(Last Updated On: December 26, 2021)

What is breast augmentation?

This is to increase the volume of the breast through the implantation of breast prostheses or breast implants. The placement of breast prostheses can be carried out in isolation, or be supplemented by a mastopéxia (“breast lift”) when breast hypertrophy is associated with ptosis.

The different types of breast implants: There is a wide variety of breast prosthesis or breast implants which differ in shape and content.

2 types of prostheses are at our disposal:

  • Breast prostheses filled with physiological serum
  • Breast prostheses filled with silicone gel. Silicone gel prostheses are either “round” or “anatomical”.

BREAST PROSTHESES AND BREAST AUGMENTATION

THE CHOICE OF BREAST PROSTHESIS?

This is the most important step in ensuring the success of the intervention. Most of the bad results are due to an unsuitable chest or breast prosthesis and therefore to a poor choice of prosthesis.

This step takes place mainly during the preoperative consultation. A final adjustment may take place during the operation if the result obtained is not exactly the one decided preoperatively.

It is therefore a question of finding the prosthesis that suits your morphology, the shape and size of your breasts as well as your wishes.

During boob job consultation, we analyze your chest and your figure. We take many measurements, we observe the height of implantation of the breasts on the thorax, the spacing of the breasts and the shape of the thorax.

Then we determine together what you want in volume and shape. Of course we will advise you on your choice.

Several tools can help you choose:

  • simulation with trial breast prostheses in the bra in front of a mirror
  • photos of breasts that you have selected
  • Use of software to help choose breast prostheses. This 3D morphing software is exclusive to the firm since we have collaborated on its latest evolution. This involves photographing your breasts using a 3D camera and simulating your result by choosing the shape and volume of the prostheses. The software displays the expected result and allows you to project yourself. The choice of software is then confirmed by a simulation with the corresponding trial breast prostheses.

The different types of breast prostheses

In almost all cases, we use silicone gel prosthesis. The wall is a silicone elastomer which can be smooth or textured.

The filling of the prostheses is made with a cohesive silicone gel which prevents diffusion in the event of rupture of the implant (photo 1)

There are 2 families of silicone breast prostheses: round and anatomical.

  • Round breast prostheses: by definition their height is equal to their width. On the other hand, it is possible to choose the projection (low profile, moderate or high profile). The projection has a direct impact on the future bra cup. (photo 2)
  • Anatomical breast prostheses: this is a tailor-made approach to breast augmentation since the range allows the choice of implant to be adapted to the width and height of the breast as well as to the projection (or bra cup) that you want.

Anatomical breast prostheses are interesting in certain cases (almost non-existent breasts, breast reconstruction, slightly ptotic breasts, tuberous breasts, etc.). However, these breast implants are a little firmer because the gel is a little harder to keep the shape and they present a risk of rotation which can modify the shape of the breast and justify a reoperation. To reduce this risk of rotation, the prostheses must be stabilized by strong adhesion of the prosthesis to the tissues. This adhesion is only possible for macrotextured or polyurethane coated prostheses.

The ban on the use of implants coated with polyurethane and macrotextured prostheses has forced us to review our strategy for choosing implants. Indeed, the benefit of an anatomical implant must be weighed against the aesthetic result with the risk of rotation requiring reoperation. We therefore reserve anatomical prostheses for very specific and well-selected cases. In other cases we use smooth or microtextured round prostheses.

In the event of a formal indication for anatomical prostheses, we use microtextured or nanotextured prostheses which have fixing lugs allowing the prosthesis to be temporarily fixed while the tissue heals around the implant. However, this process will not prevent the risk of long-term rotation.

INTERVENTION TECHNIQUE

Simplified description of the technique:

  • breast prosthesisSkin incisions: There are several possible “routes of entry”
  • Axillary approach, with incision under the arm, in the armpit
  • Lower hemiareal route
  • Inframammary route, with incision in the groove located under the breast

Placement of breast prostheses: The implants are introduced through the incision, two positions are possible:

  • Retro-glandular, where the prostheses are located directly behind the gland
  • Retro-muscular, where the prostheses are located deeper, behind the pectoralis major muscle

Other information about the intervention

  • Type of hospitalization: Usually a 24-hour hospitalization is required. However, in some cases, the operation can be done on an outpatient basis, that is to say in day hospitalization (entry in the morning, exit in the evening).
  • Type of anesthesia: Usually the procedure requires general anesthesia
  • Duration of the operation: Depending on the “approach”, the size of the prostheses to be implanted, and the possible association with a mastopexy, the operation can last between 1 and 3 hours.

Indications

An augmentation mammoplasty aims to advantageously modify the appearance of the breast. Thanks to this intervention, we can hope for an improvement in the following points:

  • Breast volume too small in relation to the general body physiognomy
  • Slight ptosis secondary to a loss of glandular volume (pregnancy or weight loss).
  • Insufficient firmness of the chest
  • Asymmetry, with one breast noticeably smaller than the other

On the other hand, with prostheses alone, one cannot correct a significant breast ptosis. This correction is only possible with the association of a mastopéxia, which results in scars often much more visible.

SUITES OPERATOIRES

THE USUAL OPERATING SUITES

The first hours following the operation are marked by fairly severe pain which requires tranquilizers by the venous route. When a drain has been put in place, it is removed the day after the operation during discharge.

After discharge, it is necessary to wear a compression bra day and night for 3 weeks.

  • The pains (more important in the case of a retropectoral position) disappear in about ten days.
  • Bruises and edemas subside in 15 to 20 days.
  • The stitches are removed on the 15th postoperative day.
  • The final appearance on the volume and on the shape is obtained in 2 to 3 months.
  • The scars will not begin to fade until after the 6th month, and only reach their final appearance after 1 to 2 years.

Duration of sick leave: Physical recovery varies from one patient to another. However, we can estimate that to resume a less demanding activity, a minimum of 5 days of rest is still desirable. For more physically demanding work (especially if it requires effort with the arms), it is better to plan at least 3 weeks off.

RISKS AND COMPLICATIONS

Risks – Complications

Anesthetic complications: Any anesthesia, however light, carries risks. They will be exposed to you during the consultation with the anesthesiologist.

Immediate complications of the procedure

  • Hematoma: this is a hemorrhage in the compartment of the prosthesis, which causes a sudden increase in the volume of a breast and which justifies rapid drainage (in the hours following the operation)
  • Infection: it manifests itself in the days following the operation by an inflammatory aspect of the breast and the temperature. It sometimes justifies the removal of prostheses and the introduction of antibiotics.

Secondary and late complications

  • Poor aesthetic results:
  • Insufficient or excessive correction.
  • Volume asymmetry between the two breasts (especially in case of pre-existing asymmetry)
  • Malposition or secondary displacement of the implants, which may justify an early revision (1 month).
  • Consistency that may appear artificial, or too hard.
  • Perception of prostheses, by touch and sometimes by sight in certain positions, especially on their upper and external edges. In some cases, it is possible to perceive folds in the prosthesis.
  • “Abnormal” scars:
  • The quality of healing is variable: sometimes we can have enlarged, adherent, hyperpigmented or on the contrary depigmented (white) scars, hypertrophic scars or keloid scars.

Galactorrhea:

  • Rare cases of unexplained postoperative hormonal stimulation, resulting in secretion of milk have been reported.
  • Areola-nipple insensitivity:
  • The sensitivity of the areola is often temporarily disturbed after surgery. However, it happens that these disorders of the sensitivity have not regressed after 6 months. More rarely, one notes conversely a hypersensitivity of the nipples.

Periprosthetic shell:

The prosthesis represents a foreign body. The normal and constant physiological reaction of the organism is to isolate it from the surrounding tissues by constituting a hermetic membrane which will surround the implant and which is called a “periprosthetic capsule”. Normally, this membrane is thin and flexible, but sometimes the reaction is amplified and the capsule thickens, becoming fibrous and retractable by compressing the implant. This envelope then takes the name of “shell”.

This retractile fibrosis is sometimes secondary to a hematoma or an infection, but most of the time its occurrence remains unpredictable resulting from random and uncontrollable organic reactions, which can appear in the first months or after several years.

Capsular retraction remains the major drawback of breast prostheses in terms of frequency (up to 10% of cases) and alteration of the result: it is the main cause of re-intervention, to decompress the shell and possibly change the prosthesis. , unfortunately with fairly frequent recurrences.

Rupture / deflation of prosthesis:

It happens that the implant lets its contents escape, suddenly or gradually, following a trauma (shock, prick, etc.), or in the long run, by wear of its envelope. With physiological serum implants, the phenomenon is quickly objectified by a decrease in breast volume. For silicone implants, it is often a mammographic check that makes the diagnosis. For more information, please visit: https://www.hayatmed.com/breast-augmentation-boob-job-in-turkey/

Written by Kathy Cooley