POST-BARIATRIC SURGERY
BREAST AUGMENTATION AND MASTOPEXY
Breast augmentation and mastopexy
(Breast augmentation and uplift )
As a result of obesity, the fat component of breast tissue increases, causing significant stretching and mechanical stress to the skin. Following massive weight loss, breasts are deflated and devoid of fat tissue, resulting in multiple functional and aesthetic irregularities. The overstretched and damaged skin will have lost its elasticity and therefore its ability to readapt to the underlying tissue. Diffuse stretch marks may appear and also the deep connective structures, which link skin and gland tissue, are damaged, which causes remarkable skin laxity and breast descent. This condition may be exacerbated by pregnancy and breast-feeding. Of course, the natural ageing process, with or without weight loss, contributes to a progressive loss of skin elasticity in the breasts.
If, following the weight loss, the gland and fat tissue are significantly diminished, the resorption and descent of tissues can be corrected by means of breast augmentation with mastopexy This procedure seeks to enhance volume with use of implants. At the same time the breasts and the nipple-areola complex are uplifted, reassembling a bigger breast in a higher position.
For post-bariatric patients, this procedure requires undertaking complex and specific surgical techniques, involving the excision of excess skin, concomitant glandular moulding and use of mammary implants. Usually an inverted –“T” technique is utilised, which causes a scar in the inner inframammary fold, in contrast to short-scar techniques ( vertical or “J”). This approach allows better skin redraping and better long-term results. However, the resulting scar can be hidden by a standard bra. Only deep, dissolvable sutures are used.
Regarding implant size, and the resultant degree of augmentation, boundaries are set by the patient’s anatomical features, such as breast and chest width, i.e. the space available for implant placement. Another important factor to consider is the implant weight; the force of gravity contributes to the recurrence of tissue descent: the bigger the implant, the heavier the weight. Therefore, in breast augmentation with mastopexy, it is advisable to place moderate volume implants, especially in post-bariatric patients. Also, generally speaking, very big implants tend towards a less natural result. The surgeon will show the patients implants of a range of shapes and sizes in order to illustrate the expected augmentation in a tangible way to arrive at the best solution in each individual case.
Implants are usually positioned, in the upper pole, underneath the pectoralis major muscle, whereas the lower part is covered by a glandular-adipose flap. This guarantees better coverage of the implants, resulting in a less palpable implant and ultimately more natural results. Additionally, the new breast configuration will be more stable with a lower risk for capsular contracture (hardened and/or abnormal looking breast).
After the surgery, breasts are excessively high, more swollen in the upper region and stretched and square in the lower pole. Gradually, in the following weeks, they settle and achieve the appropriate shape.
Breast augmentation and mastopexy is performed under general anaesthesia (the patient is asleep) with a one-night hospital stay after the surgery.
Careful administration of pain-killers during and after the surgery ensures that post-operative pain and discomfort are kept to a minimum.
