Breast enlargement
Definitions
The mammary hypoplasy is an insufficient volume of breast compared to the morphology of the patient. Mammary hypoplasy can occur from the beginning (since puberty) or appear secondarily, following an important slimming or a pregnancy followed by breast-feeding. This phenomenon can be isolated or associated to a depression of gland and a distension of the skin. This surgery with aesthetic goal isn't taken in charge by the national heath insurance.
Objectives - principles
An increase mammoplasty consists in correcting the volume considered insufficient of the breast by the placement of implant behind the mammary gland.
All the mammary implants currently used are composed of an envelope and a filling product. The envelope is made of elastic silicone (silicone elastomer). It can be smooth or rough (textured). As to the filling products, the physiological salt solution and the silicone freezing are the only authorized product today in France because they are well known and have been used for nearly 40 years. The implant are pre-filled when the filling product is introduced in factory (silicone freezing and /or physiological salt solution). The manufacturer thus fixes the range of various volumes.
Before the intervention
The scar location, the situation of the prosthesis according to the muscle, the type and size of the prosthesis, and especially the anatomical context and the desires expressed by the patient are decided during consultation. One arrives thus, after a clear talk of the various methods to be chosen and what is appropriate best for each case. Usually a preoperative assessment is carried out in accordance with the regulations. The anaesthetist doctor will be seen in consultation at the latest 48 hours before the intervention. Apart from the usual preoperative examinations, it can also be useful to check the mammography. Drugs and medication containing aspirin mustn't be taken during the 10 days preceding the intervention.
Type of anaesthesia
It's a traditional anaesthesia, during which you found yourself completely asleep
Methods of hospitalisation
one day hospitalisation is usually sufficient.
The intervention
Each surgeon adopts its own technique that he adapts to each case to obtain the best results. However, one can retain common guiding principles:
Cutaneous incision
The implant is introduced by a short incision located:
The implant harbour, which is arranged by separation and in which the prosthesis is established, is located:
In the event of mammary ptosis and low areola, it is better to associate a gesture of reduction of the cutaneous envelope but this implies a more important scar type (periareolary for instance or vertical).
It is possible that a drain is left in place a few days after the intervention so that the blood or the liquid, which can be collected, is eliminated. At the end of the intervention, a modelling elastic bra -shaped bandage is placed. According to the surgeon and possible need for an associated and complementary gesture, the intervention can last from 1 to 2 hours.
After the intervention: Operational continuations
The operational continuations can be painful the first days, especially when the implant is placed behind the pectoral muscle. It's necessary to start an antalgic treatment during a few days. In the best of cases, the patient will feel a strong feeling of tension. Oedema (swelling), bruises in the breast area and pain when trying to raise the arms are frequent at the beginning.
The first bandage is taken off after 24 to 48 hours and is replaced by a lighter bandage, a kind of elastic long-line bra made "sur mesure".
The end of the hospitalisation takes place 24 to 48 hours after the intervention, then the patient is re-examined in consultation two to three months later. A special bra is them applied ensuring a good contention. The bra is advised during approximately a month, night and day. If the stitches are not resorbable, they will be withdrawn between the eighth and the fifteenth post-operative day.
It is advised to consider convalescence of 8 to 10 days. It's advised to give up sport for one to two months.
The Result
It can be appreciated from the third month, this is the necessary time to ease the breads and the stabilization of the prosthesis. Also apart from the aesthetic improvement, the psychological repercussion is generally beneficial
Questions: What you have to know about the implants mammary
Is possible to breast feed?
The placement of implants behind the mammary gland does not seem to have of any repercussion on breast feeding. Do the prosthesis increase the risk of breast cancer? There are researches that have tried to study the relation between implant and breast cancer. But no link between the two has been proven and the placement of a prosthesis does not increase of anything the risk of the appearance of a breast cancer. Surgeons from the anti-cancer centres use regularly the mammary prosthesis for the reconstructive surgery.
Is the monitoring of the breast possible?
The prosthesis being behind the gland mammary, the clinical monitoring is simple. The presence of an implant can modify the capacity of x-rays to detect breast cancers. The patients carrying an implant mammary must specify it to the radiologist who will be able to use specific and adapted methods (echography, digitised mammography).
What of the controversy on the silicone gel?
The mammary implants filled with silicone gel were shown to be responsible for certain autoimmune diseases on patients. Today, most of the scientific work on this subject brought the proof that there is no significant increase in the risk of autoimmune disease amongst women carrying mammary implants and especially those filled with silicone gel.
What happens after the placement of a mammary implant?
It is necessary to be subjected to post-operative visits on the surgeon's request. Later on, the presence of a mammary implant does not require to carry out examinations more than usual medical supervision, but it is essential to specify to the doctor that you are carrying a mammary implant. It is imperative in the event of modification of the breast condition (hardening or on the contrary softening) to consult a doctor (family practitioner, gynaecologist, surgeon) who will be able to judge if it is necessary to have recourse to a radiographic or echo graphic examination.
The question of the implant's duration?
A prosthesis filled with gel of silicone or physiological salt solution has a duration which can't be estimate precisely a priori since it depends on possible complications. Thus, the duration of the implant cannot be guaranteed. A woman carrying implants is exposed to the risk of having to go through a complementary intervention of replacement so that the beneficial effect is maintained. However, it should be known that the quality of the implant does not have a theoretical limited lifespan: there is no expiry date beyond which the change of implant is obligatory. Thus, in the absence of complication, the implant can be preserved as a long as the patient wishes.
The specific disadvantages and risks
It is possible for the scar to have an abnormal evolution, whether it be thickening or of retraction. Pains of the breast, disorders of nipple sensitivity are also possible. In addition, a dissatisfaction of the aesthetic result can justify a second intervention after surgeon validation of course.
Formation of folds or aspect of "waves"
The implant, to remain flexible, is never filled to its maximum. So the folds of the prosthesis envelope can be visible under the skin, resulting in a waves aspect, especially in the higher, external and lower parts of the breast. In the higher part, this aspect is limited if the placement has been chosen in a retro-muscular position. This phenomenon is more frequent when the prosthesis is filled with physiological salt solution, especially if its partition is textured. It emphasises the risk of rupture and deflation by a premature wear of the envelope leading to a fold.
Capsule contraction and fibrous hull
The formation of a fibrous capsule around an implant is obligatory. It is a normal reaction of the metabolism forming a kind of fibrous membrane around any foreign body in order to isolate it and to protect itself ("membrane or capsule of exclusion"). In certain cases, this membrane is the set of an unfavourable evolution like chéloïdes of the cutaneous scars or cicatricial supports retractile: it thickens, retracts and forms a true fibrous hull around the implant. It leads to capsule contraction. There are four stages going from the normal aspect, undetectable, to the severe hull shapes with hard breast, round, fixed and sometimes painful. The frequency of this complication cannot be estimated overall since it varies according to the indication, to the type of prosthesis and to procedure. This complication is more frequent with prosthesis filled with silicone gel. The hull does not increase the risk of rupture but exposes to complications of aesthetic nature. A surgical operation can correct this by the section of the capsule (Capsulectomy). Various authors proposed technical solutions to limit the appearance of this contraction; amongst them: Placement of the implant behind the pectoral muscle, and the use of manufactured rough partition on the external face of the implant (textured prosthesis).
Breaching and deflation
Such incidents occur following a deterioration of the prosthesis envelope, i.e. container (silicone elastomer). Porosity phenomena, opening or breaching can happen following a violent traumatism, sometimes it's due to a manufacturing defect, but most frequently, phenomenon of wear is the reason. If dealing with prosthesis filled with silicone gel, the gel remains most of the time in the fibrous envelope surrounding the implant (intra capsular phenomenon). The escape does not have any clinical translation then. However, this intra capsular seepage may favour the appearance of a periprosthetic hull. More rarely, in the case of important breach related to a violent traumatism or a needle puncture, the gel escapes beyond the fibrous envelope (extra capsular breach). In small quantity, it can cause the appearance of a granule with foreign body in the form of nodule (siliconom). In case of extra important capsular rupture (traumatism), the gel may diffuse itself in neighbouring fabrics, the breast takes a very soft consistency, and inflammatory reactions can occur: the surgical extraction is then necessary.
Other disadvantages can be observed with the prosthesis mammary
An asymmetry of position of the implants can appear secondarily if the interns scar reaction moderately moves the implant. The displacement with time can happen whether there is or not an associated hull. In addition to the difference in height of the breast, the areolas are also different in height because they are climbed at the same time. The occurrence of a hull modifies the perception of the prosthesis, more palpable, more visible constitute a nuisance for the patient. It is necessary to know that this reaction is independent of surgical act and represented a differed scar reaction, unforeseeable fact depending on each individual evolution.
Obviously, a correction can be obtained, the nest way possible by a medical follow-up and a permanent contact with the expert.
Certain complications are specific
Prosthesis Mobility due to contractions of the pectoral muscle
In certain cases, when the prosthesis is put into retro pectoral, the contraction of the muscle also mobilizes the prosthesis. This explains why, it is advisable during this intervention to release the muscle sufficiently to allow independence with the prosthesis. However, the scar reaction can lock up the prosthesis into retro-muscular and provoke, the prosthesis being mobile, external disharmony. A surgical operation usually corrects this problem by releasing lower adherence and fastening the muscle.
Palpable muscular fold
When the prosthesis is in retro-muscular position, it can happen that contraction on the lower edge of the muscle presses on the prosthesis and draws a visible and unesthetic effect. It is a disadvantage due to retro-muscular position and often preferable to leave in state. In certain cases, the reduction of the muscular capacity can be adjusted by surgical ways, thus limiting this disadvantage.
Glandular allotment anomaly
In certain cases indeed, the gland is not divided in a homogeneous way and concentrates in the external segment and on the auxiliary prolongation. The gland is in a high position. There usually isn't, or in very little quantity, glands in the sub-nipple zone. In that case, the difference in glandular volume is clearly seen and a glandular fold appears, separating the higher from the subcutaneous prosthesis in the lower segment. It is sometimes possible to attenuate this disadvantage by a secondary intervention and a distribution different from the glandular segment, by a translation of the external segment towards the lower segment.
These various disadvantages are due to specific anatomic and morphologic considerations depending on the patient. Not on the intervention itself. This explains why post-intervention reactions in plastic surgery, especially one including mammary prosthesis, depend on the patients. The patients' reactions are personal and different from one another, and are independently from the surgical act, which is carried out in the most possible correct way. Regular control and comprehension are justified so that these unforeseeable evolutions are to be avoided. This shows the importance of the reflexion before an operational decision
Definitions
The mammary hypoplasy is an insufficient volume of breast compared to the morphology of the patient. Mammary hypoplasy can occur from the beginning (since puberty) or appear secondarily, following an important slimming or a pregnancy followed by breast-feeding. This phenomenon can be isolated or associated to a depression of gland and a distension of the skin. This surgery with aesthetic goal isn't taken in charge by the national heath insurance.
Objectives - principles
An increase mammoplasty consists in correcting the volume considered insufficient of the breast by the placement of implant behind the mammary gland.
All the mammary implants currently used are composed of an envelope and a filling product. The envelope is made of elastic silicone (silicone elastomer). It can be smooth or rough (textured). As to the filling products, the physiological salt solution and the silicone freezing are the only authorized product today in France because they are well known and have been used for nearly 40 years. The implant are pre-filled when the filling product is introduced in factory (silicone freezing and /or physiological salt solution). The manufacturer thus fixes the range of various volumes.
Before the intervention
The scar location, the situation of the prosthesis according to the muscle, the type and size of the prosthesis, and especially the anatomical context and the desires expressed by the patient are decided during consultation. One arrives thus, after a clear talk of the various methods to be chosen and what is appropriate best for each case. Usually a preoperative assessment is carried out in accordance with the regulations. The anaesthetist doctor will be seen in consultation at the latest 48 hours before the intervention. Apart from the usual preoperative examinations, it can also be useful to check the mammography. Drugs and medication containing aspirin mustn't be taken during the 10 days preceding the intervention.
Type of anaesthesia
It's a traditional anaesthesia, during which you found yourself completely asleep
Methods of hospitalisation
one day hospitalisation is usually sufficient.
The intervention
Each surgeon adopts its own technique that he adapts to each case to obtain the best results. However, one can retain common guiding principles:
Cutaneous incision
The implant is introduced by a short incision located:
- Either on the areola,
- or in the area of the armpit,
- or under the sub-mammarian fold.
The implant harbour, which is arranged by separation and in which the prosthesis is established, is located:
- either behind the gland and in front of the pectoral muscle
- or behind the gland and the pectoral muscle.
In the event of mammary ptosis and low areola, it is better to associate a gesture of reduction of the cutaneous envelope but this implies a more important scar type (periareolary for instance or vertical).
It is possible that a drain is left in place a few days after the intervention so that the blood or the liquid, which can be collected, is eliminated. At the end of the intervention, a modelling elastic bra -shaped bandage is placed. According to the surgeon and possible need for an associated and complementary gesture, the intervention can last from 1 to 2 hours.
After the intervention: Operational continuations
The operational continuations can be painful the first days, especially when the implant is placed behind the pectoral muscle. It's necessary to start an antalgic treatment during a few days. In the best of cases, the patient will feel a strong feeling of tension. Oedema (swelling), bruises in the breast area and pain when trying to raise the arms are frequent at the beginning.
The first bandage is taken off after 24 to 48 hours and is replaced by a lighter bandage, a kind of elastic long-line bra made "sur mesure".
The end of the hospitalisation takes place 24 to 48 hours after the intervention, then the patient is re-examined in consultation two to three months later. A special bra is them applied ensuring a good contention. The bra is advised during approximately a month, night and day. If the stitches are not resorbable, they will be withdrawn between the eighth and the fifteenth post-operative day.
It is advised to consider convalescence of 8 to 10 days. It's advised to give up sport for one to two months.
The Result
It can be appreciated from the third month, this is the necessary time to ease the breads and the stabilization of the prosthesis. Also apart from the aesthetic improvement, the psychological repercussion is generally beneficial
Questions: What you have to know about the implants mammary
Is possible to breast feed?
The placement of implants behind the mammary gland does not seem to have of any repercussion on breast feeding. Do the prosthesis increase the risk of breast cancer? There are researches that have tried to study the relation between implant and breast cancer. But no link between the two has been proven and the placement of a prosthesis does not increase of anything the risk of the appearance of a breast cancer. Surgeons from the anti-cancer centres use regularly the mammary prosthesis for the reconstructive surgery.
Is the monitoring of the breast possible?
The prosthesis being behind the gland mammary, the clinical monitoring is simple. The presence of an implant can modify the capacity of x-rays to detect breast cancers. The patients carrying an implant mammary must specify it to the radiologist who will be able to use specific and adapted methods (echography, digitised mammography).
What of the controversy on the silicone gel?
The mammary implants filled with silicone gel were shown to be responsible for certain autoimmune diseases on patients. Today, most of the scientific work on this subject brought the proof that there is no significant increase in the risk of autoimmune disease amongst women carrying mammary implants and especially those filled with silicone gel.
What happens after the placement of a mammary implant?
It is necessary to be subjected to post-operative visits on the surgeon's request. Later on, the presence of a mammary implant does not require to carry out examinations more than usual medical supervision, but it is essential to specify to the doctor that you are carrying a mammary implant. It is imperative in the event of modification of the breast condition (hardening or on the contrary softening) to consult a doctor (family practitioner, gynaecologist, surgeon) who will be able to judge if it is necessary to have recourse to a radiographic or echo graphic examination.
The question of the implant's duration?
A prosthesis filled with gel of silicone or physiological salt solution has a duration which can't be estimate precisely a priori since it depends on possible complications. Thus, the duration of the implant cannot be guaranteed. A woman carrying implants is exposed to the risk of having to go through a complementary intervention of replacement so that the beneficial effect is maintained. However, it should be known that the quality of the implant does not have a theoretical limited lifespan: there is no expiry date beyond which the change of implant is obligatory. Thus, in the absence of complication, the implant can be preserved as a long as the patient wishes.
The specific disadvantages and risks
It is possible for the scar to have an abnormal evolution, whether it be thickening or of retraction. Pains of the breast, disorders of nipple sensitivity are also possible. In addition, a dissatisfaction of the aesthetic result can justify a second intervention after surgeon validation of course.
Formation of folds or aspect of "waves"
The implant, to remain flexible, is never filled to its maximum. So the folds of the prosthesis envelope can be visible under the skin, resulting in a waves aspect, especially in the higher, external and lower parts of the breast. In the higher part, this aspect is limited if the placement has been chosen in a retro-muscular position. This phenomenon is more frequent when the prosthesis is filled with physiological salt solution, especially if its partition is textured. It emphasises the risk of rupture and deflation by a premature wear of the envelope leading to a fold.
Capsule contraction and fibrous hull
The formation of a fibrous capsule around an implant is obligatory. It is a normal reaction of the metabolism forming a kind of fibrous membrane around any foreign body in order to isolate it and to protect itself ("membrane or capsule of exclusion"). In certain cases, this membrane is the set of an unfavourable evolution like chéloïdes of the cutaneous scars or cicatricial supports retractile: it thickens, retracts and forms a true fibrous hull around the implant. It leads to capsule contraction. There are four stages going from the normal aspect, undetectable, to the severe hull shapes with hard breast, round, fixed and sometimes painful. The frequency of this complication cannot be estimated overall since it varies according to the indication, to the type of prosthesis and to procedure. This complication is more frequent with prosthesis filled with silicone gel. The hull does not increase the risk of rupture but exposes to complications of aesthetic nature. A surgical operation can correct this by the section of the capsule (Capsulectomy). Various authors proposed technical solutions to limit the appearance of this contraction; amongst them: Placement of the implant behind the pectoral muscle, and the use of manufactured rough partition on the external face of the implant (textured prosthesis).
Breaching and deflation
Such incidents occur following a deterioration of the prosthesis envelope, i.e. container (silicone elastomer). Porosity phenomena, opening or breaching can happen following a violent traumatism, sometimes it's due to a manufacturing defect, but most frequently, phenomenon of wear is the reason. If dealing with prosthesis filled with silicone gel, the gel remains most of the time in the fibrous envelope surrounding the implant (intra capsular phenomenon). The escape does not have any clinical translation then. However, this intra capsular seepage may favour the appearance of a periprosthetic hull. More rarely, in the case of important breach related to a violent traumatism or a needle puncture, the gel escapes beyond the fibrous envelope (extra capsular breach). In small quantity, it can cause the appearance of a granule with foreign body in the form of nodule (siliconom). In case of extra important capsular rupture (traumatism), the gel may diffuse itself in neighbouring fabrics, the breast takes a very soft consistency, and inflammatory reactions can occur: the surgical extraction is then necessary.
Other disadvantages can be observed with the prosthesis mammary
An asymmetry of position of the implants can appear secondarily if the interns scar reaction moderately moves the implant. The displacement with time can happen whether there is or not an associated hull. In addition to the difference in height of the breast, the areolas are also different in height because they are climbed at the same time. The occurrence of a hull modifies the perception of the prosthesis, more palpable, more visible constitute a nuisance for the patient. It is necessary to know that this reaction is independent of surgical act and represented a differed scar reaction, unforeseeable fact depending on each individual evolution.
Obviously, a correction can be obtained, the nest way possible by a medical follow-up and a permanent contact with the expert.
Certain complications are specific
Prosthesis Mobility due to contractions of the pectoral muscle
In certain cases, when the prosthesis is put into retro pectoral, the contraction of the muscle also mobilizes the prosthesis. This explains why, it is advisable during this intervention to release the muscle sufficiently to allow independence with the prosthesis. However, the scar reaction can lock up the prosthesis into retro-muscular and provoke, the prosthesis being mobile, external disharmony. A surgical operation usually corrects this problem by releasing lower adherence and fastening the muscle.
Palpable muscular fold
When the prosthesis is in retro-muscular position, it can happen that contraction on the lower edge of the muscle presses on the prosthesis and draws a visible and unesthetic effect. It is a disadvantage due to retro-muscular position and often preferable to leave in state. In certain cases, the reduction of the muscular capacity can be adjusted by surgical ways, thus limiting this disadvantage.
Glandular allotment anomaly
In certain cases indeed, the gland is not divided in a homogeneous way and concentrates in the external segment and on the auxiliary prolongation. The gland is in a high position. There usually isn't, or in very little quantity, glands in the sub-nipple zone. In that case, the difference in glandular volume is clearly seen and a glandular fold appears, separating the higher from the subcutaneous prosthesis in the lower segment. It is sometimes possible to attenuate this disadvantage by a secondary intervention and a distribution different from the glandular segment, by a translation of the external segment towards the lower segment.
These various disadvantages are due to specific anatomic and morphologic considerations depending on the patient. Not on the intervention itself. This explains why post-intervention reactions in plastic surgery, especially one including mammary prosthesis, depend on the patients. The patients' reactions are personal and different from one another, and are independently from the surgical act, which is carried out in the most possible correct way. Regular control and comprehension are justified so that these unforeseeable evolutions are to be avoided. This shows the importance of the reflexion before an operational decision
