Breast Surgery

Breast augmentation surgery

Breast augmentation surgery is typically performed on small, underdeveloped, sometimes asymmetrical breasts, which may have been poorly formed since puberty. It is also often done on breasts that have lost volume after pregnancy or purely for aesthetic reasons.

Which implant to choose?

Implants have undergone significant development and periods of success, particularly after comprehensive studies on their safety (in France and the USA), which have proven that these implants do not lead to autoimmune diseases.

However, the content and the quality of the implant shell have been modified to make them more reliable than before.

Currently, implants filled with saline solution are less commonly used due to the risk of folding over time and, in some cases, deflating. Pre-filled cohesive silicone gel implants, which are highly reliable and more similar to breast tissue consistency, are now preferred.

There are generally two types of implants: those filled with silicone and those filled with saline solution.

What kind of scar to expect?

There are three possible incision sites:

1. Periareolar incision (lower part): This incision is made at the junction between the colored skin of the areola and the white skin of the breast. It is the most commonly used approach. It allows for placing implants in front or behind the muscle but is not possible if the areola diameter is too small to accommodate the implant.
2. Inframammary incision: This incision is 3 to 4 cm long and is made in the external part of the inframammary fold, typically resulting in a very high-quality scar. This approach is the most commonly used in the USA. It allows for placing implants in front or behind the muscle and provides excellent exposure of the implant pocket (better control of bleeding, positioning of the implants, etc.).
3. Axillary incision: A 4 to 5 cm incision is made in the armpit, either vertically or horizontally. This approach is generally used for placing implants behind the muscle and provides less optimal exposure of the implant pocket for the surgeon.

Implant position

The implant can be placed in front or behind the pectoralis major muscle, depending on the initial breast shape and chest volume. When the initial breast volume is sufficient, it is generally preferable to place the implant in front of the muscle. Conversely, if the breast is very small and the patient is very thin, placing the implant behind the muscle will help conceal it as much as possible. Retro-muscular implants tend to be slightly more painful in the immediate postoperative period (muscle soreness from detaching the pectoralis major muscle). These pains can be relieved with usual painkillers and muscle relaxants.

Complications

In addition to the classic complications of any surgery (hematoma, healing problems, etc.), infections and capsular contracture are two specific complications associated with breast implants. They occur in less than 5% of cases and will be explained in detail by the surgeon during the consultation.

Postoperative care

Swelling and bruising are common.

A non-underwired sports bra must be worn for a month, and exercise is not permitted during the first month.

Breast cancer screening, such as mammograms and ultrasounds, is not affected by the implant as it remains behind the breast tissue.

Postoperative follow-up is regular, generally annually, and an annual radiological check is recommended. The lifespan of implants varies, but the current average is 10 years.

In addition to the aesthetic damage it may sometimes cause, breast hypertrophy can also lead to discomfort during physical activity and back pain. For this reason, in cases of significant hypertrophy, a surgical breast reduction may be covered by social security and health insurance.

The procedure involves removing excess breast tissue and skin, repositioning and often reducing the size of the areola, as well as reshaping the remaining gland to lift it. It is performed under general anesthesia and requires hospitalization for 24 to 72 hours.

Lifting and reducing an oversized breast requires making inverted T-shaped scars: around the areola, vertically down to the breast crease, and horizontally along the breast fold. Although every effort is made to ensure the scars are of the best possible quality, the final result of these scars is unpredictable. Most often, they are flexible and of good quality.

During the four weeks following the breast reduction, the patient must wear a non-underwired bra day and night.

Although it is sometimes possible, breastfeeding is not recommended after breast reduction as it encourages stretching of the breast, which would damage the aesthetic result. Finally, a decrease in nipple and breast skin sensitivity is possible, but it is generally temporary. The risks of complications from this surgery will be explained to you during your consultation by the surgeon who will care for you.

Breast lift, or mastopexy, or correction of breast ptosis, is the procedure that involves lifting the breast. Indeed, with time and the force of gravity, the skin and gland of the breast tend to sag. This phenomenon can be accelerated by significant weight fluctuations or pregnancy. This breast ptosis may or may not be associated with a reduction in volume.

The goal of the ptosis correction is to reposition the nipple higher, reshape the glandular tissue, remove excess skin from the lower part of the breast, and tighten the remaining skin around the gland. If the breast is also deflated, a breast implant will be placed in front of or behind the muscle to fill it (ptosis correction + breast implants).