Türkçe İngilizce Rusça
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Dr Ömer Özkan

1-Cosmetic Breast Surgery in Men (erkeklerde meme ameliyatı)

The Most Suitable Candidates for Gynecomastia

Gynecomastia corrective surgery can be performed on healthy and emotionally stable men of any age. The most suitable candidates are those with tight and elastic skin that can be shaped to the new contours of the body.

Surgery is not recommended for obese or overweight men who have not tried to correct their problems with exercise and/or losing weight. Individuals who drink alcohol or use marijuana are also not thought to be suitable. Together with anabolic steroids, these substances may lead to gynecomastia. For that reason, patients are advised to stop using these substances in order to see whether their chest decreases in size before going on to consider surgery, one treatment option.

Few complications are seen when breast reduction surgery for men is performed by a qualified plastic surgeon, and those which do arise are minor.
If asymmetry is particularly evident, a second procedure can be performed to remove excess tissue. Temporary effects of breast reduction include loss of sensitivity or numbness, and this can last for up to a year.
If the suspected cause is a medical one, you will be referred to an appropriate specialist. In extraordinary conditions, your plastic surgeon may ask for a mammogram or x-ray. These requests will not only eliminate the risk of breast cancer, but also reveal the structure of the breast.

Preparation for Surgery
Your surgeon will give you special instructions about how to prepare for your operation in terms of what to eat and drink and taking certain vitamins and drugs.
Smokers should plan to quit for at least two weeks before surgery and throughout the healing process. Cigarette smoking reduces blood circulation and obstructs proper healing.

What Will Happen during Your Operation
Gynecomastia surgery is generally performed without hospitalization, although in exceptional cases or suspected medical conditions, overnight hospitalization may be recommended.

The operation is generally completed within an hour. More comprehensive procedures may take longer, however.

Type of Anesthesia
Male breast reduction can be performed under general anesthesia, or under local anesthesia with sedation in certain cases. You will be awake, but relaxed and insensible to pain.

More radical correction can be carried out under general anesthesia, and the patient will thus sleep right through the procedure. Your surgeon will tell you which option is best for you, and why.

The Operation
If excess gland tissue is the main reason for breast growth, this tissue will be removed. This process can be carried out alone or together with liposuction.
In a typical procedure, an incision is made from an unexposed area (from the edge of the areola or the arm pit). Larger incisions may be made in more major surgery requiring the extraction of a significant quantity of skin and tissue, and this may lead to visible scarring. If liposuction is used to remove excess fat, a cannula is generally inserted through the incisions.

In exceptional situations in which very large amounts of fat and gland tissue are removed, the skin may not adapt to the contours of the new, smaller breast. In these cases it may be necessary to remove more skin so that the remaining skin will fit the new breast contour.

After Surgery

Whether the scalpel or liposuction technique is employed, you may feel discomfort for a few days after surgery. But this discomfort can be controlled with drugs prescribed by your surgeon.

In any case, you will need someone to drive you home after the operation and, if necessary, help you for a day or two.

You may experience swelling and bruising for a while, and you may even wonder whether you are healing or not. In order to reduce swelling you will be asked to wear an elasticated pressure garment every day for a week or two and then at night for a few weeks.

Most swelling disappears within the first few weeks, though you may have to wait three months or more to appreciate the full effect of the surgery. Meanwhile, it is important to begin resuming normal life. You will be encouraged to start walking immediately after surgery, on that same day, and to return to work when you feel well enough – and this may be just one or two days after the operation.

Sutures are generally removed one or two weeks after surgery. You will be advised to avoid strenuous exercise for three weeks. You will also be told to avoid jobs and sports that might involve a risk of blows to the chest region.

Generally speaking, it will take about a month for you to be able to resume all your usual activities.
You must protect the resulting wounds from the sun for at least six months. Sunlight can permanently affect skin pigmentation and may cause the wound to turn a dark color. If it is impossible to avoid the sunlight, you will be advised to use high protection factor sun cream.

2- Breast Augmentation Surgery

What is a silicone breast prosthesis (implant)?

Products containing silicone are used for different purposes in the cosmetics industry and in medicine. Breast prostheses, or implants, resemble balloons manufactured to resemble the shape of breasts. They come in round or anatomical shapes known as tear drops. One of these is selected on the basis of the status of the woman’s breast. The back part is made from silicone; the surface of the implant is textured in order to match the tissues in the body. Various substances may be used to fill the implant. The breast implants in current use may be summarized as follows:
*A silicone outer surface, the back filled with a gel of silicone origin. These are manufactured for use in various sizes. Approval was granted by the Food and Drug Administration in the USA in November 2006.
*Silicone with a hollow back (saline solution-filled): these are filled with saline solution, popularly known as salt water, during surgery until the desired volume is achieved. Implants manufactured to be ready for use have also recently become available.
*PVP : In the same way, the back is filled with a chemical substance known as PVP (polyvinyl pyrrolidone povidon). This has a gel consistency and is ready for use. This has been reported to have been withdrawn from the market by the manufacturing company.
*Soybean Oil : The back of the ready to use silicone prosthesis is filled with soybean oil. New to the field. Little information is available regarding long-term outcomes.

What You Need to Know before Surgery
If the patient to be fitted with an implant is older than 40 mammography and if necessary the radiological tests known as ultrasound are performed. Every operation has general or its own particular risks. Complaints after surgery include pain and swelling in the breast region. Bleeding and infection associated with surgery are rare conditions. Some patients complain of increased or reduced nipple sensitivity or lack of sensation around the incision. These are generally temporary. It has been suggested that certain connective tissue diseases develop in reaction to the implant, a foreign object in the body, that it is harder to provide milk for the baby and that implants can lead to cancer. But none of these have been scientifically proved. Implant-associated problems can develop in breast augmentation since the size of the breast is increased by a foreign object in the body. There may be hardening and contraction associated with the growth of a membrane known as the capsule around the implant. While a thin membrane represents no problem, a medium-thickness membrane can cause a slight hardness in the breasts, prominent in the bottom of the breast. Very occasionally the body may reject this foreign object and a thick membrane (capsule) develops around the prosthesis, trying to enclose it or even expel it from the body entirely. If a thick membrane grows, this may result in hardness in the breasts and sometimes in asymmetry. In the event of mild and medium capsular contraction, external massage can be performed to overcome the capsule around the prosthesis, or additional surgery can be performed if required. When severe capsular contracture develops there is no alternative to removing the implant. Silicone implants have a very thin outer surface and are highly sensitive to impact from the outside. Normal and medium massage is not harmful. The patient can lie face-down two months after surgery. Sometimes the implant filling may leak. If a gel-filled implant has been used these leaking substances may cause lumps to form. The effects of soybean oil are as yet unclear. If a saline-filled implant has been used, the saline solution may leak out between the tissues, in which event it is rapidly absorbed without causing any harm. In fact there is nothing harmful about this substance that can be injected into the veins and is used for other treatment purposes. It is rare for an implant to rupture, though this can be caused by impact inside a motor vehicle involved in a traffic accident, falls and injuries by sharp objects. Subsequent mammography and surgical examinations in breasts with implants are not a problem. The implant shows up as an empty space in mammographs. Silicone breast implants do not increase the risk of breast cancer and are identical to normal breast tissue. If such a condition develops cancer surgery and other standard forms of treatment are administered to breasts with implants. Before deciding on breast augmentation, you should tell your doctor what it is that you are unhappy with and what you expect from surgery, and discuss the implant to be selected, the incision by which the implant will be inserted, type of anesthesia and the early and late-term outcomes of surgery.

The operation
Surgery is performed in an operating theater under hospital conditions and under general anesthesia. It lasts 1-2 hours. A 4-5 cm incision is made in order to insert the implant. Some of the sites for this are:
Beneath the fold of the breast (submammarian)
The lower part of the nipple (circumareolar)
The armpit (axillary).
It has recently become possible to enter endoscopically and install the implant through the naval. But this technique has not yet acquired wide acceptance. But wherever entry is made from, a scar will be left. These scars will be prominent at first and gradually become less visible. Depending on the structure of the patient’s breast, the implant can be inserted wither behind the breast tissue or else behind the breast muscle (pectoral). Dual plan is a popular technique whereby the upper part of the implant is inserted under the muscle and the lower part beneath the breast. There are advantages and disadvantages to all procedures, and this detail should be properly considered prior to surgery.

After surgery
The period after surgery is generally comfortable. Pain is minimal. İf the implant has been installed behind the breast muscle, arm movement may be restricted for a few days. A bra or bandage is placed over the breast following surgery. Non-soluble sutures can be removed after 10-12 days. There is no need to remove soluble sutures. There may be swelling, lack of sensation in the nipple and a purplish discoloration in the early period. These disappear spontaneously within a short time. The patient can return to work in 3-4 days. The implant settles in place after three weeks and the breast regains normal functioning. The patient is advised to avoid strenuous sport (requiring her to run or jump up and down) for two months. Breast augmentation with implants generally gives could and permanent results, improves the individual’s mental and psychosocial well-being and bestows a greater joy in living.
The most widely used implants today are silicone gel-filled, textured, round prostheses. Implant selection and implantation vary according to the patient, the condition of the breast and the preference of the surgeon.

3- Breast Lift Surgery (meme dikleştirme ameliyatı)

Am I Suitable for Breast Lift Surgery?
If you are physically healthy and your weight is stable, if you do not smoke, if you have realistic expectations, if you think your breasts have sagged or lost their shape and fullness, if your nipples have sagged downward, if they and the brown area around them now face downward, if the skin is tense and the brown area around the nipple is wide, and if one breast is smaller than the other, then you are a suitable candidate for breast lift surgery.

The Operation

In cosmetic breast lift surgery, sagging breast tissue is reshaped and excess skin removed. The nipple is brought to an appropriate location. The operation is carried out under local anesthesia in an operating theater under hospital conditions. It lasts 1.5-2 hours. Various forms of scarring may result, depending on the degree of sagging. No matter what technique is employed, scarring around the nipple is inevitable. If breast lift surgery is performed by making an incision around the nipple, the scar around the nipple will be more evident. In other forms of breast lift surgery, in addition to a scar around the nipple, there may be a scar some 4-5 cm in length extending downward from the middle part of the lower edge of the nipple. In suitable patients, sagging can be eliminated by inserting a breast implant alone. In that case the scar is hidden where the brownish skin of the nipple meets the white skin of the breast and is minimal. There is no breast lift operation that does not leave a scar. However, while these scars are prominent at first they gradually become indistinct.

After Surgery
The period after surgery is generally comfortable. Pain does not usually create a problem. If a breast implant is used during surgery arm movements may be restricted for a few days. A bra-like bandage is applied over the breast. A separate dressing is placed over the nipple. The dressing is opened or monitored after 1 day. If biodegradable sutures are used there is no need to remove them. Patients wear a sports bra for 6 weeks and massage is recommended. Swelling may develop in the early stage, and there may be lack of sensation around the nipple and a purplish skin discoloration. These quickly disappear of their own accord.

Resuming Normal Life
Patients can return to work in 3-4 days, but are advised to avoid strenuous sports for two months. Cosmetic breast lift surgery generally gives good and permanent results, and raises the individual’s and her partner’s spirits, thus enabling them to get more out of life. The newly shaped breast is long-lasting, although weight changes, pregnancy, breastfeeding and gravity can all lead to further sagging.

4-Breast Reduction Surgery

Preparation for surgery
In addition to the blood and lung tests required prior to surgery, mammography and, if necessary, ultrasound must also be performed. Conditions such as high blood pressure, cigarette and medicine use, and diabetes must all be discussed. There is usually no need for blood transfusion for breast reduction. You will need someone to help you on the day of surgery and for a few days afterward. Breast reduction has to be performed in hospital, and you may have to remain in hospital for 1-3 days.

The Operation
In breast reduction surgery, the large breast tissue is reshaped in accordance with the individual’s body measurements. Excess breast tissue and covering skin is removed. The nipple is brought to the appropriate location. The operation is generally performed under hospital conditions in an operating theater and under general anesthesia. It lasts 2.5-4 hours. No matter what technique is employed, there will be a scar around the nipple. In addition, depending on the technique employed, there will be a scar in the shape of an upside-down T running from the center of the lower edge of the nipple. The T-shaped scar is matched to the crease underneath the breast. However, recent surgical technique has to a large extent eliminated the scarring in the breast crease region in breasts that are not very large. All that remains is a scar approximately 4.5-5 cm in length running around the nipple and to the bottom of the breast. These scars are initially very prominent but can become much less noticeable over time. The level of scarring after surgery is related to the size of the breast, the surgical technique employed and the predisposition to scarring of the patient’s skin. Some patients say they sunbathe topless. In certain special circumstances and extremely large breasts it may not be possible to perform the types of operation described above. In that case, free nipple techniques are employed. Scars from this form of surgery are again in the form of a reverse T shape.

After Surgery
The period after surgery is generally comfortable. Pain is. There may be some restrictions in arm movements. Dressings resembling are bra are worn over the breast, or a bra may be worn immediately after certain forms of surgery. Tubes known as drains are generally inserted in both breasts and removed within 24-72 hours. A separate dressing is placed over the nipple. The dressing is opened after two days for the wound to be examined. Since the sutures are generally biodegradable there is no need to remove them. The patient remains in hospital for 1-3 days. The patient wears a sports bra for 6 weeks, and massage is advised. There may be swelling in the early period, together with lack of sensation in the nipple and purplish skin bruising. These quickly disappear spontaneously.

Resuming Normal Life
The patient can return to work after one week. We recommend that strenuous sporting activities should be avoided for three months. Cosmetic breast reduction is a form of surgery that generally gives good and permanent results, that improves the patient’s and her partner’s state of mind and produces a greater love of life in both and that makes the subject of dressing and clothing much easier. The newly reshaped breast is long-lasting, although weight changes, pregnancy, breastfeeding and gravity can lead to increased breast size and sagging.

The Risks of Breast Reduction Surgery:
As with all forms of surgery, there are various risks involved with breast reduction. Although the majority of patients undergoing the operation experience no problems with it, you still need to be aware of the following points. Bleeding; a rare condition that may develop during or after surgery. The drain inserted in the breast after surgery is intended both to monitor whether there is any bleeding and to prevent even a small amount of blood from collecting inside the breast tissue. Do not take aspirin or similar drugs for 10 days before surgery, as these can enhance a tendency to bleeding. Infection: an exceedingly uncommon state of affairs. Most surgeons use protective antibiotics right from the start of surgery. Changes in nipple and skin sensitivity: there may be a temporary decline in sensitivity in these regions. Scars: every surgical procedure leaves scars as healing takes place, and the nature of the scarring cannot usually be determined beforehand. Scars may be imperceptible in some cases, while scar tissue may develop in skin and tissues in some patients. Corrective surgery or other form of treatment may even be needed in some patients. Dissatisfaction with results: you may not be happy with the size or shape of your breast. The likelihood of this is very low, but it does exist. Pain: pain in the neck, back and shoulder area may persist even after breast reduction surgery. On rare occasions, scar tissue in the skin and deep breast tissue may cause pain. Hardness in the breast: hardness due to fat necrosis or scar tissue may occasionally be observed. This cannot be predicted beforehand. Delayed wound healing: this is uncommon, but may be seen. It may take longer for some areas in the breast skin or nipple to heal entirely. Frequent dressings may be required. Healing problems are more common in smokers. Asymmetry: most women have a natural breast asymmetry. There may be differences in the shape, size and symmetry of the breast and nipple. Breast diseases: breast disease or breast cancer can develop at any stage of a person’s life, irrespective of breast reduction surgery. Frequent breast checks are important whether one undergoes surgery or not. Breastfeeding: some women who undergo breast reduction surgery may be unable to breastfeed, but this can generally be determined beforehand. If you wish to have children and breastfeed them you should discuss this with your surgeon prior to surgery. Allergic reactions: local allergy to plasters, sutures or ointment used may arise on rare occasions. Need for additional surgery: several factors influence the long-term outcome of breast reduction surgery. Additional surgery may be needed if looseness or sagging develop.