What is breast augmentation?
- Breast augmentation with breast implants or plastic surgery of the breasts, can increase an insufficient volume of the breast, or correct alterations of the breasts linked to pregnancies, weight changes, aging, etc...
- The wide choice of breast implants currently available, the development of techniques for breast enhancement with the possibility to use more natural positioning of breast implants now allow you to customize breast augmentations.
- Click here to view our before/after photos of breast augmentation surgery
Why have breast augmentation surgery?
- There are many women who want more volume in their breasts to better express their femininity, to enhance their appearance and fill their cleavage.
- Saline implants or silicone-filled breast implants not only allow an increase of overall breast size, but also to fulfill precisely parts of the breast to best change the volume or shape of the breasts.
- Breast change at all stages of a woman’s life, and each of these steps can lead to insufficient breast volume.
- They can only grow weakly at puberty: this is a breast hypotrophy. The SGA is mostly constitutional, but it can sometimes be due to trauma or a breast infection in childhood.
- Exceptionally there are birth defects that cause breast atrophy (no gland).
- Finally, breasts may grow asymmetrically, and not require an increase in volume to a breast.
- They may decrease in volume after one or more pregnancies. This volume decrease is usually accompanied by breast ptosis.
- They can also decrease the volume (and fall) after a major weight loss.
- Finally, consistency and volume of the breasts change over time, sometimes resulting in a decrease in breast volume often associated with ptosis.
- Each woman has her own morphology, but also her own wishes regarding the final outcome, we must consider both to obtain a satisfactory and lasting result.
- This is why accurate measurements of the chest are made during the consultation.
- Then several sizers are tried to confirm the selected volume.
- Finally, computer simulations are performed to confirm the desired shape.
- Preoperative mammography should be performed if it wasn't done in the previous three years. This will detect any abnormality preoperatively and serve as reference for future mammograms.
Breast implants increase the volume or size of the breasts. The prosthesis (or implant) - consists of a flexible silicone envelope and a filling material (silicone gel or saline) - and is placed behind the mammary gland.
Choice of prostheses:
The choice of the volume of the breast implants is done during the consultation, it is the result of an agreement between the desires of the patient and morphological constraints - analyzed by the surgeon, so that the result is as natural as possible.
- Regarding the form of breast implants, two types exist: the round implants and anatomical implants (teardrop).
- Each type comes in low profile model (flat), moderate profile (intermediate projection), high profile (high projection) and extra high profile (maximum projection).
- The choice of form and profile depends not only on the wishes of the patient, but also the quality of the tissue (gland, skin...), the existence of breast ptosis, asymmetry...
- Once the shape and volume of the breast implants have been selected, sizers tried at the office, computer simulations and visualization of similar cases of operated patients allow to exactly determine the most appropriate volume of the implant.
It is also possible in some cases to increase the volume of the chest by lipofilling, that is to say, harvesting the fat from certain body parts (hips, buttocks, thighs, knees, stomach...) .
- This fat is first "purified" and then injected into the breasts.
- It is often necessary to perform two or three sessions of lipofilling to obtain the desired volume.
- Mammographic preoperative assessment and postoperative by a trained radiologist is mandatory.
- This technique is currently counter-indicated if the risk of breast cancer exist.
Position of prostheses:
There are several ways to position the implants each with advantages and disadvantages:
The placement of the implants will be determined during the consultation, depending on your body type and the quality of your skin, but also the characteristics of your chest, the existence of ptosis, etc…
- Retroglandular - behind the mammary gland and in front of the pectoral muscle.
The "retroglandular" position is one for which the chest moves naturally after breast augmentation. In contrast, the edges of the implants are more easily palpable. This is also the position that can most impact negatively on the gland and the skin, especially in case of large volumes. Finally, it appears that capsular contracture is more common when the implants are in this position.
- Retropectoral - behind the pectoralis major muscle.
The retropectoral pocket hides better the edges of the implants. It is particularly suitable for skinny patients. However, the chest is generally less mobile, more firm, and subject to more or less significant deformation during muscle contraction (breast animation deformity).
Dual plane - the upper pole of the implant is behind the muscle and the lower pole behind the gland.
Several dual plane types exist depending on the amount of prosthesis that will be covered by the muscle. Dual plane positioning combines the advantages of the two pockets: the upper pole of the implant is covered by muscle. Now the upper breast is usually the place where the gland is the least abundant, where this gland decreases after more pregnancies, and where the skin is thinnest. In contrast, the lower pole of the implant is behind the gland and it evolves with time. This prevents deterioration of the aesthetic result sometimes observed when the implants are placed behind the muscle and the breast tissue sags in front of the implant.
- Can you breastfeed or have a normal pregnancy with breast implants?
The prostheses do not prevent breastfeeding. However, it is advisable to wait 3-6 months before considering pregnancy, so that the breast takes its final form before the volume changes related to pregnancy occur.
It is not particularly recommended to wait to have had all her pregnancies before breast augmentation, unlike breast reductions and especially breast lift.
- What are the effects of prostheses on breast sensitivity?
A decrease in nipple sensitivity and breast can occur for several weeks after surgery. This reduction is always temporary.
- Do prostheses/implants increase the risk of breast cancer?
No. All studies showed that prostheses with saline or silicone gel do not increase the risk of cancer, or the other diseases. In contrast, women with implants are generally better monitored and screening for breast cancer is often earlier! The prostheses do not prevent mammography screening and breast cancer surveillance. However, the presence of an implant can modify the capacity of x-rays to detect breast cancer.The patient who has breast implants should specify it to the radiologist .
- Are some activities risky when you have implants?
Some extreme conditions can cause rupture or deflation of the prosthesis, as a violent direct trauma (car accident ...) or direct puncture of the prosthesis. Apart from these exceptional cases, there is no particular risks, especially for air travel, scuba diving, etc…
- Should we change the prostheses regularly?
No. A prosthesis well tolerated and that does not leak should not be changed.
- Are the pre-filled silicone gel implants more dangerous?
Silicone is a molecule that is used universally and is especially well tolerated (it is present in the nipples of baby bottles, sunscreen, numerous cosmetics, in many medicines and bandages, medical and surgical instruments ...). To date, no scientific evidence has been given about a possible risk of autoimmune disease or cancer related to silicone. Therefore, pre-filled implants silicone gel were again authorized in January 2001
- Do anatomical implants rotate?
They can turn if the pocket is wider than the implant: it occurs in case of imprecise dissection of the pocket by the surgeon. They can also move easily if the envelope is smooth or micro-textured. Finally, they may sometimes move away from the pocked when a serous collection (especially due to the absence of drainage after the operation) occurs or when a phenomenon of double capsule (more frequent with highly textured implants). Thus, an accurate and appropriate choice of textured implants reduces cases of rotation of anatomic implants.
How does a breast augmentation take place?"]
Duration of the operation: 60-90 minutes
hospitalization time: 24-48 hours, hospitalization takes place on the morning of surgery fasting.
Type of anesthesia: general
- Some drugs favoring the bleeding should not be taken during the 10 days preceding the intervention: aspirin, anti-inflammatory, anti-coagulants…
- Some drugs can be taken before surgery to reduce swelling and post-operative bruising.
- In some cases, harvesting of fat is performed (hips, thighs, knees, abdomen ...) and re-injected into areas where the prosthesis might be too noticeable.
- A drainage by suction drains externalized in the armpits can reduce the risk of hematoma: these suction drains will be removed the day of the release.
What happens after the intervention?
- An uncomfortable feeling of tension is common for a few days; pain occurs, especially when the implants are placed behind the pectoralis major muscle.
- Analgesics will be given systematically to calm the pain. Pre-chest position and dual-plane positions are not painful.
- Furthermore a reduction or temporary exacerbation of areolar sensitivity can be after surgery.
- There are rarely bruising (bruises) and sometimes edema (swelling) of the breasts, giving them a bigger and more rounded appearance to their upper pole for 2 to 4 weeks. Some drugs are given to accelerate the reduction of swelling and bruises.
- The first dressing is done the day after the operation: a thin, waterproof bandage is placed over the scars, to allow for showers
- A contention bra elastic fabric that open from the front, the size and cap have been defined with the surgeon before the operation, must be worn day and night for 6 weeks.
- During this period, any intensive sport soliciting chest is prohibited. In general, avoid anything that can cause implant displacement or malposition during the first 6 weeks.
- Work and any normal activity are resumed 3-4 days after surgery, but it is best to take a week off, especially if your job is physically demanding.
The risks of breast augmentation
Complications may happen in all breast surgery:
- Hematoma or risk of postoperative infection, although this is very rare. They require appropriate treatment (drainage, antibiotics ...)
- Alterations in the sensitivity, including the nipples, can be observed, but normal sensitivity returns within 6 to 12 months.
Specific risks related to implants:
- The formation of folds or "waves": the implant, to remain flexible, is never filled under tension. Therefore, the folds of the envelope of the prosthesis may be visible under the skin. This phenomenon is most noticeable when the woman is thin and her breasts are underdeveloped. In these cases, lipofilling performed during surgery reduces the risk of visibility and palpability of the folds.
- Capsular contracture: the formation of a fibrous capsule around an implant is normal. This is a normal reaction of the body that forms a sort of fibrous membrane around any foreign body to isolate it. In some instances, and unpredictably, this membrane thickens, retracts and forms a true fibrous shell around the implant. This is the capsular contracture, which results in a loss in the flexibility (which at most can become hard), a possible deformation of the breast (which can become round) and sometimes pain. When troublesome, the shell should be treated with minor surgery. To limit the appearance of this contracture, it seems preferable to use prostheses with a rough envelope (textured) rather than prostheses with a smooth envelope.
Rupture and deflation: such an incident occurs as a result of alteration of the envelope of the prosthesis (violent trauma, manufacturing defect, age of the prosthesis, wear). For a prosthesis containing saline, partial or total deflation, fast or slow results in a return of the breast to the initial volume. It is then necessary to change the prosthesis. For a pre-filled with silicone gel prosthesis, the gel remains mostly in the capsule that surrounds the implant (intracapsular leak). The leak has then no clinical translation. However, this can promote the onset of capsular contracture. Much more rarely, the leak can be extracapsular. It can be localized and give a foreign body granuloma, or diffuse in the whole breast. The implant must then be changed.
The scars of breast augmentation surgery
There are different possible locations for scars, they depend on where the prosthesis were inserted:
- Scar in the inframammary fold
- Periareolar scar
- Axillary scar
A transareolar access (just under the nipple in the middle of the areola) also exists, but I do not use it due to the permanent loss of nipple sensitivity that can occur.
Each of these scars has advantages and disadvantages:
- The inframammary fold access is ideal when there is a strong inframammary crease and that does not have to be moved. There is no glandular scar. It enables extremely precise positioning of the implants and is therefore suitable for anatomic prostheses. However, it can leave a conspicuous scar if the patient heals poorly. A transient decrease in the sensitivity of the lower chest is observed in the weeks following the operation.
- The periareolar scar is very inconspicuous when the areola is not dark. It also allows for a very exact position of the implant and is thus also used for anatomical prosthesis. However, it may leave a visible scar when poorly positioned, if the patient does not heal well, or when the areolas are pigmented or small. A transient decrease in the areolar sensitivity is usual for a few weeks after the operation.
- The axillary approach is the only one that is located away from the breast and may be imperceptible when properly positioned. However, the dissection of the pocket is less precise, and is blind if it is not done endoscopically and / or with specific instrumentation. It does not permit , in my opinion, the positioning of anatomical implants, because it is impossible to fully control the axis of the prosthesis being very remote from the latter (in the armpit). Implant malposition also occurs more often (round or anatomical), even with very experienced surgeons, especially because there is more dead space
After breast augmentation
- The improvement is immediately visible, but the shape of the breast is not natural (breasts too projected) the first 3-4 weeks and a there is little too much volume because of edema. The final shape of the breasts can only be judged after 3 months and the final appearance of scars after 6 months.
- The durabily of the result depends of the lifespan of the implant. On average they have an estimated 10 years of lifespan (less for saline implants). The prostheses filled with cohesive silicone gel have a longer lifespan, however in France, we do not currently have the necessary perspective for the precise quantification. In all cases, the lifespan of the implant cannot be guaranteed. A woman having implants is at risk of necessitating a secondary intervention to replace the implants. However, be aware that usually a good quality implant does not have a lifetime that is theoretically limited: there is no deadline beyond which the implant change is required. Thus, in the absence of complications, the implant can be kept as long as the patient wants.
- A clinical and mammographic follow-up is necessary after the operation to check the integrity of implants.
Last update of this page : 06-06-2019