From August 1, the Ministry of Health will activate the National Register hey Regional and provincial registers of breast implantswho will receive data relating to all the additive or reconstructive breast operations performed in every area of the Italian territory.
Already present in many countries, the establishment of these registers has the purpose of allowing, in addition to a greater traceability of the plantsThe clinical monitoring of subjects undergoing implantationthe traceability of patients in case of need and the epidemiological monitoring.
Italy is the first country in the world that today has a register compulsory feeding by manufacturers and surgeons who implant or remove prostheses on the national territory.
In Italy, based on the surveillance and market surveillance activities carried out by the Directorate General of Medical Devices and Pharmaceutical Service (DGDMF), it turns out that they are about 55,000 breast implants implanted on average every year, of which the 63% for aesthetic purposes (mammoplasty augmentation) and the 37% for reconstructive purposes following mastectomy.
In fact, mammoplasty is the most requested plastic surgery procedure and accounts for about 16% of plastic surgery procedures with 1,624,281 operations performed worldwide only in 2020.
In the presence of these numbers, which appear to be continuously increasing, it becomes essential to disseminate information relating to the various aspects related to the health of women with breast and non-breast surgery.
Breast reconstruction after a mastectomy
The reconstructive operation following a mastectomy is an integral part of the treatment of breast cancer as it represents a very strong incentive for the rapid return to an active and positive life.
The professor Peter Lorenzettispecialist in Plastic, Reconstructive and Aesthetic Surgery and professor at the University of Camerino, has been collaborating for several years with theNational Association of Breast Operated Women (ANDOS) which promotes initiatives for the complete rehabilitation of women who have undergone breast surgery from a physical, psychological and social point of view. “When a mastectomy is performed, there are various reconstruction hypotheses that depend on the type of surgery performed,” explains Lorenzetti. «If a subcutaneous mastectomy is performed with sparing of the areola and nipple, it means that the skin will remain intact and the entire glandular portion will be extracted. This is an intervention possible in some types of less aggressive tumorsor in cases of preventionwhen the presence of is found in women genes indicating a high incidence of breast or ovarian cancer. In these cases, a mastectomy is performed and a breast implant is inserted. Other times the reconstruction in mastectomised patients does not include the insertion of prostheses but may involve the use of other types of flaps».
The use of prostheses in reconstruction is therefore minor compared to cosmetic surgery, but it should be remembered that «no comparison should be made between what is the aesthetic quality of the result obtained from a breast augmentation and what is obtained from breast reconstruction surgery. Because the soft look of breast tissue isn’t replaceable or repairable in the same way.”
Reduction mammaplasty: when it is “necessary” to make the breast smaller
Instead we talk about reduction mammaplasty when intervening on volume of a very large breastup to those that are called gigantomastia, giant breasts on which a reduction of the breast tissue takes place. Operations often necessary to prevent the development of specific disorders and pathologies.
Professor Lorenzetti, is the reduction intervention linked to a health issue?
«A true reduction intervention is always determined by a health problem. When there is an excessive increase in breast tissue, weight affects the spineyes they have shoulder pains it’s a Continuous and constant bowing of the upper spine. It’s as if a person were to put a 2-pound bag around their neck and walk around their entire lives with it hanging around their neck! In the long run, it is clear that will result in a slow, continuous and inexorable bowing of the upper part of the spine. Reductive mammoplasty, in this case, represents a functional intervention, of necessity».
Can it also be performed through the National Health Service?
«Yes: despite the long waiting lists, it can be performed in public facilities and it is also an operation which, in the case of insured patients, is reimbursed. In particular, however, it can only be performed by the National Health Service if it is a gigantomastia (the diagnosis in this sense is made by a specialist, ed); however, there remains a world of slightly larger breasts that experience problems, but which do not fall within the coverage of the Health System.
Can we get an idea of the costs of breast augmentation and/or reduction?
«Both in the case of augmentation and reduction mammoplasty, the operation cannot cost less than 6 thousand euros and no more than 10-12 thousand. Below this cost, in my opinion, it is not possible to have maximum safety and quality».
What is meant by “security”?
«By safety I mean an operation performed in a structure with an operating room up to standard, anesthesia and nursing staff before, during and after the operation. Finally, hospitalization and appropriate drugs ».
Breast augmentation: the “rules” of breast implants
When you are about to have a breast implant implanted, who decides the size?
«The surgeon decides them, explaining his motivations to the patient. The size of the prosthesis must in fact be chosen in a very precise manner, verifying how wide the implant base of the breast is. If it is 10 cm, the prosthesis cannot be wider, because if you insert a prosthesis with a width greater than 10 cm, you will not have lateral and medial coverage and you will see the edges.
Do dentures need to be replaced after a certain number of years?
«There is no certainty about the effective duration of the prosthesis. I personally performed operations thirty years ago on patients who still have the same today. The latest generation ones, however, are technologically superior and more advanced than those of 30 years ago. On paper they should last a long time, even if nobody can say for sure».
How do you know if it’s “all right”?
“To be sure, you can undergo an ultrasound examination and, after the age of 40, a mammogram with which to check the integrity of the prosthesis”.
Doesn’t the presence of prostheses “obstruct” in some way the control examinations related to prevention?
« Far from it. Exams such asultrasound and the mammography can be performed normally e they are even more necessary in patients who have prostheses precisely because when the state of the mammary gland is checked, the integrity of the prosthesis can also be checked. Only in doubtful cases is resorted to an even more thorough examination, which is the MRI».
In the case of breastfeeding, are there any contraindications?
«There is no problem of any kind: even with breast implants you can breastfeed normally and well».
Why is it important to have a National Register of Breast Prosthetic Implants?
“Because you can have control over how many prostheses are implanted, which ones are removed and for what reasons they are removed, so as to be able to exclude very, very rare associated pathologies that appear every now and then”.
Communicating prosthesis implants to the Registry becomes an obligation for the doctor but also for the manufacturer…
«One more guarantee: many times these prostheses are implanted in unauthorized environments, studios or clinics. Compulsory reporting by the company can help control these interventions where health safety is at risk.
Source: Vanity Fair
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