BREAST AUGMENTATION WITH IMPLANTS
Breast augmentation is the most performed cosmetic surgery in the world in order to increase breast volume by placing breast implants inside breast. Breast enlargement is for all women with mammary hypothrophy (insufficient development of the mammary gland).
This lack of development from puberty may be the result of a loss of volume after pregnancies, breastfeeding or a weight loss.
The psychological impact is a loss of femininity, lack of self confidence, discomfort in clothing causing wearing bra “cheating.”
Women used to coming to us after a long reflection, never on a “whim”.
Although they all have the same problem, they are all different and our approach must be adapted to each one.
Our duty is to answer during the consultations to all questions .?
What type of implants ?
In front of or behind the muscle?
From what incision?
Return home the same day ?
Do we have to change them ?
And especially : ” Does it hurt Doctor? “
HOW TO CHOOSE THE WAY FIRST OF BREAST ENLARGEMENT (HOW TO CHOOSE THE SCAR)?
We can define three criteria:
1. The first concerns the patient, it is the discretion of the scar, it must be hidden and of good quality.
2. The second criterion concerns the surgeon is the visual comfort to create the “pocket” that will accommodate the implant.
3. The third concerns both the patient and the surgeon, it’s the orifice through which we slide the implant in a suitable size in order not to traumatize and take the risk of subsequent rupture.
Dozens of ways first were suggested to achieve breast enlargements but few bring together all the advantages.
Personally, I do not use the axillary way even though the scar is very inconspicuous, I blame poor visibility to achieve the detachment.
The hemi-areolar way through his position at the center offers the best visibility but should not be proposed when the areola has a small size. In addition, there is a rare possibility of retraction of the scar that can cause the development of a small notch.
The sub mammary way is my favourite practice. Inconspicuous, covered by the breast it allows a dissection without touching the mammary gland. The implant is never traumatized when it is slidden by this method.
The possible incisions to place a breast implant:
A- lower hemi-areolar incision
B- sub-mammary incision
IN FRONT OF OR BEHIND THE PECTORAL MUSCLE ? (THE CHOICE OF THE POSITION OF THE IMPLANT)
This is often the first question from our patients. This proves that they have already found out regarding operative techniques! We have the choice between three anatomical positions of the implants :
-the first is in front of the pectoral muscle. This procedure is faster, less painful for the patient because it has no contact with muscle structure. The prothesis is under the skin and the gland and the risk of this position is the visibility of the upper edge of the implant that gives the breast a ball shape.
-The second is strictly retro muscle . The implant is totally enclosed under the muscles of the thorax (pectoral muscle, serratus anterior, rectus). The disadvantage of this position is the appearance in some patients of a double fold in the lower pole of the breast which draws the limit between the gland and the lower edge of the prosthesis.
-the third is the DUAL PLANE or double plane .The prosthesis is under the pectoral muscle in its upper portion and behind the gland in its lower and external portion. The result is very natural, the upper edge of the implant is hidden by the muscle and the gland down perfectly fit the prosthesis. This technique is particularly adapted to correct the breasts with a little sagging skin often occurs after pregnancy.
The implant is in front of or behind ?
A- The implant is in front of the pectoral muscle
B-The implant is behind the muscle using the technique of the double plane or DUAL PLANE.
PHYSIOLOGIC SALINE OR SILICONE GEL (CHOICE OF THE IMPLANTS)
Breast implants today are composed of a shell and a filler. The envelope is either composed of a silicone polymer, an inert product and harmless to the body or polyurethane. This membrane can be smooth or more often rough.
For the content, there is a choice between physiologic saline ( salted water) and silicone gel.
The advantages of physiologic saline implants
The content of the implant is harmless in case of rupture of the shell. The serum is quickly absorbed into the body.
The implant is inflated during its position, so the volume can be adjusted in order to correct a breast asymmetry.
The implant is slidden into the pocket before being inflated consequently the scar will be smaller.
The drawbacks of physiologic saline implants
Physiologic saline by its consistence gives a result less natural to the touch, especially regarding slim patients or with thin skin.
A sensation of folds is often noticeable at the outer edge of the breast.
The main drawback is the possible total deflation of the breast in case of rupture of the implant.
In conclusion, the lack of natural and the risk of a sudden loss of volume, nowadays, dissuade us of using implants in saline.
They may nevertheless keep an indication in patients whose pre-existing breast is wide (the sensation is hidden by the breast) and in patients who are reluctant to change implants every 10 year.
The advantages of silicone gel implants.
The flexibility of silicone implants is very close to that of a natural breast. The natural is optimal and the implant is often indistinguishable. Silicone gel is the ideal choice for small breasts and slim patients, with thin skin.
The sensation of folds is greatly reduced by the use of cohesive gels.
The volume of the implant is fully stable over time.
The drawbacks of silicone gel implants.
The only drawback of this gel is the risk of movement in case of rupture of the implant. This risk is very low especially as the cohesiveness of modern gels prevents from the spread in case of rupture, nevertheless requires monitoring over time regarding the sealing of the membrane .We advise our patients to meet us every two year with an ultrasound echography.
ROUND OR ANATOMICAL BREAST IMPLANT ? ( THE CHOICE OF THE SHAPE OF THE IMPLANT)
SHAPES OF THE BREAST IMPLANTS
A- ROUND IMPLANT: maximum projection in the centre
B-ANATOMICAL IMPLANT: maximum projection in the lower part
These prostheses are most commonly used. They are always placed below the pectoral muscle.Their volume is proportional to their diameter, which requires a broad basis for their utilisation. They exist in different projections.
These are prostheses whose shape looks like a drop. Unlike round implants the maximum of projection isn’t located ( noticeable) in the middle but in the lower portion of the prosthesis.
We can define two parts in these implants, a lower basis which provides the volume and an upper part which become thinner to be inconspicuous.
The surgeon will have a significant range of prostheses and will be classified according their width, height and their projection (height or thickness of the implant). A specific surgical training is required.
The development of anatomical implants is a real progress in breast enhancement surgery. This allows us to get more natural results in case of sagging skin or when the distance between the areola and the sub-mammary crease is short.
BEFORE THE OPERATION
Breast enhancement can not be considered without several preoperative consultations.
The first consultation, allows us to understand your request and depending on the clinical examination of your breast, we’ll outline the main points of the therapeutic project. It allows us to give you the most complete information on the principles and constraints of the intervention.
After the meeting, a special information sheet will be given, as well as a detailed estimate.
A radiological assessment (mammography and / or ultrasound) is mandatory before any plastic surgery or cosmetic surgery of the breasts.
The 2nd consultation, allows to review the explanation, to read carefully the radiological assessment, and determine together what will be the volume of the implant. We work on a photographic database (before and after pictures) and a simulation by dragging “extras” of various sizes in your bra. Natural is always preferred.
Three days before the surgery, antiseptic showers, and axillary hair removal will be prescribed.
AFTER THE OPERATION OF BREAST ENLARGEMENT
Breast augmentation by placing implants can be painful in the hours following the intervention. That’s why we always advise a hospital overnight.
In this case, pain medication of an adequate strength to dull the pain is prescribed for several days
The drain placed during the procedure is removed the next day out.
At the end of the procedure an elastic bra-like bandage will be put in place.
Local cares are necessary and the dressings prescribed allow showers. If bruises are rare a breast oedema is not uncommon but will fade within 2 to 3 weeks after the operation.
The resumption of business activities is possible 7 days, except for a sedentary job but 15 days are required for physical work.
The resumption of sporting activities will not happen before six weeks when round implants have been placed. A period of 8 weeks is better when we have recourse to anatomical implants to prevent from risks of rotation.
Postoperative risks and complications of breast enhancement with implants.
Postoperative follow up of this intervention are most often very simple. Nevertheless, some complications are possible. They will be written in the information sheet Breast implants and breast hypoplasia (hypoplasty)
Advice to increase comfort and prevent from complications are offered as postoperative card (which you can find by clicking on the link)
plastic surgeon near Geneva
123RF.com Leonello Calvetti Piotr Marcinski