Seno alto e sodo: i consigli del chirurgo plastico 
Breast high and hard: the tips of the plastic surgeon
Lift it and change its shape: a comprehensive review of traditional techniques and on the 'latest news.
Pregnancy, weight loss, aging, but also simply due to the constitutional problem skin types. The relaxation of the breast is a problem shared by women of all ages, and is not tied, as many believe, at a high volume of the breast. Even women with small breasts are very likely to have a breast that failure, in medical terms, is called ptosis, and that to be correct, it requires a surgical procedure called mastopexy.
The mastopexy is an operation whose technique has evolved considerably in recent anni. Un tempo le incisioni erano consistenti e lasciavano cicatrici molto visibili; oggi le incisioni sono sottili e confinate in alcuni punti del seno.
Stabilire il grado di cedimento
Come calcolare il grado di ptosi mammaria? Molte donne ricorrono alla “prova della matita”, inseriscono cioè una matita nel solco sottomammario: se questa cade vuol dire che il seno è alto e sodo, se rimane al suo posto vuol dire che il seno è rilassato. In realtà, per calcolare esattamente il grado di ptosi si misura la distanza tra il solco sottomammario e la parte finale del seno.
Se la distanza va da 1 a 2 centimetri la ptosi è lieve ; se va dai 2 ai 4 centimetri la ptosi è media ; se supera i 4 centimetri (fino a 10 centimetri) è elevata . A seconda del tipo di cedimento mammario il chirurgo stabilisce il tipo di incisione da praticare.
Ptosi lieve : fino a 2 centimetri
Per i lievi cedimenti mammari si esegue una incisione attorno all’ areola del capezzolo e attraverso questa si riporta la ghiandola mammaria verso l’alto, ancorandola con speciali punti di sutura interni al muscolo grande pettorale.
Bisogna poi prestare particolare attenzione alle strutture esterne, che, per non lasciare cicatrici grinzose, devono essere fatte bene, in modo che la cute non sia troppo tesa.
Un inconveniente di questo tipo di incisione è che non si riesce a rendere il seno conico e ben proiettato in avanti. Ciò va detto in anticipo alla donna, in modo che possa eventualmente decidere per una incisione periareolare (attorno all’areola), accompagnata da un’incisione verticale.
Ptosi media : fino a 4 centimetri
Per i cedimenti di 3-4 centimetri si ricorre a un incisione attorno all’areola del capezzolo e a un piccolo taglio verticale che va dall’areola del capezzolo fino al solco sottomammario .
Il chirurgo isola poi la porzione di tessuto mammario (grasso and mammary gland), which fell in the lower part of the breast, and extend vertically anchored to the pectoralis major muscle with special stitches. The aim is to fill the upper part of the breast that is empty, making the breast high and firm.
flaps of excess skin is then removed and the particular suture (the skin is reunited in a vertical direction and around the areola of the nipple) can make a good projection of the nipple.
L ' areola is usually redefined (if the outlines are blurred) or reduced (if it is too large). An enlargement of the contours of the nipple areola can be caused by traction of the skin to which the seno è soggetto nel periodo della gravidanza o in occasione di un aumento di peso.
Ptosi elevata : più di 4 centimetri
Nei casi più seri il cedimento del seno, quando cioè la ptosi supera i 4 centimetri, è consigliato ricorrere a una incisione a “L”. Questa comprende: la zona attorno all’areola del capezzolo, un piccolo taglio in senso verticale che va dall’areola del capezzolo fino al solco sottomammario, e uno lungo il lato del solco sottomammario verso l’ascella (la piega che separa la mammella dal torace).
Dopo aver praticato l’anestesia generale si procede alle incisioni, quindi al sollevamento e all’ancoraggio mammary gland to the pectoralis major muscle. After removing the excess skin of the areola of the nipple is repositioned, thanks to a special reunion of the skin (the sutures should not over stretch the skin), is projected upward.
If the breast, in addition to be falling, it is also abundant, you can also remove a portion of breast tissue (gland and fat), doing so too is an understatement. When 
removes a portion of the gland, the surgeon is of course careful not to jeopardize the operation of milk ducts (the channels that allow the passage of breastmilk), so it can remain intact the possibility breastfeeding. With this technique, the breast can be alleviated by 300 to 900 grams.
Often in these interventions also changes the size of the areola (brown or areas surrounding the nipple): women generally prefer to reduce it.
The cosmetic surgery can last from 2 to 4 hours, admission to nursing home is 24 hours.
Convalescence, examinations and the costs to do ptime
Immediately after surgery the scars are reddish and clear, but within a few weeks to settle. For at least a month after the operation is suggested to wear a bra restraining (those to do sports are ideal), not to make big efforts or sports activities.
The breast assumes its final appearance after about 3 months after surgery, and scars disappear almost completely within 6-10 months (depending on the ability to scarring of the skin).
Only 10 percent of the cases the scar can leave small folds or cords, you can not correct a minor operation under local anesthesia, to do at least 6 months after the first.
exams to do before undergoing surgery are : blood analysis and urinalysis, electrocardiogram.
Evaluations the surgeon
During the first encounter with the woman the specialist evaluates the following factors:
1. The reasons that led the person to want to change its appearance. It 'important to be aware that a slight relaxation of the breast is completely natural and, if normal, not ugly.
2. The age of the woman . For we must remember that, before being subjected to any
surgery, the breast must have completed its development.
3. The size of the breast . If the breast is large, the surgeon often, in addition to "lift"
should also reduce the amount of breast tissue (gland and fat) during the same surgical procedure. In practice, the standard mastopexy is added to the breast reduction.
4. The shape of the breast. It must be said at this point that a beautiful bosom must correspond to specific characteristics
, so it should be conical in shape, her nipples should "look" slightly outward and forward, and the two breasts should not be too close should be of the same volume and the same height.
5. The measures breast . Breast ideal (regardless of the size and shape) should have
between the nipple and areola of the inframammary fold a distance of about 6 cm.
from the apex to the base of the nipple at the top of the breast should be a distance of about 10 cm
.
The news: the natural bra
Normally if your breasts do not "take" you wear a bra. Nothing could be more obvious, but in this case we are talking about a completely new context of 'appearance: a subcutaneous internal bra. This is not the traditional graft of synthetic material (implants), but an all natural breast support , consisting of the same fabric as the woman who si sottopone all’intervento chirurgico.
I vantaggi della nuova “protesi naturale” sono: la durata permanente e la inalterabilità nel tempo; la dimensione minima delle cicatrici; il fatto che al tatto non si avverta la sua presenza.
La metodica è stata ideata dal chirurgo padovano Masino Scutari . In pratica, si esegue una piccola incisione intorno all’areola del capezzolo, si asporta una piccola porzione di fascia muscolare che avvolge i muscoli pettorali, la si dispone a “coppa” sotto la mammella e se ne ancorano i margini destro e sinistro al muscolo pettorale.
Il nuovo autotrapianto non provoca rigetto in quanto il tessuto della is well tolerated by the patient herself. In contrast to artificial prostheses (similar techniques involving the use of silicone liners or networks in materials that were extraneous to the body) the muscles do not develop the so-called "fibrous capsule " which over time can give the breast an unnatural shape and consistency is hard to touch.
The impossibility of the formation of fibrous capsule is possible due to the fact that the two tissues that come into direct contact, or the mammary gland and the fascia of the pectoral muscle are integrated gradually to form a single body.
The new technique is suitable not only cases of ptosis (falling), but also for interventions to reduce breast . The only limit: given the limited extent of the engraving, for a very large and sagging breasts is necessary to use traditional techniques that require larger incisions (vertical L-shaped to inverted "T").
must also consider the type of breast muscle of women.
The fascia should be wide and thick in fact fairly consistent, in order to ensure effective support. These parameters are checked by the surgeon during the first medical examination.
The operation step by step
1 The surgeon draws the outline of the incisions on the skin that will do. You draw a smaller circle along the edge of the areola of the nipple, and a larger circle at a variable distance from the first. The first incision is used to define the areola of the nipple, the second serves as the access route to the subcutaneous tissue to perform the surgery, and limit the portion of the excess skin to be removed (ie the one between the two concentric circles).
2 Depending on the needs of women, we practice together with a local anesthesia or sedation anesthesia.
3 Starting from the incision periareolar is dissected in the subcutaneous tissue of the breast high (up to the collarbone), down (to the inframammary fold) and laterally (up to the armpit).
4 is free then the strip of muscle "big chest" from the top half of the mammary gland to the clavicle. He then pulls out a "plate" of connective tissue (which acts as a strong and flexible support) that covers the surface of the muscle. The rectangle of fascia taken has a base equal to the semicircle of the breast height equal to the distance between the nipple and the inframammary fold. To get an idea of \u200b\u200bthis natural support you can imagine a bra "A balcony".
5 At this point, then goes on to place the support beams under the breast and in setting its outer edges, with special points, the muscle "pectoralis major." It then goes to the external.
After the operation
In the days immediately after the operation is taking antibiotics. 2 weeks after you remove the bandages restraints (these are special patches analgesics). For the three months following also are advised to wear a bra restraining.
In the event that the scars remain slightly shriveled around the areola del capezzolo, si può procedere, dopo alcuni mesi, con un piccolo intervento di correzione della cicatrice in anestesia locale.
AUTORE :Dr Masino SCUTARI MD chirurgia plastica ricostruttiva PADOVA www.chirurgoesteticoonline.com
Oltre ai diversi interventi chirurgici per l'aumento del seno, sempre più donne stanno scoprendo sistemi e tecniche di tipo naturale che promettono bene. Tra i piu usati in italia troviamo il programma per l'ingrandimento e tonificazione
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pectoral muscles in the long run will suffer skin loses its natural elasticity. In addition, the ligaments that hold the breast is anchored to the skin stretched over causing an irreversible breast ptosis. 
