Cosmetic breast surgery
Breast augmentation with implants
Hypoplasia of the breasts can be corrected thanks to the use of breast implants.
Hypotrophy or hypoplasia of the breasts is a term used for having breasts which are too small in relation to the overall body shape. It may be congenital (from birth) or as a result of a pregnancy, weight loss or a hormonal imbalance. Hypoplasia may be isolated or associated with breast sag (breast ptosis). Hypoplasia of the breasts is often resented by the patient who sees this as a violation of her femininity. This is generally followed by a decline in self-esteem in social relationships, love and sex life. Breast augmentation by surgically inserting implants restores the breast volume desired by the patient. To some extent, breast augmentation can correct sagging breasts in moderate cases.
Principle of the procedure
The procedure is performed under general anesthesia and takes between 1 and 2 hours. The hospital stay is 24 hours. The surgeon places the implant on each breast either directly under the gland (subglandular or chest position) or under the pectoralis muscle (submuscularly or submuscular). In some cases, the implant position is both submuscular at the neckline and sub-glandular on the underside of the breast (dual-plane). The scar may be located either in the armpit (axillary incision) or around the lower half of the areola (areolar incision) under the breast (inframammary route). For the treatment of ptosis the associated scars are more serious and variable in appearance depending on the degree of ptosis correction.
The range of possibilities (implant position in front or behind the muscle, incision placement, choice of volume and shape of the implant) is such that the surgeon may adapt his technique to suit each patient, thus performing a "tailor-made" breast augmentation.
The implants currently used are filled with either a silicone gel (preferably) or saline solution (salt water). The casing, in turn, is either covered with silicone or polyurethane foam.
The pre-filled silicone gel implants provide a more natural appearance and consistency and have a longer lifespan. Priority is almost always given to this type of implant. The saline-filled implants may be the preferred choice of patients (because of an unjustified fear of the silicone), however the result is less natural, folds or visible waves are frequent and their abrupt deflation causes an immediate breast sagging effect.
Like conventional breast implants, the polyurethane prosthesis is filled with certified silicone gel. However, their casing is made of polyurethane foam and not silicone. This type of implant has been used for 40 years and has the CE (European standard) and FDA approval (Food and Drug Administration label for use in the U.S. market).
Breast implants with a polyurethane coating have some distinctive features:
- The existence of a "Velcro" effect can almost eliminate the risk of secondary displacement or rotation found with anatomically shaped implants. This "velcro" effect also more effectively corrects moderate breast ptosis and / or prevents its occurrence.
- The capsule risk, usually feared with conventional implants with a silicone casing, is extremely low with polyurethane foam covered implants. Nevertheless, progress in recent years in the design of breast implants has significantly reduced the rate of capsule occurrences, even with coated silicone implants.
- After the polyurethane foam covered breast implants are placed, the breasts will be firmer for the first year, and then they will become more flexible than breasts with traditional implants.
- The cost of polyurethane implants is a little higher but the lifetime of those implants also (because of the lack of capsular contracture) and the aesthetic result is frequently better. Two manufacturers currently market this type of implant : Silimed (Brazil) and Polytech Health Aesthetic (Germany).
The shape of the implant is either round or anatomical. Anatomical implants fill the lower part of the breast well and offer a more natural result. As for the round implants, they are best for the neckline ; although the result is less natural, round implants can better suit to young patients avid to obtain a more "provocating" breast.
The volume of the implants is determined with the advice of the surgeon who takes in consideration the desire but also the anatomy of the patient.
The after-effects can be uncomfortable for the first few days, especially when the implants are large and placed sub muscularly (feeling of painful pressure). If the implants are placed sub glandularly, there is almost no pain. In all cases, analgesic treatment adapted to the intensity of the pain will be prescribed.
Edema (swelling), ecchymosis (bruises) and a hindrance to elevate the arms are frequent in the early stages. A drain is not necessary. The dressings are semipermeable, therefore showers are allowed. Special adhesive dressings will need to be applied to the scars for 2-3 months to improve their appearance.
Returning to work is possible between 5-10 days after surgery depending on the job.
The patient can resume sporting activities after 1 or 2 months.
Complete healing is achieved within 2 to 3 weeks. The stitches are dissolvable and are concealed.
A support bra must be worn 24 hours a day for 1 month.
Risk of complications
As with anysurgery, a number of complications can occur. But the likelihood of these complications is reduced in the hands of a qualified plastic surgeon and in the presence of a competent anesthetist. The patient’s compliance to instructions given by the surgeon is also essential and include :
- stopping smoking 1 month before and after the procedure (reduction of all risks);
- not taking aspirin for 10 days before and after the procedure (reduced risk of hematoma).
Apart from the traditional complications linked with surgical procedures (hematoma, infection, healing problems,...), some complications are more specific to breast implants :
- The formation of scar tissue "capsules" (adhesive capsulitis) is due to a normal reaction of the body against a foreign body. This reaction typically results in the formation of a thin flexible membrane around the implant. Sometimes this reaction is more intense and the membrane becomes thicker. The breast becomes firmer and sometimes even painful. The occurrence of these capsules is unpredictable and can lead to a new procedure to remove or break up the scar tissue (capsulotomy or capsulectomy). Fortunately, advances in the field of implants and surgical techniques have led to a decrease in the rate of capsule creation and their intensity.
- The implants have a limited lifespan. The membrane wears out and eventually become porous or breaks up. Violent trauma can also cause a rupture. A rupture can go unnoticed or otherwise cause other symptoms (formation of a capsule, breast deformity). Implant rupture is not serious, but must result in changing both implants.
Health Insurance coverage
As this procedure is considered purely for aesthetic purposes, no coverage is provided by health insurance. In some rare cases such as a total absence of breast (breast agenesis), a partial reimbursement of the cost of the procedure may be considered upon prior agreement.
Frequently Asked Questions
At what age can breast implants be inserted ?
In principle, the patient must be at least 18 years old, in order to understand the implications of such a procedure. But in the case of malformed breasts (tuberous breasts, Poland syndrome) or in patients with severe stunting or the absence of breasts (mammary agenesis), the procedure may be considered at the end of puberty.
Do breast implants prevent pregnancy or breastfeeding ?
With breast implants, pregnancy and breastfeeding are possible and are not dangerous to the mother or the child.
What is the lifespan of implants ?
The most recent implants are strong and durable. In the absence of signs of wear (appearance of a capsule, change of the breast shape),it is not necessary to change the implants routinely, even after 10 years. However, monitoring by your surgeon is recommended (every 2 to 3 years before 10 years, every year after 10 years).
Polyurethane implants have a longer lifespan thanks to the lower risk of capsular contracture.
Breast implants and autoimmune diseases ?
It has been scientifically established that that breast implants do not increase the rate of autoimmune diseases.
Breast implants and breast cancer ?
The risk of breast cancer is unchanged in the presence of breast implants. However, mammography breast monitoring can be made more difficult by the presence of breast implants, especially those in the pre-muscular position (directly under the gland). In some cases, additional monitoring techniques may be required (MRI, ultrasound).
Breast implants or fat injections ?
Fat injections (lipomodelage or lipofilling) in the breast may be a substitute for breast augmentation with implants, or complement it by making it more natural.
Lipofilling of the breast is not possible in all patients.
Implant Benefits :
- one initial procedure
- larger augmentation possible
- possible even if there is no fat available
Benefits of fat :
- as natural as native breast (visual aspect and touch)
- life-long results
- nearly non-existent scars
- associated with liposuction of excess fat (silhouette reshaping)
Implant disadvantages :
- risk of complications specific to implant (rupture, capsules, infections, rotation or malposition)
Disadvantages of fat :
- 1-3 initial procedures
- need enough fat reserves from the patient
- variations in results because of strong weight change
Author: Dr. Christophe Laveaux
Specialist in aesthetic surgery - Antibes
Reproductions, even partial, of the texts are allowed on the express condition cite the author (Dr. Christophe Laveaux) with a direct link to the article mentioned.