Breast augmentation

The implant can be round or anatomical, « waterdrop shape ». Anatomical implants recreate the natural shape of the breast. However, they may rotate and create a deformation of the breast. For that reason, the use of anatomical implants will always be considered during a consultation and the shape of the implant will be chosen accordingly by the patient.

The different projections for each implant appear to give a somewhat rounded shape to the breast. The projection of the implant will be defined according to the size of the breasts before the surgery, the expectations of the patient, and the anatomy of the chest. The larger the chest, the smaller the projection will be to occupy its space.

The implant can be placed in front of or behind the pectoralis major muscle.

A positioning in front of the muscle is best suited for athletes or patients with a certain breast volume.

A positioning behind the muscle will be considered for patients with small breasts or patients who are very thin. In addition to these solutions, two other options can be considered:

The dual plane positioning of the implant, under the muscle in its upper part and under the gland of its lower part, is a solution combining the benefits of both positions and avoiding the drawbacks. Finally, a common practice consists of placing the implant in its physiological position, in front of the muscle and filling the upper area of the cleavage using lipofilling in order to obtain a natural result even on thin patients.

Scars are usually located under the arms or the breasts so as to be discreet. They can be located in the armpit (axillary scars), on the areola (periareolar or transareolar scars), or under the breast (submammary scars). An areolar scar is likely to cause a loss of sensitivity in the area of the breast.

• The size of the implant will be defined during 2 test consultations aimed at defining the best solution for the patient.
• A mammography and an ultrasound examination are always required.

Blood analyses will be done and urine monitoring will help determine the potential presence of an asymptomatic urinary infection, which should be treated before surgery in order to prevent an infection of the implant.

The surgery is performed under general anesthesia in a semi-upright position in order to see the results in a standing position. It usually lasts 1 hour. The patient arrives in the morning and returns home in the evening or the next morning.

Generally it is not necessary to use drains.

There is no dressing, but a medical bra should be worn day and night during the first month. Patients will be able to go back to their normal activities after 1 week and sports activities can be resumed progressively after 1 month. Post-operative physiotherapy will help the recovery proceed faster for good mobility in the arms and attaining the natural suppleness of the breast.

The definitive shape and volume of the breasts will be determined somewhere between 3 to 6 months following the surgery. Regular check-ups will be scheduled after the surgery.

Following a breast augmentation in France, the patient will be given the implant traceability card, with references and serial numbers, along with the operative report after the surgery. It is strongly advised to replace implants after 10 years in order to avoid potential complications such as capsular contractures.

Potential complications may include the following:

• Bruising: postoperative bleeding generally appearing within 24 hours following the procedure. Surgery is immediately carried out in order to contain the bleeding. Aspirin-based and anti-inflammatory medication must be avoided 8 days before the procedure in order to reduce the risk of bleeding.
• Infection: it is very rare in cosmetic surgery and generally avoided through strict aseptic conditions before the surgery (depilation, showers with Betadine…) and the elimination of all sources of infection such as dental infection or cystitis.
• Capsular contracture: an excessive scarring of the tissues around the implant. This can occur if there is bruising or from an underlying infection. It is best treated quickly when it appears. However, when the capsular contracture is in place, and the breast is painful and distorted, surgery will be required. Postoperative check-ups are essential in order to detect and to treat a potential capsular contraction.

The first shower is permitted the day after the surgery but baths should be avoided during the first month. The scars must be protected from the sun during the first year after the surgery in each and every case.