysis of the results have shown that the defect can also appear in patients with normal mammary glands.

The double fold looks like additional roundness or “steps” under the lower bust line. These bulges are downwardly displaced implants.

Signs of the defect appear immediately after augmentation mammoplasty or after a long time (from six months to one and a half years).

Video: At a consultation with a surgeon

Why does it appear

The most common cause of double folds is:

• shortened;
• reduced;
• or underdeveloped lower chest area.

Most of the glandular tissue is concentrated on top of the glands (in the upper pole).

Typically, cone-shaped or tubular breasts are designed this way; it can also be a specific feature of properly formed glands with an elevated inframammary fold.

The defect often occurs due to:

1. violation of surgical technique;
2. incorrectly selected access;
3. or unsuitable implants.

Most often, cases of double fold formation are recorded in the following situations:

• partial combination of a subpectoral pocket with access along the mammary fold in patients with a pronounced submammary fold and thin skin;
• formation of a subpectoral pocket through infraareolar access with excision of excess skin;
• creation of a subglandular pocket through infraareolar access.

A double fold is formed when the natural inframammary fold cannot be eliminated and because of this there are two of them: natural and artificial under the endoprosthesis.

Thus, a “conflict” arises between the tissues and the implant. This is the reason for the appearance of an early double fold, which appears immediately after mammoplasty or after the swelling has subsided.

A late double fold can form over time, and not immediately: several months after the intervention or even years. The causes and timing of the appearance of late double folds are different.

Among the causes of late double folds are:

• mammary fibrosis;
• sliding of glands from the endoprosthesis (“waterfall effect”);
• lowering of the endoprosthesis below the artificial fold.

Most often, a late double fold is formed due to mammary fibrosis. In this case, the capsule is compressed, which in turn compresses the implant, and the soft breast tissue is pulled up.

The prosthesis itself moves downwards. In such a situation, it is enough to perform a capsulotomy on the existing prosthesis, or replace it, if necessary.

The risk of developing complications is increased among women in whom the bulk of glandular tissue is localized in the upper pole of the glands.

For this group of patients, the choice of implants must be made especially carefully. It is better to give preference to anatomical prostheses with a high or ultra-high profile.

When planning mammoplasty, the surgeon must take into account an important feature of the breast: remembering the shape of the mammary fold, as well as the risk of defect formation in the presence of sagging glands.

What to do with a double fold after mammoplasty

A double fold can only be corrected surgically. The secondary operation consists of excision of the skin and its straightening. The result of the correction depends on how correctly the mammary fold is formed.

To correct the deficiency, the contour is supplemented with an implant. In this case, the surgeon artificially forms the inframammary fold, and places it slightly lower than the natural one.

In tubular and cone-shaped breasts, the inframammary fold is greatly exaggerated. The lower pole of the glands is practically absent; the glandular tissue is located on top and has a tubular structure.

When eliminating such a defect, it is necessary to select the correct shape of the endoprosthesis and necessarily adapt the gland tissue.

The best way to correct tubular glands is the use of ultra-high-profile anatomical endoprostheses, which have a truncated base and an “umbrella”-shaped opening of the distant part of the tubular gland.

In addition, the areola hernia is simultaneously eliminated using the purse string method. The glandular tissue concentrated in the upper part finds a place at the top of the truncated prosthesis and is placed in its slope, without forming bulges in the future.

Similar tactics are used to eliminate cone-shaped breast deformity. The only difference is that in the case of a cone, there is no need to eliminate the areolar hernia and reduce the size of the areolas.

The same approach is justified for normally formed glands with a reduced lower pole and a high natural mammary fold.

In this case, only careful selection of the endoprosthesis and precise surgical separation of the natural fold are required. In such a situation, the memory of the skin's natural fold should be taken into account.

If it retains its shape even after deep detachment, its tension is eliminated by through perforation performed with a sharp needle.

If there is a “waterfall effect” - “flowing down” of the breast relative to the prosthesis, the correction is performed in exactly the same way as with an early double fold.

The breast is repositioned with opening of its lower border and areolar pexy. If the prosthesis meets the specified parameters, its replacement is not required, otherwise it is replaced with a more suitable one.

Repeated intervention is much easier to tolerate and does not require long-term rehabilitation. The deformation persists for a week or a little longer, after which it gradually begins to disappear.

As with regular augmentation, wearing a compression bra is required.

Why is it dangerous?

This complication is not dangerous, but it causes considerable aesthetic discomfort.

After all, the main goal of mammoplasty is to improve the appearance of the breasts and give them a seductive shape.

The presence of a defect indicates that the main goal has not been achieved, therefore, repeated correction cannot be avoided.

How to prevent

To prevent this, a combined insertion of the endoprosthesis is required, i.e., the creation of a two-plane bed for it.

The upper area of ​​the implant is located under the “trimmed” pectoralis major muscle.

When it contracts, the correct pressure is applied to the prosthesis from above, and it is located in a straightened state, maintaining a normal shape, due to which a normal lower pole of the breast is formed.

If the prosthesis is inserted completely under the muscle (including the lower pole), due to the work of the muscle from above, it is forced upward, and a double fold effect occurs.

Using the described approaches, it is possible to eliminate a double fold on an already operated breast.

In this case, the surgeon makes a decision regarding maintaining the implant (if the appropriate size is selected) and adapting soft tissue to it, or replacing it.

It should be noted that eliminating a double fold is not an easy task. Usually, the elimination of the defect is carried out not in one operation, but in several small corrections after the mammoplasty itself. It is much easier to prevent complications.

It must be remembered that the result of the operation depends not only on the qualifications of the plastic surgeon.

During the rehabilitation period, a woman must follow all the doctor’s recommendations:

• wear a compression bra;
• take prescribed medications;
• carry out skin care;
• avoid physical activity.

Thus, the problem of double folds after mammoplasty remains relevant to this day. This does not always depend on the category of doctor or on new varieties and forms of prostheses.

A woman should approach mammoplasty thoughtfully and carefully, evaluate all possible risks and understand whether the operation is a necessity or just a temporary whim.

M In Russia we call this phenomenon of the operated mammary glands a double fold; Western surgeons call this offensive situation that occurs after prosthetic mammary glands a “double bubble” or “double bubble”. The terms are different, but the situation is the same... We will use both of these terms in the article, using the abbreviation “D-B”.

The main reason for the appearance of a double fold is restrictive, that is, a shortened, reduced or underdeveloped lower pole of the mammary glands, when the main part of the glandular tissue is concentrated on top of the mammary gland (in its upper pole). Most often these are tubular, cone-shaped breasts and well-formed mammary glands, but with elevated inframammary folds (Fig. 1).

Rice. 1. 1a - tubular mammary glands; 1b - cone-shaped mammary glands; 1c - combination of cone-shaped (left) and tubular (right) deformation of the mammary glands in the same patient; 1d - correctly formed mammary gland with a naturally elevated inframammary fold.

In order to correct this deficiency during mammoplasty, it is necessary to supplement the missing lower pole of the gland with an implant. In this case, the surgeon is forced to artificially form the inframammary fold much lower than the natural one.

But first, a little anatomy (Fig. 2).

The mammary gland is located on the chest wall and has the following landmarks relative to the ribs. The origin (upper pole) is located at the level of the II-III rib. The nipple and areola are located at the level of the V-VI ribs. The inframammary fold is at the level of the VII-VIII ribs. The tissues involved in the formation of this organ are the following (from the surface inwards):

2) Subcutaneous fat;

3) Superficial fascia with a network of Cooper's ligaments, which is woven into the gland;

4) Mammary gland;

5) Fascia of the pectoral muscles;

6) Pectoral muscles;

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

All structures are involved in the formation of the inframammary fold. Basically the Cooper's ligamentous apparatus, in which all the glandular tissue is suspended like in a hammock. It is these ligaments, coming almost from the skin and intertwining with the fascia of the pectoral muscles, perforating the glandular tissue, that form the inframammary fold.

Naturally, such a complex structure is difficult to separate. “D-B” occurs when the natural inframammary fold cannot be destroyed and there are two of them: artificially formed under the implant and natural. That is, there is a “conflict” between the implant and tissues. This is the reason for the formation of the so-called early double folds, which become visible immediately after surgery or after the swelling has subsided. Late double folds may occur within a few months after surgery or several years later.

Naturally, the reasons for late “D-B” are different, as are the timing of their occurrence. But more on that later.

Let us consider in more detail the anatomical structures of early “D-B”, methods for eliminating them and the nuances of surgical techniques that prevent their occurrence.

So, the “risk group” is tubular, cone-shaped and normally formed mammary glands with elevated (above the VI-VII ribs) inframammary folds.

Tubular (or tubular) are called mammary glands with an excessively narrow base and excessively large areolas in diameter, such that the dimensions in diameter of these two landmarks are almost equal (Fig. 3a).

Rice. 3. 3b - reasons for the formation of a double fold during tubular breast prosthetics

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Rice. 3v Tubular breast prosthetics were performed using an ultra-high-profile anatomical implant with a truncated base and a reduction in the areola.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Naturally, the inframammary fold is greatly exaggerated. The lower pole of the gland is practically absent, the glandular tissue is concentrated in the upper pole and has a tube structure. When eliminating this deformation, it is necessary to strictly select the shape of the implant and be sure to adapt the gland tissue:

The ideal way to eliminate tubular breasts, in our opinion, is to use ultra-high-profile anatomical implants with a truncated base and opening of the distal (part of the glandular tissue under the areola) section of the tubular gland in the form of an “umbrella”. In addition, at the same time, the areola hernia is eliminated using the “purse-string” method. The glandular tissue concentrated in the upper pole finds its place in the upper part of the truncated implant and easily fits into its slope, without subsequently forming a protrusion (Fig. 3c).

We consider a similar approach to be the most justified in cases of eliminating cone-shaped deformation of the mammary glands. The only difference is that with a cone there is no need to eliminate the areolar hernia and reduce the diameter of the areola.

Cone-shaped is called a form in which the width of its base is 3-4 orders of magnitude greater than the distal (areolar) part of the gland, while the glandular tissue has the shape of a pyramid (Fig. 4);

Rice. 4 Cone-shaped breast prosthetics were performed using an ultra-high-profile anatomical implant with a truncated base.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Rice. 5. Correctly formed mammary gland with a naturally elevated inframammary fold. The augmentation was carried out using an ultra-high-profile anatomical implant with a truncated base.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

We consider the same approach justified if, with a normally formed breast, there is a reduced lower pole with a naturally high inframammary fold, as mentioned earlier. In this case, most often only a careful selection of the implant and clear overcoming (surgical separation) of the natural fold is necessary.

In this situation, it is necessary to take into account the memory of the shape of the skin of the natural inframammary fold. If it retains its shape even after deep detachment, its tension is overcome by means of through perforation caused by a sharp needle.

To avoid a double fold, a combined installation of the implant is necessary, that is, the formation of a two-plane bed for it. The upper part of the implant stands under the trimmed pectoralis major muscle. (Fig. 3b, 3c). At the same time, when it is in a contracted state, there is correct pressure on the implant from top to bottom, as a result of which it is always in a straightened state and has a constant shape, which allows the formation of a normal lower pole of the gland, overcoming natural restriction.

If the implant is installed completely under the muscle, including the lower pole, then due to the work of the muscles from below, the implant is squeezed upward and the same “D-B” effect is obtained. (Fig. 6)

Rice. 6. Increased deformity in the form of a double fold with tension in the muscles of the chest wall. Occurs only when an implant is placed fully into the muscle bed.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

The approaches described above make it possible to eliminate “D-B” already on the operated mammary glands. In these cases, the surgeon decides to leave the previously placed implant, if it is selected correctly, and adapt the soft tissues of the gland on it or change both (Fig. 6a, 6b, 6c).

Rice. 6a. Double fold after tubular breast prosthetics. Corrected using an ultra-high-profile anatomical implant with a truncated base, flattening the lower segment of the gland and eliminating the areolar hernia.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Rice. 6b. Double fold after cone breast replacement (left). Corrected using an ultra-high-profile anatomical implant with a truncated base and flattening of the lower segment of the gland.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Rice. 6th century Double fold after prosthetics with a round low-profile implant of normally formed mammary glands with a naturally high inframammary fold. Corrected using an ultra-high-profile anatomical implant with a truncated base and plastic surgery of the inframammary fold.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

I would like to note that this is a rather difficult task - eliminating a double fold. It is much easier to prevent this situation! As a rule, when eliminating an existing “D-B”, it is necessary to carry out not one operation, but several minor corrections after the main operation.

The causes of late double folds are as follows:

1. Mammary fibrosis;

2. Sliding of the gland from the implant - “waterfall effect”.

3. Lowering the implant below the formed fold. (Fig. 6c)

Late:

The most common situation is the occurrence of “D-B” due to mammary fibrosis. With it, the capsule is compressed: it compresses the implant, and the soft tissues of the gland are pulled upward, as they are fused to the anterior wall of the capsule, while the implant itself is displaced downward, displaced by these tightened tissues of the gland. In this situation, it is usually sufficient to perform a capsulotomy on the existing implant, or replace it if its condition requires it (Fig. 7).

Rice. 7. Mammary fibrosis on the right; an open capsulotomy was performed.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

With the waterfall effect - “flowing down” of the gland relative to the implant - the problem is solved in the same way as with early “D-B”, i.e., a reposition (redistribution of the lower pole) of the mammary gland is performed with the opening of its lower border and areolar (purse-string) pexia. If the implant continues to correspond to the given configurations, then its replacement is not necessary, otherwise it is replaced with the most suitable one (Fig. 9).

Rice. 9. “Waterfall effect” combined with a double fold. Corrected by areolar mastopexy with re-prosthetics with ultra-high-profile anatomical implants.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

IN In conclusion, I would like to note that the problem of the occurrence of double folds always remains relevant, regardless of the qualifications of the surgeon and of more and more new forms of implants that manufacturers offer. It is not for nothing that over the past 10 years, every congress dedicated to aesthetic surgery of problematic mammary glands begins and ends with reports on preventing the occurrence of “D-B” and on methods for eliminating already formed double folds. And we would like to wish all patients and doctors that this cup will pass them by, and if they do encounter this problem, then intuition and experience would help both of them overcome it!

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Today, the article was written for those who are not happy with their bust and want to undergo an operation such as mammoplasty - improving the appearance of the breast. After reading the article to the end, you will learn how to choose a surgeon, why there is such a wide price range for breast surgery, when and why a doctor may refuse or delay your operation. And also, why you need to wear compression underwear and how long you can’t sleep on your side and stomach and other interesting things for those who want unearthly beauty for their bust with the help of a plastic surgeon’s scalpel.

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If previously mammoplasty (correction of the breast, its shape and size) was the lot of Hollywood stars, today any resident of a large city can sign up for the operation.

Thanks to the variety of modern prostheses, accompanied by a lifetime guarantee, errors are minimized, and breasts after plastic surgery look beautiful and almost natural. The main thing is to choose the right implant and find an experienced plastic surgeon.

Types of mammoplasty, photo

When talking about mammoplasty, many ladies mean exclusively breast augmentation. It just so happens that a significant part of women are dissatisfied with the volume of their décolleté and hope to change it to a greater extent. However, there are other types of interventions in the mammary gland that are also in demand today:

1. Mastopexy– lifting sagging breasts. It can be combined with the installation of prostheses or done independently. In fact, during the operation, excess skin and fatty tissue are simply removed.
2. Augmentation mammoplasty– traditional and widely popular breast augmentation using prosthetics.
3. Reduction mammoplasty– a more rare, usually performed for medical reasons, breast reduction. Using liposuction, the surgeon removes all unnecessary fat, glandular tissue, and so on.
4. Aesthetic correction of the nipple-areolar complex. It is possible to reduce the size of the areola (pigmented circle) or restore the appearance of the nipples after other operations.

Now you know all the popular types of interventions with a plastic surgeon’s scalpel. I suggest you look at a series of photos that famous movie and show business stars went through.

If you decide to have surgery, you are interested in many of the nuances that are shown in the video: how a consultation with a plastic surgeon takes place, the course of the operation itself and its result after rehabilitation.
Those who is more than +18- follow the link to YouTube and you can watch it there.

Indications and contraindications for mammoplasty

Like any operation, there are also indications and contraindications. Let's consider them when planning to improve your breast condition.

You may also find useful an article about how to treat it with medications and folk methods, the reasons for its appearance or if you want to know, as well as what it is. Good advice is waiting for you in the article - just follow the links. You will learn a lot of new things from the article where it is described or.

Indications for plastic surgery

Each lady who decides to undergo surgery has her own motives. Sometimes she just wants to meet the world's beauty standards set out on glossy covers. Sometimes she dreams of remaining sexually attractive to her man even after the birth of three babies.

It happens that youth complexes are to blame, and breast surgery allows girls to love their body. But there are also very specific indications for mammoplasty - medical or aesthetic.

From point of view medicine The following indication situations are distinguished:

1. mastectomy (removal of the mammary glands requiring subsequent reconstruction)
2. gynecomastia (visually voluminous breasts in men)
3. implant replacement
4. loss of part of the breast due to injury
5. sagging breasts (ptosis)
6. macromastia (“swelling” of the breasts to incredible, uncomfortable sizes)
7. asymmetry, as well as various anomalies and defects in the development of glands

Cosmetic indications include all the nuances related to the aesthetic side of the issue. They are extremely subjective, and each lady decides for herself whether it is worth enlarging her breasts in this situation or not. Main cosmetic indications for mammoplasty:

• difference in the size of the right and left breasts after completion of lactation
• unaesthetic sagging of the breasts due to pregnancy, prolonged breastfeeding or sudden weight loss, violation of its shape
• micromastia (naturally tiny breasts)

Now you know the medical and aesthetic indications for breast surgery. What about the contraindications for such intervention in the mammary gland?

Contraindications to mammoplasty

The list of contraindications to mammoplasty is very extensive. It contains both mandatory items characteristic of any operation, as well as specific, original ones. Breast augmentation is rarely mandatory, so a surgeon who has doubts can quite easily refuse a potential patient.

However, in reality the situation looks different. In only 2-3% of cases, the doctor actually does not agree to perform mammoplasty. All other issues are resolved individually, during consultation, when analyzing specific conditions. For example, with restored liver function and stable functioning of the immune system, surgery can be performed even on a carrier of HIV infection or someone who has suffered from dangerous types of hepatitis (B, C).

Serious contraindications to mammoplasty:

• diabetes mellitus (decompensation, subcompensation)
• immunodeficiency
• pregnancy
• malignant tumors
• exacerbation of chronic diseases
• mental illness
• school age
• breast diseases
• acute infection with high fever
• benign neoplasms in the breast (in case of incomplete treatment)
• scleroderma and other connective tissue diseases
• all kinds of blood clotting disorders, taking anticoagulants
• some endocrine diseases
• lactation and the first six months after its completion

In most cases, you just have to wait: postpone surgery, treat the infection, wait for the compensation stage, finish breastfeeding.

Review of prices for mammoplasty in Moscow

On average, in the capital, the operation itself costs 120-200 thousand rubles (excluding the cost of prostheses). Correcting the size of the areola or the shape of the nipples is slightly cheaper, about 36-50 thousand rubles. If you have planned endoprosthetics with a one-stage lift, then such mammoplasty will cost you much more (the price in Moscow will immediately jump to 275,000 - 350,000 rubles). To replace existing implants you will have to pay about 60,000 rubles.

For mammoplasty, the price depends not only on the tariffs of a particular surgeon, but also on the selected implant. The cost of silicone prostheses ranges from 30 to 60 thousand rubles. Anatomical (drop-shaped) ones are more expensive than spherical ones because they look more natural. Much depends on the manufacturer and the texture of the implant (rough ones, for example, “take root” faster).

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The choice of what to save on is always up to the client. You can find a simpler clinic and enlarge your breasts for a modest 50,000 rubles. Or you can spend money on an experienced and popular professional and pay 400 thousand. The difference in prices for mammoplasty is due to the “stardom” and experience of the capital’s surgeons, the appetites of prestigious clinics, an elite hospital and a notoriously generous clientele. In any other city, the operation will cost much less, but the specialist you will get is not so eminent. However, sometimes an increase in the price of mammoplasty in Moscow is quite natural if the operation is complicated by difficult access or you have chosen the most expensive implant.

IN base cost usually include:

• tests
• materials
• surgeon's work

You have to pay additionally the actual prostheses, as well as anesthesia and hospitalization. The recovery period also costs a lot of money, and you certainly shouldn’t skimp on it. There are, however, clinics that offer an all-inclusive service, when all consumables are already included in the specified amount. The average price guideline from which to base your search for a surgeon is 140 thousand rubles for the whole thing.

Recovery after mammoplasty

Optimal rehabilitation or recovery after mammoplasty takes a couple of months. After about 60 days, all discomfort associated with the operation and its consequences will go away, and swelling will subside.

But you shouldn’t rush: you will feel a foreign “chill” inside for a long time, and the path to an ordinary lace bra without wires is not close. You will have to wear compression garments for a long time after mammoplasty (you can buy them at any medical store, in the section of postoperative dressings and bandages).

Productive recovery after mammoplasty will require patience. Do not remove compression garments, pick healing scabs from scars, or use any creams without consulting your doctor.

To avoid complications after mammoplasty, you should blindly trust your surgeon and follow all his recommendations. For example, you can wash your breasts only after a week (and then without a washcloth). For the next 30 days, any physical activity, sudden lifting of arms, swimming and rowing movements are prohibited. You can’t drive in the first two weeks; the same time limits apply for taking a warm bath and having sex. It is better not to visit the bathhouse for a month, and - for many the hardest point - you should not sleep on your stomach for the same amount of time.

Scars, stitches, scars after mammoplasty – an inevitable, but temporary “evil”. Don't be alarmed: after six months, with proper care, they almost disappear. The initial result largely depends on the quality of the threads and stitching technique, which takes into account the structure and elasticity of your skin.

Do you want your recovery after mammoplasty to go smoothly? Shift some of the responsibilities to loved ones, remove all stress from yourself, get plenty of rest, walk and eat right.

Complications after mammoplasty (suppuration, swelling, migration of the implant) are prevented with the help of timely prevention - wearing compression garments, avoiding exercise, taking antibiotics, sleeping on your side, carefully observing your own breasts, sensations and changes.

Main complications after mammoplasty

As after any operation, complications are also possible here. Here are the main ones:

• suppuration, infection
• scars
• prosthesis migration
• seroma
• double bubble after mammoplasty (the so-called “double fold”)
• capsular contracture
• numbness of nipples, loss of sensation
• ripples on the skin
• bleeding
• implant rupture or crack

An unpleasant side effect (quite rare, but still existing) is a double fold (bubble). It may not occur immediately, but rather late, three to four months after the operation. Double bubble after mammoplasty does not always arise through the fault of the surgeon: sometimes it is caused by the individual anatomical features of the gland. In fact, an additional circle in the form of a fold or bubble is formed by the implant, which never connected with natural tissues and slid down. Such unsuccessful mammoplasty needs quick and careful correction.

Contracture after surgery– an extremely common complication of mammoplasty, it occurs in 10% of all patients. This is a capsule-shaped tissue formation around a fresh implant, a kind of protective response of the body to the invasion of a silicone guest. Contracture itself is not dangerous and is not considered a serious complication unless it is large and does not deform the prosthesis, causing it to rupture.

Seroma after mammoplasty is an accumulation of intercellular fluid in one of the breasts. It becomes noticeable soon after surgery and can be corrected surgically or medicinally. Most often, the serous fluid is pumped out with a syringe, monitoring the result on an ultrasound.

In case of strong and asymmetrical displacement of one implant, when the defect is clearly noticeable and does not look aesthetically pleasing, it is required revision mammoplasty. And to avoid “seasonal migration”, you need to purchase high-quality compression garments and not remove them without the surgeon’s permission.

Increased temperature after mammoplasty absolutely normal in the first days (while you are in the hospital). This is how the body encounters a foreign body and reacts to swelling. However, if a sudden fever finds you at home, this may indicate that an inflammatory process has begun - rush to the doctor.

How to choose a surgeon for mammoplasty? Reviews and recommendations

Doctors themselves constantly repeat how modern, safe and relatively accessible mammoplasty has become today; reviews after the operation, however, are also negative. Before you gather your courage and sign up for a consultation, you should carefully study all the possible pitfalls and consequences of optional surgical intervention.

Having finally decided that you need mammoplasty, you should read reviews about doctors and clinics in advance. There are plenty of forums on the Internet where people share their own stories, honest assessments, before-and-after photos, and advice.

By typing in a search engine, for example, “ mammoplasty, Moscow, Babayan Gaik Pavlovich", in one click you will find out all the opinions about the results of the work of the eminent doctor.

If you want to find out why repeated breast augmentation operations are performed (the first one was unsuccessful), how the mistakes of a plastic surgeon are corrected and what they depend on, watch the video.

Thanks to reviews, you can create a personal rating of plastic surgeons in Moscow for mammoplasty. And you will choose a specific specialist from several of the best during a personal consultation (based on internal comfort, degree of trust and pricing policy).

The most frequently asked questions and answers – from the patient and the plastic surgeon

Q: Does breast surgery cause cancer?
A: Modern silicone implants are not oncogenic.

Q: Will new artificial breasts interfere with breastfeeding?
A: No, prostheses are installed under the muscle or under the mammary gland and do not affect lactation in any way. However, after involution, the shape of the breast may change slightly.

Q: How often are implants replaced?
A: Modern dentures come with a lifetime warranty. The reason for the replacement may be the patient’s personal wishes (for example, if her weight has changed or she wants a larger size) or medical indications.

Q: At first, only sleeping on your back is allowed. When can you sleep on your side after mammoplasty?
A: After two weeks, sleeping on your side is no longer prohibited, and after a month you can even treat yourself to lying on your stomach.

Q: Why are sizers (implant simulators) needed?
A: They allow you to literally try on the results of the upcoming surgery and choose the correct shape and size of the prosthesis to ensure you are satisfied. 3D modeling on a computer also performs the same function, but only external implant simulators (sizers) give a woman an idea of ​​the weight and texture of her future breasts.

Q: Is it possible to make artificial breasts look and feel real?
A: Yes, but it all depends on the professionalism of the surgeon. An experienced doctor will select the ideal anatomical implants and perform the operation so that the new breast will be indistinguishable from natural breasts in appearance. Although you shouldn’t expect magic: from some angles, a trained eye will still recognize silicone.

Q: Are diving and airplane flights permanently banned after mammoplasty?
A: Not forever. Pressure changes should be avoided only for the first 14 days to avoid discomfort.

Q: I would like to put on a regular bra as soon as possible... How long to wear compression garments after mammoplasty?
A: From one to two months, your doctor will decide more precisely. A compression bandage fixes the implants, prevents them from moving, prevents sutures from coming apart, reduces pain and relieves swelling; its importance cannot be underestimated!

As you can see, breast surgery has its own nuances, indications and contraindications. It is better to learn about them before visiting a medical institution and be prepared for various moments.

Now you know how to choose a surgeon (reviews), why there is such a wide range of prices (different professionalism, star rating of the surgeon and the cost of the implant), when the doctor can refuse the operation or postpone it a little, why it will be necessary to wear compression garments and how long you can’t sleep on the side and stomach and other interesting things for those who want unearthly beauty for their bust.

Girls, I wish you common sense when choosing the size of the implant and a successful operation!

What do you think about plastic surgery today? - share in the comments.

Waterfall deformity is a delayed postoperative complication of augmentation mammoplasty. It is classified as one of the varieties of double bouble, just like snoopy breast.

Waterfall deformity or waterfall is a telling name, since it accurately characterizes the type of deformity of the mammary gland: stepwise distortion of its lower pole.

Such a defect does not pose a threat to the patient’s health, but it brings significant psychological discomfort.

Causes

Until recently, it was believed that the risk of developing such deformities existed only in women with breast tubularity, and the more pronounced it was, the higher it was. However, recent studies of patients conducted in this area indicate that this is not always the case. Currently, the following risk factors are identified that contribute to the development of waterfall deformity:

• remodeling of the thoracic parenchyma during correction of grade 3 and 4 tubularity;
• severe ptosis of the mammary glands;
• use of large volume implants;
• change in the position of the inframammary groove.

As an analysis of recent publications on the topic of tubular breast enlargement shows, grades 3 and 4 of this defect do not require remodeling of the breast parenchyma, since it is illuminated during augmentation.

The combination of ptotic breasts, into which large-volume endoprostheses are implanted, creates a high risk of deformation of the mammary glands. In this case, the surgeon must warn the patient about the possibility of developing postoperative complications in the near future.

Correcting the position of the inframammary groove carries the risk of the connective tissue striving to restore its previous location due to shape memory. Thus, in the presence of these factors, the plastic surgeon must take a responsible approach to planning breast augmentation and surgical technique.

Correction

Correction of waterfall deformity is carried out either surgically or using a minimally invasive technique - lipofilling. The latter will be justified if the defect is mild or moderate. To do this, the patient’s own fat is transplanted from problem areas of her figure to the area of ​​breast distortion. The effect of lipofilling lasts for 2-5 years, depending on the individual characteristics of the patient’s body.

In more complex cases, repeat mammoplasty will be justified, which, in principle, avoids the removal and replacement of implants.

Mammoplasty is a good way to restore the shape of a woman’s breasts. A woman who decides to undergo surgery must follow all doctor’s instructions. In preparation for surgery, you need to pass all tests and be examined by a therapist and anesthesiologist. If this is not done, there is a risk of complications or unsuccessful breast surgery. According to statistics, this situation occurs in 4% of women.

Loss of sensitivity of the nipple and areola

Minor sensory disturbances may be associated with edema. The swelling will subside and sensitivity will be restored.

Most often, the sensitivity of the nipple and areola is not affected by submarinal (under the breast) and axillary access. It is disrupted with periariolar access (the border of the areola and the skin on the chest).

Numbness of the breast after plastic surgery

This in most cases occurs because the nerve branches were crossed during surgery and time is needed for their recovery. The recovery period is different for everyone, on average about six months.

If this is not done in advance, severe consequences, complications and scars may occur after mammoplasty.

Purulent wounds around the implant

Occurs in 1–4% of patients. The reason may be:

• natural rejection breast implant;
• entry infections during the operation.

It may appear a year or more after surgery. They are treated with antibiotics, and in severe cases the implant is removed.

Infection

Any operation is associated with infection. The first factor is the qualifications of the surgeon and his professional work experience. The second factor is the patient’s failure to comply with hygiene requirements after surgery.

Accompanied by a temperature above 38 degrees, redness and purulent discharge. Antibiotics and antiseptic drugs are prescribed, and in difficult cases, the endoprosthesis is removed or replaced.

Seroma and hematoma

It is normal for a small amount of fluid to collect around the breast prosthesis, but seroma after mammoplasty is a lot of clear serous fluid.

The more extensive the surgery, the more likely it is that seromas will appear. If the gray is left unattended, it can persist for a long time and cause hardening. Surgically removed using a syringe.

Any irritant can cause gray matter:

• reaction body onto the prosthesis when the capsule has not yet formed;
• physical loads, injuries;
• early refusal of wearing compression linen;
• non-compliance restorative period.

To prevent seroma formation, you should wear compression garments for at least 6 weeks.

A hematoma is a collection of clots of dried blood in sacs around a breast implant. It is accompanied by severe swelling, fever, and inhibits muscle mobility. Treatment of the hematoma is mandatory.

Tissue death

Tissue death - necrosis - occurs when the implant compresses the blood supply in the chest due to scar tissue (capsule) growing around it.

To prevent this from happening, in 1968 W.C. Dempsey and W.D. Latham suggested installing a breast implant subpectorally (under the pectoralis major muscle).

Scarring

Immediately after the operation, the surgeon applies a special plaster to the scar. It makes it possible to maintain body hygiene at first.

It is important to allow scars and cicatrices to heal quietly in the first months. Surgeons recommend:

• Not scratch scar, but let it heal and form;
• smear the formed scar with a special silicone gel;
• stick silicone strips that allow the skin to breathe and do not allow water to pass through, and also visually make the scar invisible;
• don't visit swimming pools, postpone a trip to the sea;
• Not load chest area, scars should not stretch.

After a few months, the incision line will not be visible at all. But if a woman’s visible part has an unaesthetic appearance and this bothers her, plastic surgery has ways to correct this:

• excision of a scar or scar;
• grinding.

There cannot be the same time period until complete recovery. Therefore, if the scar is red, you need to wait until it turns white. Otherwise, you can get a keloid.

Breast change

After surgery, breasts may change shape and become denser. This change is called capsular contracture.

Essentially, a capsule of fibrous connective tissue is formed around the implant, which thickens and thickens over time. Normally, the capsule is very thin and measures 1/10 of a millimeter. But with capsular contracture, the capsule grows to 2-3 mm or more.

It gradually squeezes and compresses the implant, which leads to its deformation, and therefore to a change in the shape of the breast and to pain. In severe situations, it leads to atrophic changes in breast tissue.

If capsular contracture is detected, corrective surgery is performed. The implant is changed and the capsule is removed.

Temperature

In the first days, this is a natural reaction to a foreign body; the temperature after mammoplasty will be 37 or higher. In the following days, a “hangover” condition may occur. The surgeon will prescribe antibiotics and monitor the patient's condition.

Possible complications associated with implants

A capsule is formed around the breast implant. Capsular contracture is more common with silicone implants. Capsular contracture, consisting of fibrous tissue, begins to compact the implant, which leads to pain. The aesthetic appearance of the breast also deteriorates.

Surgery for severe capsular contracture allows removal of the capsule itself and the endoprosthesis. Mild cases do not require surgery.

Implant rupture

High quality implants undergo many stages of testing at factories, which indicates their safety. They are filled with state-of-the-art cohesive gel and come with a lifetime warranty. Even if the implant ruptures, the gel will not leak into the soft tissues and will not harm the patient’s health.

Implant rupture may not be visually noticeable. But it is detected on a mammogram or MRI.

Severe tears can ruin the appearance of the breasts and cause inflammation, swelling and pain.

Deformation of the endoprosthesis

If after mammoplasty one breast has become larger than the other, this will disappear in the first months after the operation, when the swelling goes down.

In another case - with an incorrectly selected endoprosthesis or placement.

In the third case, deformation may have occurred:

• More susceptible to deformation saline implants.
• Has the meaning volume implant filling: normal and overfilled. When overcrowded, there is less wrinkling.
• Textured endoprostheses are more deformed and wrinkled than smooth ones.
• Implants "under the muscle" are deformed to a lesser extent.
• A special type of deformation also includes double bubble complication.

Implant displacement

It takes time for a breast implant to become firmly entrenched in the tissues. To do this, immediately after the operation the patient is dressed in compression garments. To avoid asymmetry and displacement, it is recommended to completely avoid physical and strength loads on the chest and upper abdomen for three months.

If after three months adjustment is still needed, additional procedures are prescribed.

A loose pectoral muscle may cause discomfort during the postoperative period, but this goes away over time as the muscle and implant adjust to each other.

Saline implants are more likely to dislodge because they are heavier than silicone ones.

An implant that is placed above the muscle is more susceptible to displacement than an implant that is placed under the muscle.

Double fold (or double bubble)

Double bubble after mammoplasty is a serious aesthetic complication. The chest does not look like a single whole, but as if folded.

30% of women have a specific anatomical feature of Cooper's connective tissue ligaments. These ligaments are located under the breast and support the weight of the entire glandular part. After surgery, when swelling goes down, a small percentage of women face this problem. Surgeons offer correction.

During correction, an incision is made, part of the breast tissue is excised, carefully straightened and fixed in a new place to a new submammary fold.

The double fold after mammoplasty will still be noticeable for some time, but after a week this deformity will disappear. Patients after such correction must wear compression garments for two weeks.

Calcification

This is a specific complication of breast surgery, which is associated with the individual characteristics of the body. The mammary gland becomes deformed and its aesthetic appearance is lost.

A deposit of calcium salts forms around the implant - calcification. During examination and palpation, the surgeon identifies foci of calcification and may suggest implant replacement or correction surgery.

There is no prevention for this complication.

These deposits may be mistaken for tumors on mammography.

Symmastia

This is an aesthetic complication after mammoplasty, in which the implants are located very close to each other. Visually, the mammary glands seem to have “grown together.”

The reason may be:

• choice too volumetric breast implants;
• anatomical location of the mammary glands.

To avoid symmastia, an experienced surgeon must select the correct size of the breast implant, otherwise you will have to make a correction with smaller implants.

Skin ripples

Mostly such ripples occur on cheap breast implants. Ripples after mammoplasty can also appear when the capsule covering the implant is not fully formed on one of the breasts. If the ripples do not go away, the surgeon suggests correction.

When the volume of native breast tissue is small, breast implants are usually installed “under the muscle”.

Reduced efficiency of breast cancer diagnosis

Breast implants and silicone have not been proven to cause cancer. Patients who have had a gland removed due to cancer are fitted with endoprostheses.

Sometimes it happens that a patient came for mammoplasty and an oncological disease was detected.

Experienced surgeons sometimes combine operations: during mammoplasty, for example, fibroadenoma is removed. And the removed material is sent for further examination.

Endoprostheses make mammography examinations more difficult, which reduces the effectiveness of diagnosing cancer.

To prevent implant rupture during palpation and examination, it is necessary to warn the doctor about its presence.

Decreased ability to breastfeed

Breastfeeding issues are discussed with the surgeon in the preparatory period. Both saline and silicone endoprostheses do not have a negative effect on pregnancy and fetal development, even in the event of rupture.

With periariolar access (through the isola incision), the ability to breastfeed is significantly reduced or completely lost, as the ducts are crossed.

With submarinal (under the breast) and axillary access, the mammary gland is not injured. But if there were complications, the risk of impaired ability to breastfeed remains.

After breastfeeding, at least 6 months later, you can begin preparing for mammoplasty.

Capsular contracture

In medicine, capsular contracture is a formation that consists of dense fibrous tissue. It forms around the implanted implant, gradually squeezing it. But it is a normal reaction of the body to a foreign body.

But you should consult a doctor when signs of capsular contracture begin to bother you. Among them, hardening of the neoplasm and its increase in size are noted.

The causes of contracture formation are:

1. Accumulation serous fluid around the implant, which leads to its detachment.
2. Inflammation.
3. Non-compliance recommendations specialist during the rehabilitation period.
4. Hematomas, formed after surgery.
5. Wrong size implant.
6. Hit silicone between the implant and fibrous formation as a result of rupture of the first.

In cases where the capsular contracture is large, repeated surgery is performed to remove it.

In order to prevent the development of such a complication, it is necessary to follow all the specialist’s recommendations during the rehabilitation period, use implants with a textured surface, wear special compression garments and regularly visit a specialist.

If your chest itches or there is a lump in the area where the implant is located, you should consult a doctor.

Pain

Often after mammoplasty, patients complain that their breasts hurt. Unpleasant sensations occur for 2-3 days after surgery, provided the healing process is normal and all doctor’s recommendations are followed. But you should know that the duration of the recovery period is individual in each case.

After mammoplasty, the nipples may hurt, which is also not a deviation, provided that the pain does not increase, but gradually disappears.

The causes of pain are injury to soft tissues during surgery and their stretching during the recovery period.

Swelling of the abdomen

Swelling is a normal reaction of the body to surgery.

But abdominal swelling after mammoplasty is not observed in all patients. Often, an unpleasant symptom occurs when access during surgery is carried out under the breast.

It appears gradually. Swelling immediately after a breast augmentation procedure is observed only in the mammary glands. After 1-3 days it drops onto its stomach. In appearance, it is swollen; when pressed, marks may remain.

The color of the skin changes only when there is bleeding. In this case, bruises and hematomas appear on the abdomen.

Unsuccessful breast surgery can lead to swelling. In this case, the symptoms will be pronounced, they will constantly increase and worsen.

To relieve swelling, it is recommended to apply cold to the abdomen, wear compression garments after surgery, and eat right. In the first days after surgery, you should not take a hot bath, shower, or visit a sauna or bathhouse. In severe cases, it is necessary to use homeopathic remedies in the form of creams to relieve swelling.

Preventive measures and reducing the risk of complications

After any plastic surgery you must:

• Do not visit pool, sauna, bathhouse, solarium, from 4-6 weeks.
• Do not take hot baths.
• Homemade aquatic Procedures should be taken only with a special silicone strip on the incision, and not earlier than after a week.
• In the first 7-10 days sleep on your back with your head elevated so that swelling subsides faster and discomfort decreases. Two weeks later - on the side. Not earlier than in a month - on the stomach.
• Even if the patient is compression underwear, do not lift weights. This threatens complications and new operations.
• Don't engage sports. Intense training on the chest and upper abdomen and back can displace the thoracic endoprosthesis from its location, which again threatens complications and correction.
• Do not exercise for the first time after surgery sex. This may cause the seams to come apart. It is recommended to start planning pregnancy no earlier than a year after mammoplasty.
• Don't fly to airplane in the first few weeks after surgery.
• Accept medicinal medications prescribed by the surgeon.