Breast Enlargement Procedures
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 and skin stretching and a lowered areola. This insufficient breast volume is often a source of physical and psychological distress for the patient who feels she lacks femininity, with also a lack of self confidence and poor self-image which can lead to an inferiority complex. Breast augmentation with implants is the solution to these problems. 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 who can adapt them to the patient to a certain extent during the procedure.
NEW GENERATION SILICONE GEL IMPLANTS
The great majority of implants used in UK, India and elsewhere in the world are pre-filled
These implants, which have now been used for over 40 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. At present all implants available have been certified as safe by the EU and FDA in USA. 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.
THE SURGICAL PROCEDURE
This surgery is usually performed under General Anaesthesia The incisions normally employed are – 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, or in – 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. Additional surgery In case of ptosis (sagging breasts, a lowered areola), it is appropriate to associate a breast lift (mastoplexy); this implies additional larger scars (around the nipple, or in a vertical position). Dressings and drains A drain may be left in place for a one day 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 with each surgeon and of course lasts longer with additional surgery but in general the operation lasts one to two and a half hours.
There can be 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 of the strength necessary to dull the pain, is prescribed for several days. Even if there is no pain there will be a strong sensation of tightness. Swelling and bruising of the breasts and difficulty in rising 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, and then an elasticized bra can be recommended to be worn night and day for a few weeks. If the stitches are non-absorbable they will be removed several days after surgery. 5 to 10 days convalescence is necessary before returning to work. Patients are advised to wait for one to two months before practicing any sports.
The following problems can occur occasionally after surgery : – Stiffness with insufficient softness and mobility (especially with larger implants). – 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.