- Breast Augmentation
- New generation pre-filled silicone gel implants
- Before the operation
- Hospital stay and type of anesthesia
- The procedure
- After the operation
- The result
- Imperfect results
- Frequently Asked Questions
- Possible complications
- Alternatives to breast augmentation - Breast Augmentation with Fat Injection
- My Way … “Metron Ariston”
Augmentation mammaplasty, commonly known as Breast Augmentation, is one of the most popular procedures of Plastic Surgery, involving the use of implants to achieve the desired result of fuller breasts and/or to restore breast volume loss.
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, skin stretching and a lowered areola. This insufficient breast volume can often be a source of physical and psychological distress for the patient who feels she lacks femininity, negatively impacting her self-confidence and self-image which can lead to an inferiority complex. Breast augmentation surgery can provide not only a solution to these problems, but also deliver an impeccable aesthetic result.
The procedure can be carried out at any age above 18 – below this age the procedure is not advisable. 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 and can be adapted to the patient to a certain extent during the procedure.
New generation pre-filled silicone gel implants
The vast majority of implants used are pre-filled silicone gel implants. They are made of soft silicone gel inside a strong impermeable envelope of silicone rubber which can be rough or smooth.
The most important points concerning the new generation of implants, which ensure their safety, are the new improved envelopes and the gel itself. The shells, which are now stronger, prevent any leakage of gel (which was a cause of capsule formation) and have much greater resistance over time. 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.
These implants, which have now been used for over 50 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.
Before the operation
After studying the anatomic features of the patient, the plan for the operation will be determined. This will also take into account the technique of choice, 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 the patient in consultation at the latest 48 hours before the operation. In addition to the usual preoperative tests, it is highly advised that the patient is screened by mammogram and ultrasound before surgery.
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 eight 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: Aesthetic breast surgery can be carried out on day-care basis – the patient leaves on the same day after some hours of medical supervision. However, in some cases a short hospital stay can be preferable. The patient arrives in the morning (or sometimes the previous evening) and is discharged the following morning.
The incisions – There are several possible approaches:
- 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.
- 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.
The position of the implant – This can be in a pocket made in the breast tissue behind the mammary gland and in front of the pectoral muscle, or behind both the mammary gland and the pectoral muscle.
The choice of incisions and implant position will have been predetermined during the preoperative consultation, after clearly explaining the different options and the best choice for each case taking into account all the relevant parameters (height, weight, pregnancies, breast feeding, body shape, body fat, size of the existing breasts, muscle tone).
Additional surgery – In case of ptosis (sagging breasts, a lowered areola), it is appropriate to associate a breast lift (mastopexy).
Dressings and drains – A drain may be left in place for a few days 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 for each case but in general the operation lasts two to three hours.
After the operation
There can be some 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 could be prescribed for several days to dull the pain. Even if there is no pain there will be a strong sensation of tightness.
Swelling and bruising of the breasts, and difficulty in raising 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. Then an elasticized bra can be recommended to be worn night and day for a few weeks.
Most patients are able to return to work within a few days. It is recommended to refrain from any strenuous activities that could raise pulse and blood pressure for a couple of weeks. Also, patients are advised to wait for about one month before practicing any sports.
This can be truly seen from two 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, too. 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 that 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.
The following imperfect results can occur occasionally:
- Asymmetry of the final volume in spite of the use of different sized implants to correct the problem.
- Stiffness with insufficient softness and mobility (especially with larger implants).
- An artificial appearance especially for very slim patients, the upper limit of the implant is visible.
- 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 – Following Breast Augmentation, 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, 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 prothesis! 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. It should be noted however that the new generation implants are far more hardwearing and reliable. The notion of replacement after ten years is not the rule – implants 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 the 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 one to two years, but in case of a change observed in a breast, or an accident affecting the breasts, an appointment must be scheduled.
Breast augmentation, even if performed for aesthetic reasons, is a genuine surgical procedure, with the consequent risks related to all medical acts. There may be surgical and aesthetic complications. Concerning anesthesia, the anesthesiologist will inform you about all the anesthetic risks. You must be aware that anesthesia can sometimes cause unpredictable body reactions that can be difficult to control. The presence of an experienced anesthesiologist, in a surgical environment, guarantees that the risks are practically statistically negligible.
In general, techniques, products and monitoring methods have progressed considerably over the last decade, giving optimal safety, especially when the surgery is elective and the patient is in good general heath. In general, after augmentation mammaplasty there can 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.
Possible complications inherent to all breast surgery:
- Hematoma: blood can surround the implant shortly after surgery. In case of heavy bleeding it is necessary to return to the operating room to drain the blood and stop the bleeding.
- Serous effusion: this means an accumulation of lymphatic liquid around the implant. It is a frequent complication often associated with considerable swelling. It gives rise to a temporary increase in the volume of the breast or breasts. It decreases gradually and disappears.
- Infection: rare after this procedure. It can require more than one course of antibiotics and the removal of the implant for several months following drainage. After this time interval another implant can be put in place. Three types of infection exist:
- – Late (silent) infection: this has few symptoms and can occur several years after implantation.
- – A micro-abscess: more frequent than the above, they can form on stitches and are absorbed after their removal with local treatment.
- – Toxic shock syndrome: rare cases of this have been reported.
- Skin necrosis: this occurs when tissue is starved of oxygen due to interruption of blood supply to the area involved. This can be favored by high blood pressure, hematoma, an infection or heavy smoking by the patient. It is a rare complication but is formidable as, if serious, it can reveal the surface of the implant, notably by splitting the stitches. A second operation is often required, with possibly the need to remove the implant.
- Abnormal scar: occasionally the healing process is unpredictable, and scars can be less discreet than expected. They can be widened, retractile, hyper- or hypo-pigmented, hypertrophic, or rarely, keloid.
- Sensory changes: this is frequently found in the first few months but usually diminishes over time; Rarely however, a certain degree of dysesthesia (heightening or diminution of sensitivity) can persist around the areola and the nipple.
- Galactorrhea/milk secretion: very rare cases of unexplained postoperative hormonal stimulation have been reported, giving rise to milk secretion which sometimes collects around the implant.
- Pheumothorax: very rare, has specific treatment.
Specific implant-related risks
- Wrinkling or rippling: the implant is soft and natural, and for this reason the outer envelope of the implant can form creases, which can be palpable or visible in certain positions under the skin, giving a ‘ripple’, effect.
- Capsular contractures: it is a normal physiological reaction that a fibrous shell should develop around an implant. A normal reaction to the presence of a foreign body in the organism is to isolate it from the foreign body with a hermetic membrane called a ‘periprosthetic capsule’. Normally this membrane is thin, supple, and imperceptible but the reaction can increase and the capsule can thicken, become fibrous and contract exerting pressure on the implant, it is then known as a ‘capsule’ There are four stages of hardening that range from a normal undetectable aspect to severe forms giving hard, round, immobile breasts which can be painful. Capsular contraction can follow infection or a hematoma, but often has no determined cause, resulting from unpredictable organic reaction. Surgical techniques have made great progress in recent years, but especially the design and products used for the implants are much improved, this means a considerable reduction in the number of cases of capsular contraction and their seriousness. If necessary, the capsule can be incised in a surgical procedure (capsulotomy).
- Rupture: implants have a limited life-span, as the silicone rubber envelope of the implant can deteriorate. It can become porous, have tiny leakages or split. This can be rarely after an accident, a puncture with a needle or because of a manufacturing flaw. Much more often, however this is due to deterioration of the implant over time. In all cases this will result in a leakage of the filling product, with different consequences according to the product concerned: If the implant is filled with physiologic solution or resorbable hydrogel the implant will deflate partially or totally, either suddenly or slowly. With silicone gel (non-absorbable) this will remain inside the membrane surrounding the implant. This can cause capsule formation or can remain un-noticed. In some cases, much rarer now, (mainly because the modern gels are more cohesive), the gel can penetrate the surrounding tissue. Rupture of the implants usually requires an operation to change them.
- Recent research has demonstrated that there may be some association between Breast-Implant-Associated Anaplastic Large Cell-Lymphoma (BIA-ALCL) and Polyurethane Breast Implants. Although this is a rare disease, many interesting theories surrounding its development have been advanced lately, indicating that implant surface may play a crucial role. Most BIA-ALCL cases are associated with macro-textured implants, but from a strictly scientific point of view, this link is not supported by any clear clinical evidence.
Alternatives to breast augmentation – Breast Augmentation with Fat Injection
Techniques of transferring fat using liposuction and lipo-filling have greatly evolved and are being used to augment and reconstruct the breast in a natural way. Fat injection/transfer to the breasts has several advantages over implants, such as:
- Fat is a completely natural substance that comes from the patient’s own body.
- Harvesting of the fat can be used to enhance your shape.
- The breast can be sculpted and shaped.
- There are minimal incisions with this procedure, which reduces the possibility of scarring.
- Fat grafting to the breasts can be used to disguise breast implants that do not look natural.
Fat transfer or lipo-filling used as a breast implant and its combination with liposuction has been used for over 20 years. However, the technique has been criticized as it can lead to fat dying, leaving cysts in the breast and/or calcifications, which can be seen on mammograms and which mimic cancer. Moreover, this technique is not for every patient. It is best suited to those who want to increase bra size by one cup size, those who require increased fullness in the upper pole of the breast, and after ‘conservative’ breast cancer surgery.
Patients who undergo this type of treatment must have been screened by mammogram and ultrasound before surgery, and followed up with regular mammograms and ultrasound for several years.
Risks and Safety:
Fat transfer breast augmentation risks include:
- Necrosis (death) of fat cells
- Possibility that some of the transferred fat cells will leave the breast area
You may additionally have to undergo touch-up injections to retain your improved shape if you choose this type of surgery.
My Way …. “Metron Ariston”
My choice is to obtain a natural result!
Disproportionate breast enhancements are no longer a trend. Successful breast augmentation should harmonize with the patient’s frame, offering a natural and less obvious result. Cutting edge advancements in breast implant technology provide patients with a wide array of safe choices, both as regards material and shape, safeguarding impeccable results. Breast augmentation improves not only the volume but the shape of the breasts, too. The scars are usually hardly visible. The result is a ravishing aesthetic improvement, as added breast volume affects the figure in general, while this usually entails a positive psychological effect, as well.
Although Breast Augmentation is one of the most popular aesthetic procedures of Plastic Surgery, it may have significant complications, such as formation of capsular contracture, implant dislocation and wrinkling/rippling of the skin. For this purpose, I highly recommend the Sub-muscular placement of breast implants, which provides a more Natural Appearance of the breasts and eliminates complications, providing:
- Low Capsular contracture rate
- Low incidence of synmastia (when implants appear to merge, leaving no space between breasts)
- Low rate of wrinkling/rippling
- More accurate mammograms
“Nano” Breast Augmentation: Breast Augmentation has never been more Safe & Aesthetically Balanced …
Ground-breaking advances in nanotechnology have influenced implant design & engineering. Creating a controlled nanotexture on implant surface provides positive results in terms of bacterial growth and guided tissue integration. The smooth Nano surface allows the body to more readily accept the breast implant, vastly reducing implant related complications such as capsular contracture, rupture, double capsules, or late seroma, while ensuring optimal aesthetic results.
This webpage aims to provide some information about the subject. Individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.
American Society of Plastic Surgeons, British Association of Plastic, Reconstructive and Aesthetic Surgeons, French Society of Plastic, Reconstructive and Aesthetic Surgery