Breast enlargement using prostheses or breast implants

This intervention is for women who consider their chest to be too small.
This may be due to a congenital absence of development of the mammary gland that may be more or less significant (agenesia or hypoplasia) or loss of volume due to dieting or pregnancy.
The flat chest may be normal in shape but it may also be asymmetrical (not always correctable) or drooping (ptosis).

BEFORE THE BREAST IMPLANT OPERATION

Choice of prostheses

The choice of prostheses is very important to ensure that the operation is successful. This will be done during the pre-operative consultations depending on your wishes and your shape.
The choice of a prosthesis should be based on three main criteria:

Content: All mammary prostheses consist of a silicone envelope (smooth or textured, rough) that may be filled either with physiological serum (very little used since 2001 due to the fact that these prostheses frequently deflate) or with silicone. The silicone once used was very liquid and if the envelope broke it could leak out. It was abandoned. The new silicone gel is a “cohesive” gel, i.e. if the envelope breaks it remains compact and there is no danger of it spreading. This is what is used currently.

Shape: Prostheses may be round or so-called “anatomical” (teardrop-shaped), which gives interesting results in some cases (virtually non-existent breasts, breast reconstruction, slightly drooping breasts, etc.). Such implants are slightly firmer because the gel is slightly harder and there is a risk of rotation that could change the shape of the breast and justifier a re-intervention.

The volume of the prosthesis (and thus of the future chest) needs to be determined on the basis of tests performed in the doctor’s office. If the breasts are of equal size, it is possible to insert a prosthesis having low, medium or high projection (the breast will “stick out” more). Between two sizes, a slightly smaller and less projecting prosthesis will produce a more natural result.

A new type of prosthesis has been on the market for several years. These prostheses are covered in polyurethane foam. They appear to be of interest in that they reduce the risk of rotation (anatomical prostheses) and of a retraction of the shell. Although their use is of interest at the moment, the take-up in France is limited.

Choice of scar

If the breast is normal in shape and the areola is correctly positioned, the patient has the choice of three types of scar:

• Sub-mammary (in the crease under the breast), suitable if the breast is slightly heavy and drooping.
• Low hemi-areolar, though this is impossible if the areola is too small or axillary (in the armpit hair region).
• If the breast droops slightly, it is sometimes necessary to accept a larger scar since the simple insertion of the prosthesis (see the section on mammary ptosis).

Choice of position for the mammary prosthesis

There are two possible positions for the prosthesis:

• Retro-glandular: the prostheses are positioned directly behind the breast and under the skin.
• Retro-muscular: the prostheses are positioned at greater depth, behind the large pectoral muscle: this is a more painful operation but gives a more natural look.
• A new technique known as “dual plane” consists in place the upper part of the prosthesis behind the muscle and the lower part behind the breast and this may be interesting in certain cases (such as when there is also ptosis).

Mammary prostheses operations

• Type of anaesthesia: Usually general.
• Length of operation: Depending on the type of mammary prosthesis and any association with cosmetic breast surgery, the intervention may last for between one and two hours.
• The principle of the operation is that after having detached the muscle (or the breast) by making one of three possible incisions, to create a cavity that is as accurate as possible into which the breast implant will be inserted.
• A drain will be inserted (usually removed the next day).
• Sutures will be performed using re-absorbable thread so there will be no stitches that require removal.

AFTER THE BREAST IMPLANT OPERATION

• It is usually necessary to stay in hospital for 24 hours.
• The first hours following the breast implant operation are usually marked by quite significant pain which at first will require intravenous pain relief injections then subsequently tablets to be taken at home for three to 10 days.
• The dressings will be replaced once or twice a week for a fortnight.
• No strenuous movements must be performed with the arms (pectoral muscles) for the first month and the patients should not drive for a fortnight. During the first month, a bra and a special strap must be worn night and day in order to ensure the mammary implant stays in place.
• Physical recovery varies from one patient to the next but a minimum of five days’ rest is desirable before resuming a non-strenuous activity. In the case of work requiring greater exertion (especially if effort is required with the arms), plan to stop working for at least three to four weeks. After one month, it is possible to resume normal activities and all types of movement are permitted.
• The definitive aspects of the volume and shape of the breast will emerge after two to three months. The scars will only start to fade after the sixth month and will only achieve their permanent appearance after one or two years.
• Sequels and possible complications involved in breast implants will be explained to you by Dr COURBIER during the consultation and in the literature supplied to you.

The shell

The shell is a normal reaction of the body which creates a membrane around the mammary prosthesis in order to isolate it. This shell is actually necessary to prevent the prosthesis from moving (that is why it is important to avoid large movements before it is able to form). The shell is generally thin, allowing the breasts to feel flexible and natural on contact. Exceptionally with new prostheses, it may be thick (a retractile shell) making the breast harder and less natural. In some very rare cases, there may be a need to re-operate to break the shell.

Life span of the mammary prosthesis

At the time of writing there exists no definitive mammary prosthesis that will last for a whole lifetime. Like all the prostheses used in surgery, the mammary prosthesis wears out over time and one day it will have to be changed. In the case of physiological serum implants, the phenomenon is soon detected due to a reduction in breast volume (the prosthesis deflates). In the case of silicone implants, the diagnosis is often made through breast examination.

The date of the change depends on monitoring via a digitised mammogram performed every 2-3 years