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DEFINITION, AIMS AND PRINCIPLES
Mammary hypoplasia is defined as a breast volume which is insufficiently developed in proportion to the patient’s morphology. It can be a pre-existing condition (small breasts from puberty) or appear later, after substantial weight-loss, a pregnancy followed by breast-feeding, or hormonal problems.
It can occur alone or be associated with ptosis that is sagging of the breasts and skin stretching and a lowered areola.
This insufficient breast volume is often a source of physical and psychological distress for the patient who feels she lacks femininity, with also a lack of self confidence and poor self-image which can lead to an inferiority complex. Breast augmentation with implants is the solution to these problems.
The procedure can be carried out at any age above 18, below this age the procedure is not advisable.
This is a purely cosmetic procedure and cannot be reimbursed by health insurance. Only rare cases of total absence of breast formation (mammary agenesis) can be partly reimbursed after prior permission.
The implants used at present are composed of a shell and a filler. The shell is always made of silicone rubber, but the filler can vary. The implant is termed ‘pre-filled’ when the filler was inserted during the manufacturing process (gel and/or saline solution). The different volumes are therefore fixed by the manufacturer. Implants filled with saline solution are filled by the surgeon who can adapt them to the patient to a certain extent during the procedure.
NEW GENERATION PRE-FILLED SILICONE GEL IMPLANTS
The great majority of implants used in France and elsewhere in the world are pre-filled silicone gel implants.
These implants, which have now been used for over 40 years have been proved to be safe and to be the best product for this procedure since they are very close to the consistency of a normal breast. There has been great progress in this domain since the late 1990’s; any weak points have been eliminated. At present all implants available have been certified as safe by the EU and FDA in USA.
Cohesive silicone gel which has a thicker consistency will not spread in case of rupture of the envelope.
Added to this increased reliability is the fact that this new generation of silicone implants exists in different shapes, making it possible to adapt them to individual needs. Thus we find, in addition to the classic round implants, anatomic ‘teardrop’ shapes which can be higher, wider or more pointed.
This diversity of shape, associated with a range of volumes means that the choice of implant can be tailored to the figure and the expectations of the patient.
BEFORE THE PROCEDURE
After discussion between the patient and the physician who will have clearly explained the different options the best choice for each case is agreed on during the preoperative consultation taking into account all the relevant parameters ( height, weight, pregnancies, breast feeding, body shape, body fat, size of the existing breasts, muscle tone..).
After studying these parameters and anatomic features of the patient, the surgeon will determine the plan for the operation. This will also take into account his preferred technique and the expectations of the patient and the positioning of the scars, the type and size of implants, and the position of the implants above or below the muscle.
A thorough preoperative examination with blood tests will be carried out as prescribed.
An anesthesiologist will see you in consultation at the latest 48 hours before the operation. In addition to the usual preoperative tests it can be helpful to use medical imagery, (mammography, and echography).
No aspirin-based medication should be taken during the 10 days preceding the operation.
You will probably be asked not to eat or drink anything for six hours before the operation.
HOSPITAL STAY AND TYPE OF ANESTHESIA
Type of anesthesia
This is usually classic general anesthesia; you will sleep throughout the operation. Rarely ‘twilight’ anesthesia is used (local anesthesia with intravenous sedation); this can be discussed with the surgeon and anesthesiologist.
Hospital stay
One day in hospital is usually sufficient. The patient arrives in the morning (or the previous afternoon) and leaves the next day.
However the procedure can be carried out in an ambulatory setting, the patient leaves after some hours of medical supervision.
THE PROCEDURE
Each surgeon has adopted his or her own specific technique, which he or she adapts in order to obtain the best results in each case.
We can however give some basic points:
The incisions
- Peri-areolar approach (around the areola) the incision is either below the circumference of the nipple or horizontal to the nipple.
- Axillary approach
The implant is inserted through a small incision situated in the armpit, or in
- The inframammary approach
The incision is in the inframammary fold.
These incisions correspond of course to the position of future scars which will thus be hidden in natural folds or lines.
Additional surgery
In case of ptosis (sagging breasts, a lowered areola), it is appropriate to associate a breast lift (mastoplexy); this implies additional larger scars (around the nipple, or in a vertical position).
Dressings and drains
A drain may be left in place for a one day after the procedure in order to evacuate any blood or liquid which may form around the implant.
At the end of the procedure an elastic bra-like bandage is put in place.
The length of the procedure varies with each surgeon and of course lasts longer with additional surgery but in general the operation lasts one to two and a half hours.
AFTER THE OPERATION
There can be pain for the first few days after the procedure, particularly when the implant is large and/or placed behind the muscle. In this case pain medication of the strength necessary to dull the pain, is prescribed for several days.
Even if there is no pain there will be a strong sensation of tightness.
Swelling and bruising of the breasts and difficulty in rising the arms are frequent immediately after surgery.
The original dressing is removed a few days after the procedure and is replaced by a lighter dressing, and then an elasticized bra can be recommended to be worn night and day for a few weeks.
If the stitches are non-absorbable they will be removed several days after surgery.
5 to 10 days convalescence is necessary before returning to work.
Patients are advised to wait for one to two months before practicing any sports.
THE RESULT
This can be truly seen from one to three months after surgery, the time necessary for the breasts to become softer and for the implants to settle. The procedure will have improved not only the volume but the shape of the breasts. The scars are usually hardly visible. The added breast volume affects the figure in general; this means that more elegant clothes can be worn.
Added to this aesthetic improvement there is usually a positive psychological effect due to enhanced femininity.
Duration of results
The implants have their own life-span, but without taking this into account the result of this procedure concerning volume, is long-lasting. The exception can be when a patient puts on a lot of weight. It is true however the shape and firmness of the ‘enlarged’ breasts will suffer, like ordinary breasts, from the effects of aging and gravity which cause drooping, more or less rapidly according to age and support quality of the skin, and also the volume of the implants.
DISAPPOINTING RESULTS
The following problems can occur occasionally:
- Stiffness with insufficient softness and mobility (especially with larger implants).
- The implant can be detected when touched especially when the thickness above the implant is reduced (skin + fat + gland) and when the implant is large.
In cases where the patient is not satisfied with the result certain problems can be corrected by revision surgery after a few months.
FREQUENTLY ASKED QUESTIONS
Pregnancy/breastfeeding
After having this procedure there is no problem regarding pregnancy either for the mother or the child, but it is advisable to wait for six months after surgery. Breastfeeding is still possible in most cases.
Auto-immune disease
Many international research papers published on the subject have shown that there is not a higher risk of contracting this type of rare disease with implants compared to the general female population.
Implants and breast cancer
To our knowledge at present we can affirm that breast implants, including those filled with silicone, do not increase the risk of breast cancer. However, during screening techniques clinical examination and palpation can be affected, especially in case of siliconoma or capsular contraction. The presence of the implants can also make it difficult to carry out and read routine mammographies. It is necessary to explain beforehand that you have implants. Other radiological techniques can be used; echography, MRI etc.
Furthermore, if there is doubt as to a diagnosis of breast cancer you must be aware that more invasive exploratory techniques may be used in order to be sure of the result.
How long will the implants last?
Although it is true that some patients can keep their implants for decades without major changes, an implant, whether filled with silicone gel or saline cannot be said to last for a specific time, this is not a permanent life-long prosthesis. A patient with implants must expect them to be replaced at some point in time, if the initial effect is to be maintained. It is impossible to predict the life-span of an implant, of whatever type, as this depends on wear which is variable.
This means that no guarantee can be given regarding their life-span.
It should be noted however that the new generation implants are far more hardwearing and reliable. The notion of replacement after ten years is no longer justified, they only need to be replaced if a problem is detected, or the patient wishes to change their size or shape or to correct ptosis
Follow up
It is important to keep the appointments with your surgeon during the weeks and months following the operation. After this stage regular medical visits with, for example your gynecologist, or for routine mammography will continue this follow up. You must tell each physician that you have breast implants.
A specific visit concerning the implants is advisable every two to three years, but in case of a change observed in a breast, or an accident affecting the breasts, an appointment must be scheduled.
POSSIBLE COMPLICATIONS
Breast augmentation with implants, although essentially an aesthetic procedure is nevertheless an operation, and this implies that the risks inherent to any surgery apply here.
A distinction should be made between risks related to the anesthesia and those related to the surgery.
• For the anesthesia, the anesthesiologist will explain the risks during the preoperative consultation. You must be aware that anesthesia can cause unpredictable reactions, which can be difficult to control: the presence of an experienced anesthesiologist, in a surgical context, means that the risks are statistically practically negligible.
In fact, techniques, products and monitoring methods have progressed considerably over the last twenty years, giving optimal safety, especially when the surgery is elective and the patient is in good general heath.
• Concerning surgery: by choosing a competent, qualified Plastic Surgeon, used to performing this procedure, you limit the risks to a large extent, without however eliminating them completely.
In general after augmentation mammoplasty the recovery period is straightforward. There can however be complications some of which are inherent to all breast surgery, some linked to the placing of a foreign body in the breast: that is to say risks linked to implants.
We apologize for not showing any photos here for ethical reasons. You may refer to the following website for before and after photos: www.plasticsurgery.org
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