Breast prostheses

Breast hypoplasia is defined by a volume of breasts that is insufficiently developed in relation to the patient's morphology. It can be the consequence of insufficient development of the gland at puberty, or appear secondarily by loss of glandular volume (pregnancy, weight loss, hormonal disturbances…).
Lack of volume can also be associated with ptosis ("drooping" chest with sagging skin distension gland and areolas too low).
The procedure can be performed at anytime from 18 years of age.
The breast implants currently in use consist of a envelope and a filler.
The envelope is in any case made of a silicone elastomer. This membrane can be smooth or textured (rough). Some of them contain polyurethane.
The content is the filling product in the envelope.
Physiological liquid prostheses contain physiological serum (salt water), which is completely safe. They are either pre-filled at the factory or inflated by the surgeon during the operation, allowing for some intraoperative volume adaptation.
Pre-filled silicone gel prostheses are increasingly being used. They ensure a soft feel within the breast that is close to a natural consistency. Gels are more or less cohesive. Cohesiveness limits perspiration, i.e. the " transpiration " of the gel through the wall, a possible source of shell. It prevents the diffusion of silicone in the event of rupture.
The form
In addition to the classic round prostheses ensuring a beautiful cleavage, there are also profiled "drop" prostheses called anatomical for a perhaps more natural breast appearance.
This wide variety of shape and volume makes it possible to optimize and adapt the almost "tailor-made" choice of prostheses according to the patient's morphology and personal expectations.
There are also prostheses filled with hydrogel: This is an aqueous gel registered since 2005 and consists mainly of water gelled by a cellulose derivative. This gel, which is more natural in consistency than physiological serum, is also resorbable by the body in the event of a rupture of the envelope.
There are prostheses whose silicone shell is covered with a foam of Polyurethane which will be "integrated" into the surrounding tissues. They therefore provide a form of tissue "catch" that can be interesting in some difficult cases. The safety of polyurethane being today clearly recognized, these implants have experienced a certain increase in recent years because they would make it possible to better perpetuate their positioning, reduce the overweight induced on the lower breast pole and prevent the rotation of anatomical implants. The risk of inducing a hull phenomenon is deemed to be lower. However, they have a number of disadvantages and employment difficulties that will have to be weighed against each other.
In any case, the choice of the type of prosthesis will be the result of a discussion with the surgeon who will advise you on the most appropriate choice for your particular case.

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An interview followed by a careful examination will have been carried out by the surgeon, who will take into account all the parameters that make each patient a special case (height, weight, pregnancy, breastfeeding, thoracic and mammary morphology, skin quality, importance of fat and the present gland, musculature, etc.).
Based on this anatomical context, the surgeon's preferences and habits and the patient's expressed wishes, an operating strategy will have been agreed on. This will determine the location of the scars, the type and size of the implants and their positioning in relation to the muscle.
A preoperative blood test will be carried out in accordance with the prescriptions. The anaesthetist will be seen in consultation no later than 48 hours before the operation. A radiological check-up of the breast is prescribed (mammography, ultrasound).
No medication containing aspirin should be taken within ten days of the operation. You will probably be asked to fast (do not eat or drink anything) six hours before the procedure.
Type of anesthesia:
It is usually a classic general anaesthesia during which you are completely asleep.
In rare cases, however, a "vigilant" anaesthesia (local anaesthesia deepened by tranquilizers administered intravenously) may be used (to be discussed with the surgeon and the anaesthetist).
Hospitalization conditions:
The procedure usually justifies a one-day hospitalization. Entry is then in the morning (or sometimes the day before in the afternoon) and the discharge is authorised the next day.
However, in some cases, the procedure can be performed on an "outpatient" basis, i.e. with an discharge the same day after a few hours of supervision.

Each surgeon adopts a technique that is unique to him/her and that he/she adapts to each case to obtain the best results.
Skin incisions:
There are several possible "ways of approach":
•
areolar approach with incision in the lower segment of the areola circumference or horizontal opening around the nipple from below.
• Axillary approach with incision under the arm in the armpit.
• Submammary approach with incision placed in the groove under the breast.
A small drain can be set up depending on the surgeon's habits and local conditions. It is a device designed to evacuate blood that could accumulate around the prostheses.
At the end of the operation, a "shaping" plaster is applied with an elastic bandage.
Depending on the surgeon, the approach and the possible need for complementary procedures, the operation can last from one to two and a half hours.

The postoperative period can sometimes be painful in the first few days, especially when the implants are large and if they are placed behind the muscles. An analgesic treatment, adapted to the intensity of the pain, will be prescribed for a few days. In the best case, the patient will experience a strong feeling of tension.
Edema (swelling), bruising and discomfort when lifting the arms are common in the early stages.
The first bandage is removed after a few days. It is then replaced by a lighter bandage. A bra can then be recommended night and day for a few weeks.
Most of the time the sutures are internal and absorbable. Otherwise they will be removed after a few days.
It is advisable to consider a convalescence with interruption of activity of five to ten days.
It is advisable to wait one to two months to resume sport.
A period of two to three months is necessary to assess the final result. This is the time needed for the breasts to regain their full flexibility and for the prostheses to stabilize.
Some imperfections can occur occasionally:
• an asymmetry of residual volume incompletely corrected despite implants of different sizes;
• a slightly too much firmness with flexibility and mobility considered insufficient (especially with large implants);
• a somewhat artificial appearance, especially in very thin patients with too much visibility of the edges of the prosthesis, especially in the upper segment;
• the touch perceptibility of implants is always possible, especially when the thickness of the tissue cover (skin + fat + gland) covering the prosthesis is low. This direct palpation of the prosthetic membrane or even folds is more frequent in thin patients with large volume implants filled with pysiological serum and in a pre-pectoral position.
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About Breast prostheses

VARIOUS QUESTIONS
Pregnancy/breastfeeding
After a breast implant placement, a pregnancy is possible without any danger for either the patient or the child, but it is recommended to wait at least six months after the operation. Breastfeeding is not dangerous either and remains possible in most cases.
Autoimmune diseases
The very large amount of international scientific work carried out on this subject on a large scale has unanimously demonstrated that there is no greater risk of this type of rare disease occurring in patients with implants (particularly silicone implants) than in the general female population.
Prosthetics and cancer
Until recently, the state of science suggested that the implantation of breast prostheses, including sillicone, did not increase the risk of developing breast cancer. This is indeed still the case for the most frequent breast cancers by far (adeno-carcinomas) whose incidence is not increased by the installation of a breast prosthesis.