Breast augmentation is one of most commonly performed cosmetic procedure now a days in İstanbul, Turkey. Patient presents with different situation for breast augmentation. Some patient has small breast size as compared to rest of body appearance and they want to improve their figure. Some patient have congenital breast hypoplasia, Poland syndrome due to which breast is not developed properly. Patient with tuberous breast deformity and post mastectomy reconstruction also present for breast augmentation. The ideal size and shape of female breast is inherently subjective and relates to both personal preferences and to cultural norms.

EVALUATION

Patient is evaluated in detail during the visit. Detailed history is taken that include presenting problem of patient, concern of patient, goal and expectation of patients. Any history of medical related and breast related problem including like Poland syndrome, surgery, tuberous breast deformity. Family history of breast cancer and any history of lump in breast is also taken. History of pregnancy and lactation is also important in evaluation. Co morbid condition like diabetes, hypertension, heart disease is also important to note and any medication like oral contraceptives pills, nsaids and anticoagulants is necessary.

After detailed history physical examination is done of chest and breast. Any asymmetry of breast, nipple areola complex and chest is noted and informed to patient. Precise measurements are made. These include marking of Inframamary fold, nipple to inframmary fold distance, suprasternal notch to IMF distance, intermmmary distance , chest and breast circumference. Different ways are used to measure the size of breast and size to be increased. Sizer are available, or bag of water or rice is placed under bra to check the expected size.procedure is explained to patient, outcome, complications and recovery time also and informed consent is taken.

TECHNIQUES AND INSCIONS

Two techniques are commonly used for breast augmentation.

• Breast augmentation with implants and with fat grafting. Different type of implants are available that include silicon or saline implant, round or anatomical implant, low profile, intermediate and high profile implant, smooth and textured implant.
• Most commonly now a days silicon textured implants are used with medium to high prolife for good projection.

Different inscion for implant placement can be inframammary fold inscion, periareolar inscion, transaxiallry inscion, trans umbilical inscion. Commonly used inscion is inframmary fold inscion. Different pockets can be created for implant placement include subglandular, submuscualr, dual plane etc.

Fat grafting is new method of breast augmentation. Fat is harvested from body abdomen or thighs, processed and injected in breast in different planes. It can be done alone or with new techniques of BRAVA device to make a space with suction. It may need to be repeated to make symmetry as 20-30 percent fat is absorbed.

PROCEDURE

preoperatively marking is done in standing position. This procedure is performed under general anaesthesia. After preparation of patient commonly used inframmary fold inscion is given, pocket is created either submuscualr or subglandular.pocket is made appropriate not too much medial not too much lateral to make better shape in natural look and to avoid complications. Heamostais is secured. Pocket is washed with gentacin antibiotics solution. Gloves changed and implant of same size on both side is opened and inserted in pocket. Adjustment done and wound closed, dressing done.

POST OPERATIVE CARE AND RECOVERY

Patient is placed in recovery room with head end elevation. Appropriate analgesia and anaesthesia is given. Initial swelling and bruising take about one week to settle. Patient is advised yoga type exercise. Follow up visit can be done in 3-5 days. Patient can be returned to routine life in 3-5 days with agressvie exercise is avoided for 3-6 weeks. Complete resolution of edema takes about 2-3 months.

COMPLICATIONS

• Bruising
• Swelling
• Heamatoma
• Seroma
• Infection
• Alteration of nipple sensation

these complications are less with good care and can be managed conservatively. These are in range of 3-7 percent.

COMPLICATION RELATED TO IMPLANTS

• Asymmetry
• Implant malpostion
• Rippling
• Capsular contracture
• Implant rupture

these complications if occur are first managed conservatively, if not settled then implant need to be removed and changed with change in pocket location.

COMPLICATIONS RELATED TO FAT GRAFTING

• Fat necrosis
• Oil cyst formation
• Calcification

COST OF BREAST AUGMENTATION IN Istanbul, Turkey

• The cost of breast augmentation is starts from Rs. 140,000 to 160,000 If done with implant.
• If breast augmentation is done with fat then price is between Rs. 100,000-120,000