Interview with Speaker / Dr. Peep Pree

Top surgeon Dr. Peep Pree will attend the "I AM BEAUTIFUL 2018" beauty seminar on October 13th with a presentation "Breast Plastics". We spoke with Dr. Pree about problems in the field of breast beauty surgery, and what procedure can beautician do her/his client, who has or has not undergone breast beauty surgery.

Foto: Gerda Carina
Foto: Gerda Carina

What is the biggest problem concerning breast beauty surgery? 

Today, breasts are no longer the most important issue in the field of cosmetic surgery in the world. At present, the main theme is the installation of butt implants. In this regard, the biggest problem has been the unprecedented number of deaths of patients in the transfer of the posterior fat. Fortunately, this procedure is not as widespread in Estonia as in America and South America, where much more attention being paid to the buttocks. In Estonia, more attention is still being paid to the size of the breasts.

Which gives cause for concern? 500 000 operations done by officially licensed surgeons and this number is growing. Breast cult in the world have been around since the 1950s and this continues. Even Kate-Moss-like-women with small breasts have not changed this trend. There is still a desire for big breasts and this is just very useful for beauty surgeons! In both, in the America and in Estonia, breast enlargement is the most common procedures. Like every good thing in good hands, it is a relatively small operation. I emphasize the word "relatively" here, because unexpected problems can occur in every situation. Just like life in general, this is not an entirely troublefree area.

In the field of beauty surgeries, this may be problem due to the fact that the widely requested operations are provided by different levels of clinics and differently trained professionals. The problems here arise that patients are not adequately informed of the potential concomitant risks and very often patients can easily be fooled.

Let's take a look, starting with most popular ones.

Breast enlargement surgery is the most popular, the most scandalous, the most enjoyable. For me, as a plastic surgeon, this is the easiest operation. In this with 100% knowledge, I can say that there are no lifelong breast implants. Today there are no breast prosthesis models that have been in use without modification or upgrades for a long time. All prostheses are being developed, they are trying to make them better, but since there is no comparative moment, we do not know if we are making them better or worse.

All prostheses in the human body are aging, will be worn out or broke. Silicone prosthesis crack. At the very beginning, very small microtubes will be formed, which, however, are sufficient for the silicone gel, which is used as a filler, gets out molecule by molecule.

Since 1994, the alternative filler for breast prostheses has been saline solution - 0.9% sodium chloride or physiological solution and completely harmless to the human body, unlike silicone gel, which our body can not get rid of itself when it is in the body. When the breast tissue becomes infected, the silicone moves to the lymphatic pathways of the breast and then to the lymphatic pathways and lymph nodes of the entire body, from which it is detected only during the studies. It was bad news now.

The positive thing is that the human body protects itself against a foreign body. Silicone prosthesis is a foreign body and the body protects itself from prosthesis by building a capsule around it. Such encapsulation is not felt, and no change in the shape of the breast is observed. Encapsulated silicone can be diagnosed with an ultrasound examination. The same study done for pregnant women and familiar to many women. This is a simple procedure and breast prostheses should be routinely controlled every two years. So, it's instantly to see if the breast prosthesis is healthy and does not require replacement.

In medicine, "spare parts" have been internally used in human body for a long time, and due to this, their lifespan has been prolonged: pacemakers, artificial joints, etc. Breast prosthesis is a medical device that meets the highest standards. Also, filling injections qualify for the same category - this is a microimplant.

What are the myths about breast implantation? 

The biggest misconception about installing breast prostheses is that they are life-long. There is always the possibility that there is a certain percentage of implants breakdowns. Patients should be informed of this risk, and dignified manufacturers will do this. Unfortunately, there are those manufacturers who think that marketing is more important than honesty about product. Fortunately, it is not known that products from such manufacturers are being used in Estonia.

Another misconception is that breast prosthesis retain their shape. Patients are not informed that increased breast can, over the years, stretch, slip or lose its beautiful shape. Similarly, the capsule mentioned above, may shrink around foreign body in the body over the years. The breasts become visibly rocky, so you can see that it is a foreign body. A typical example is a certain group of fitness -omen who have a very low percentage of subcutaneous and breast fat, so that nothing is covering so-called "plastic ball" well enough. Perhaps the third problem is encapsulation of breast prostheses, or hardening of the breasts.

Another problem is that silicone is not suitable for a very small percentage of women. It occurs in 1-2 cases per 100 000 operations. They will have a rejection, or more simply, a person has an allergy to silicone plastics. It is not possible to diagnose with external methods.

Now, we have come to the biggest concern with today's breast prosthesis surgery, a malignant tumor of the lymph system that occurs inside the capsule of the breast prosthesis. It should not be confused with breast cancer. Breast cancer has been studied for so long and today's knowledge may suggest that this is not a threat. There has been sufficiently of history to study breast cancer- more than 60 years - when the first prosthesis in America were laid.

Perhaps the biggest and most painful problem with the breast prosthetic world is the large-cell lymphoma BIA-LCL. Quantity of women with this diagnosis are different by the research articles, but there are has been 500-600 cases. In America around 300 cases. The closest to us is 2-3 cases in Finland. This particular cancer has not yet been detected in breast prosthesis patients in Estonia. Fortunately, there it is a surgical cure for early detection. If left untreated, cancer transplants may be transmitted through the lymphatic system and lead to death. About 10 people have died in the world, with this diagnosis. The disease does not occur immediately, the average meridian is eight years, but the range at which the disease is detected is 2-28 years after surgery.

Certainly, customers must be informed of this risk factor and the client must give a consent indicating that she/she is aware of the risks.


What would you like to say to the beauticians? 

The problem of Sickle Cell Lymphoma is important and I definitely would like to address this matter, since rising the awareness about it, is one of my missions.

The most important tip that could be passed on to a beautician is that if the beautician is in contact with a client who has breast prosthesis, then examine, whether the person has been in routine checkup every two years and if not, encourage them to do so. Often, a beautician sees a person more often than a surgeon after surgery. Many people never come to follow-up after surgery, and if the beautician recognizes the client for taking care of her appearance and encourages her to regularly go to follow-up after surgery, then this indicates that the beautician takes care of the client more than just her eyebrows and sees her as a whole.

I would also draw beautician attention to that, that beauticians should encourage their customers to care not only for their faces but also for the decollete, especially if they have breast prostheses. If you want to draw attention to your breasts, you should also take care of your décolleté. A beautician can help keep her décolleté fresh and cared for.

So far, in breast surgery is one of the most popular surgery is breast enhancement. If you want to have moderate enhancement of the breasts, there's an alternative to silicone and it's fat. The prerequisite is that the breast does not increase dramatically, and the customer has "stocks" of their own, from which fat tissue can be taken. Women who have lost a breast to cancer are generally more prudent in restoring their breast and do not expect a drastic change in breast size. For them, this is an operation paid by the Estonian Health Insurance Fund, which is good news. Postoperative breast reconstruction is available today in Estonia and does not require a thick wallet. This was a small sister of breast enlargement surgery - fat transplantation.

Breast surgery also has breast augmentation surgery, and then a small percentage of women want breast reduction surgery. The percentage of different breast operations varies from region to region. In Estonia, women usually have smaller breasts, and women of Russian nationality are more likely to have bigger ones. Breasts change a lot in the lifetime. They are affected by pregnancy, weight loss, aging. To some extent, the breast can be corrected with a very good brassiere, but this is not a permanent solution. Breast lifting and reduction is done by the Estonian Health Insurance Fund contracts at Tartu University Hospital and PERH. In a private clinic, the client must pay for everything for himself, and often people do not have this opportunity. Large breasts can cause health problems, putting the weight of the spine, muscle and spine muscles. There is also talk of headaches caused by the weight of large breasts that come from neck problems. So breast reduction surgery is often associated with health.

Breast enlargement is only a matter of improving the quality of life through the world of thinking. I'm a lifequality surgeon, I'm not a health surgeon, but mental health is also health.