PEER-REVIEW | PREGNANCY AND AESTHETICS | to cause breast-feeding difficulties. Surgery may also
damage the lactiferous ducts and the nerves in the nipple-areola area. The presence of radiologically opaque breast implants
(either saline or silicone) might interfere with the radiographic sensitivity of the mammograph, that is, the image might not show any tumour(s) present. In which case, an Eklund view mammogram is required to ascertain either the presence or the absence of a cancerous tumour, wherein the breast implant is manually displaced against the chest wall and the breast is pulled forward, so that the mammograph can visualize a greater volume of the internal tissues. Nonetheless, approximately one-third of the breast tissue remains inadequately visualized, resulting in an increased incidence of mammograms with false-negative results35 Hyaluronic acid injection treatment has now largely
.
been discontinued in the UK and Ireland as a breast enhancer due to the lack of consensus amongst radiologists regarding how to examine breasts that have been injected with filler. The technique involved injecting stabilised hyaluronic acid into the deflated breast and then moulding to the desired shape. The benefits are that it requires only a local anaesthetic and will leave no scarring, although bruising, swelling and discomfort for a few days are expected. The effect however only lasts for 12 months, after which further injections are required. The procedure has also drawn criticism as its long term effects are relatively unknown. The only medical trial was supported by the manufacturers, involving 1000 patients in Japan, and anybody taking the procedure will be entered into a European-wide research trial. Problems with this treatment included capsular formation and product migration. The author witnessed some patients with small lumps of product that required aspiration. The breast augmentation patient is usually a young
woman whose personality profile indicates psychological distress about her personal appearance and her bodily self-image, and a history of having endured criticism about the aesthetics of her person. In 2008, a longitudinal study conducted by Lipworth et al, reported that women who sought breast implants are almost 3.0 times as likely to commit suicide as are women who have not sought breast implants36
.
Breast sagging Solution: Breast lift Breast lift (mastopexy) refers to cosmetic surgery designed to lift or change the shape of a person’s breasts. The surgery may involve repositioning the areola and nipple, as well as lifting the breast tissue and removing skin37
. A breast lift may be performed alone, or in
combination with placement of breast implants; when implants are used, the procedure is typically called breast augmentation. The effects of a breast lift are often reduced with time as the shape and distribution of existing breast tissue tends to be temporary, as the effects of gravity and ageing continue, causing ptosis to recur over time38
62 ❚ . A classification system has been suggested March 2015 |
prime-journal.com by Regnault and modified by numerous authors39 . The
most commonly used system is as follows: ■ Grade 1: Mild ptosis — nipple just below inframammary fold but still above lower pole of breast
■ Grade 2: Moderate ptosis — nipple further below inframammary fold but still with some lower pole tissue below nipple
A breast lift
may be performed alone, or in combination with placement of breast implants; when implants are used, the procedure is typically called breast augmentation.
■ Grade 3: Severe ptosis — nipple well below inframammary fold and no lower pole tissue below nipple; ‘Snoopy nose’ appearance.
Pseudoptosis is inferior pole ptosis with nipple at or
above inframammary fold; usually observed in postpartum breast atrophy. Women who experience multiple pregnancies
repeatedly stretch the skin envelope during engorgement while lactating. As a woman’s breasts change in size during repeated pregnancies, the size of her breasts change as her mammary glands are engorged with milk and as she gains and loses weight with each pregnancy. In addition, when milk production stops (usually as a child is weaned), the voluminous mammary glands diminish in volume, but they still add bulk and firmness to the breast. These changes in the mammary glands contribute further to sagging.
Melasma Solution: Azelaic acid (20%), hydroquinone,
tretinoin, intense pulsed light, fractional CO2 laser Melasma is the formation of irregular pigmented patches and are commonly found on the sun exposed face in the period surrounding pregnancy. It is thought they are caused by increasing levels of both estrogen and progesterone and may be seen outside pregnancy during administration of the oral contraceptive pill40
. The
hormones are thought to stimulate melanocytes resulting in increased production of the normal tanning protective chemical but why this pigment occurs in patches or even gets caught in the dermis is less well known. There appears to be a racial predisposition to the problem, especially in East Europeans and Jews41
. It is also known to occur in
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