Endoscopic Assisted Breast Augmentation With A Robotic Arm 

Many women are uncomfortable or unhappy with the appearance of their breasts because how their breasts look is important for women. Breast maturation generally ends by the age of 18. However sometimes some problems may arise in relation to the appearance of the breasts; for example breasts can be too small. No medication or cream will make them grow larger. The most efficient and healthy method when the breast size is too small is to use breast implants (silicone) to make the breasts larger. Breast implants are preferred because they do not cause any change in ultrasound and mammography images of the breast tissue and rib cage. The reason why we do not prefer fat transfer to breasts is that this method can cause problems in monitoring breast tissue.

Breast implants
Breast implants are primarily classified in two categories according to their core materials. Both types have silicone outer shells. Breast implants are categorized as cohesive gel implants and fluid implants. Cohesive gel breast implants are filled with silicone gel and fluid implants are filled with saline. None of the breast implant types cause any disorder, disease or cancer in the body. We prefer to use cohesive gel implants with the approval of the patient.

The two breast implant shapes are round and tear drop. The type of surgery to be performed for the patient also plays a role in determining the shape of the implants to be used. Depending on the silicone outer shell, textured or smooth surface implants can be used. Textured surface implants are mostly preferred for tear drop shape implants. We prefer to use smooth surface round implants with the approval of the patient. This type of implants does not rotate; and is not felt from outside since they are soft and have a similar consistency to natural breasts. When the person is in supine position breasts should look round and firm when the person is standing, the breasts assume a natural tear drop shape. There will be no visible ridges or rippling.

Implants can be placed through skin incisions within the armpit, under the breast, within the areola or through an umbilical incision.

If for example there is a complaint for sagging and loss of volume; a breast lift surgery is planned and the incision is made under the breast-within areola to place a round shape implant. Thus we create a breast lift mechanism made of muscular covering for the implant and prevent sagging.

If there is no ptosis (sagging) incisions are made within the armpit, under the breast or within areola to place the implants under the chest muscle fascia. The patient's wishes, breast structure, rib cage structure are the determining factors for the above. We prefer to place implants under chest muscle fascia through incisions within the armpit. When implants are placed under fascia, the integrity of the breast and muscle structure is not lost and this is the most preferred technique among those who exercise regularly. What makes this technique unique is that it is possible to have 20 x zoom endoscopy with a robotic arm. This technique, which facilitates entry and dissection, allows the operation to be completed with almost no bleeding. Implants are placed easily and more precisely in surgical pockets when endoscopy-assisted technique with a robotic arm is used. Since there is no bleeding, no post-operative drainage is necessary. Since the incision is away from the implant place, there is no strain on the incision and healing is not impaired. There is no risk of split opening of the incision and infection and there is almost no visible scar.

The incision is through the natural creases under the armpit so there will be no extra, visible scar, and the best part is that there will be no scar on the breast. It is a painless technique and the patient feels relatively comfortable after the operation. The only disadvantage of the method is the restriction of arm movements for 1-2 weeks.

What does the patient want?
The most important factor in deciding about the size (cc) of the implant to be used for breast augmentation before the operation is the patient herself. The patient needs to explain clearly what she expects from the operation, and what size and shape of breast she wants so that the surgeon can make necessary planning according to the patient's body type and size.

'Avsar' Mask with 3D Printing Technology
3D Avsar Mask of the post-operative breast showing the full size and shape of the breast is very important and helpful both for the physician to get prepared for the operation and for the patient to see and approve her new breasts before the operation. This is called "before-after simulation" and the first person to use this 3D print technology in this field was Dr Avsar and now this technique is known as Avsar Mask and used worldwide. In this technique first the patient's breasts are scanned to create a 3D model. And when the data is processed with a computer, the best shape and size of breasts for the patient are found. During this process it is important to hear patient's expectations and comments therefore a 3D mask is created and given to the patient for review. One of the most important elements of this technique which differentiates it from the others is that it allows the patient to see, touch and experience her new breasts. So the patient enters into the operation with a better peace of mind and minimizes the risk of an undesired outcome.

Which examinations are done before a breast augmentation surgery?
Similar to any breast surgery, patients younger than 40 must have a breast ultrasound, and patients older than 40 must have a mammogram.

How long does a breast augmentation surgery take?
A breast augmentation surgery is a short surgical operation. It takes average 45-60 minutes under general anesthesia.

How is the recovery after the surgery?
The person can go home the next day after the surgery. She can go back to work if it is a desk job after 3 days of home rest. The patient can resume an active life style after an average of 4-6 weeks.