What are the problems, that make men and women turn to the plastic surgeons? The answer to this question gave the Head of the Department of Plastic Surgery of Yerevan State Medical University Artavazd Sahakyan in his interview to NEWS.am Medicine.

Doctor, please tell me in what cases women seek your help? The question is about breast and mammary gland operations.

Women come to us for two different reasons. First of all, when it is a question of health: there are neoplasms or congenital abnormality - breast asymmetry; Poland syndrome, when one breast is smaller than the other, no underlying muscles.Besides, there is concomitant pathology of hand or upper limb. Also there are women, who apply to us after cancer and mastectomy, as a result of which one breast is missing, and the young woman suffers mental trauma.In fact, she is in the state of forced isolation from society, from the man she loves. Secondly, there are women after childbirth, after weightloss, as they obtain mastoptosis, i.е. their breasthangs down. In this case, they turn to us for the purpose of improving the appearance of the breasts. Our patients are also small briest holders, whom we do breast augmentation (enhancement). Often there are women with a big breast, who apply to us to reduce the breast, as they have pronounced gigantism.

If women have benign tumors - lipoma, fibroadenoma, then before the surgery they need mammographic or sonographic study.

We try to remove the tumour, so that there is no scar or they are barely noticeable. Besides that, applying different microsurgical flaps, at big breast tumours we are able to recover the defect immediately, i.е. recover its shape, especially in young women.

And how can girls and women realize that they have problems with breast? Do they feelpain, discoloration, orsomethingelse?

From 11-13 years, when the breast is growing, the girls must be very careful;to palpate during the bath or shower, and if there is any induration or something like that, they need to apply urgently to the doctor. Patients with breast cancer we send to the oncologists or we operate together, because in the initial stages of the disease it is possible to remove the breast and immediately restore it. And also I would like to mention, that the first operation on breast recovery after mastectomy on the territory of the former USSR was done by us with the use of abdominal flap. The reconstructed breast is practically no different from the natural one. It is even better, because there is no threat of cancer any more.

The woman will not be able to feed any more, the breast is restored aesthetically.It contains fat, muscles, but there is no mammary gland in it, which always carries the risk of breast cancer. Now the breast is reconstructed with the use of abdomen, the lateral surface of the chest, buttocks or the thigh of the patient.This method is used in all the developed countries worldwide, though in Armenia our colleagues oncologists are very skeptical about this issue.Among 600 cases of breast removing annually in Armenia, only 1 or 2 cases are sent to the plastic surgeon for breast reconstruction. On average, we have 5-6 patients annually, and there has not been any failure yet – in my practice there are 40 breast restored. This is a very small figure.

What type of anesthesia is used during such operations?

Taking into account the seriousness of the operation, we use endotracheal anesthesia. In cases of fibroadenoma, small breast tumors we usually use local anesthesia. Mostly such tumors are in girls 13 - 25 years old.

What for the asymmetry of the breast, it is an inherent pathology. Such women have nipple located higher that the norm, the breast is smaller than the norm or sometimes completely absent. In this case more often we apply thoracodorsal flap, i.е. we transplant the muscle from the back, and under the muscle we enclose the implant, in order to recreate the shape and the volume of the breast. For breast augmentation we use the fat from the abdomen or implants again. Nowadays it is very popular to enlarge breast with the help of different implants, but periodically there are reports on violations at productions. There was a big scandal in France: during the operations 30000 technical non-medical silicones were used.

Breast enhancement is done also with the use of women's own fat. Here it is necessary to carry out several procedures to get a great effect - it is possible to recreate the breast of Gina Lollobrigida.This method is widespread recently in Europe and worldwide.

Which technique is used during surgery?

For liposuction, for example, we use a special technique that helps «pick up» the fat. And we use a special syringe to do fat injection. Often vascularized skin-fat flap from the abdomen, buttocks and back is used. Previously the fat of belly, buttocks and back muscles wasused; recently in overweight women it is possible to take the fat from the thighs. Recreating the nipple and areola - this is a technical issue and it is rather easy to do. Made nipple is no different from the natural one.

Are these operations cheaper in Armenia than in Europe and Russia?

Yes. In Armenia they are cheaper 3-4 times. As for breast augmentation surgery, the option with the use of autologous fat is more expensive than using silicone.

How much time is needed for the patient, so that her breast after surgery looked like it was before? Is a special care needed for the operated breast?

Within two weeks, if the process goes without complications, the breast grafts. Regarding scarring, they often remain in the upper and lower parts of the breast.Scar is lifetime, but with the lapse of time it becomes less noticeable.Usually remains t-shaped scar on the breast crease and around the areola.But the results are usually very good and the patients are happy. Sometimes there is a need of repeating the plastic surgery. Of course, any woman should attend twice a yearmammology center for checking. Therefore, women who underwent surgery also visit a specialist, and there is no special care needed for their breast.

What other parts of the body do you deal with?

Besides breast we operate face, lips, eyelids, nose, ears, labia, etc., but most often we do rhinoplasty. But during the rhinoplasty it is necessary to examine the evidence of the operation, because often there are unstable patients and patients with mental disorders.

In women above 50 we often remove wrinkles, do face and necklift to rejuvenate. Very often are cases with basal cell carcinoma and squamous cell carcinoma of the face - malignant skin tumors. In advanced cases, the abovementioned tumors destroy the nose, ears, lips, jaw, and in these cases it is only with our help, that the patient can be saved.These are rather complex operations.Sometimes patients come when they do not have a nose, ear, jaw or mouth. In such cases we operate in 2-3 stages. Our goal isthe reconstruction of the organ. About abdominoplasty: it is usually done in middle-aged women after pregnancy or childbirth, to recreate the waist and improve the contours of the body, strengthen the abdominal wall, and remove excess fat.In addition to these operations girls are turning to us for intimate plastic in order to reduce the labia majora even at young ages.It is possible to improve their appearance with the help of plastic operation. When it is hyperplasia of labia, the girls feel uncomfortable.We also reduce the diameter of the vagina after childbirth.

Often our patients are women, who have excess fatty tissue on the outer surface of both hips, andfor correction of the external contours of the buttocks. This problem is common among Armenian women and people of Caucasian origin.

We restore amputated limbs, hands, feet and other body parts.

Often our patients are men who apply for hair transplant. We had three cases with transsexuals, but in Armenia there is no sex reassignment surgery. But it is not the only case we have male patients, there are different diseases of penis, also for enhancement of that organ. There are different implant often used during impotency. A hard problem is reconstruction of the penis. The hardest part during such operation is  – creation of the urethra, through which the patient can urinate. Penis can be recreated"A la carte": by its height and magnitude. If a man has saved his testicles and prostate, he may fertilize.