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Augmentation and Breast Reconstruction

Medical Definition of Augmentation

Many women wish to have bigger breasts, estimating their breasts too small since always or become too small following a pregnancy or slimming. In all cases, the most commonly used approach is the prosthesis or breast implant. According to the scientific literature, less than 1% of women who wish to have larger breasts are ready to go through surgery. However, in the United States, the number of women and girls who choose implants for aesthetic reasons more than doubled between 1997 and 2000.

Medical treatments

Breast implant method

It is by far the most frequent and reliable intervention to give satisfaction to a woman judging the size of her breasts insufficient. The surgical procedure is to introduce prosthesis, usually by an incision around the areola of the breast.
Since 2001, surgeons have been using cohesive silicone gel, and silicone gel breast prostheses have become increasingly popular. Other prostheses, containing physiological saline, that is to say a saline solution are much less used now because the touch of the breast is sometimes less pleasant and the deflation of this type of prosthesis more frequent.

Lipofilling method or fat self-graft

This operative technique is often used for breast reconstruction after breast ablation surgery, more rarely for the aesthetic increase of the breasts. It consists of removing fat from the woman’s body (belly, thighs, breeches), in order to reinject her into the breasts. The method seems ideal, but presents several difficulties: some of these injected fats are then resorbed by the body. And the rate of fat resorption is difficult to predict, leading to breast asymmetries or insufficient breast volume. This therefore often requires editing. On the other hand, the fat used in its resorption can sometimes cause cysts in the breasts. And then, this method is inapplicable or insufficient for women who do not have a sufficient natural stock of fat.

A short history of implants

Breast implants filled with very oily silicone gel were developed in the 1960s, while there was no legislation controlling the medical device market. In the United States, the government agency Food and Drug Administration (FDA) has such authority since 1976, but other devices (heart valves, cochlear implants, prostheses etc.) were treated primarily, breast implants being still, at the time, relatively uncommon.

In 1990, nearly a million American women had such implants and the FDA still did not, as required by law, require manufacturers to prove their efficacy and safety. However, the media reported more and more anecdotes and opinions that serious health problems could be linked to these devices. In fact, like the silicone gel used at that time, it always migrated a little through the wall of the implant, which could lead to the production of antibodies which, feared, could be the source of “self- immune system “(polyarthritis, scleroderma, fibromyalgia, etc.).

In 1991, the FDA enforced the law and asked manufacturers to provide the relevant studies. These, however, must be based on large populations and identical devices, and be spread over long periods of time; none of these conditions could be fulfilled at the time, it was thought to remove the implants outright from the market, the time to conduct adequate research. But a powerful lobby opposed it, supported in particular by women with breast cancer. Although their manufacturers have yet to demonstrate safety, silicone breast implants remain on the market as “public health needs”, being accessible only to certain clienteles in the context of clinical research. .

Between 1995 and 2001, there was a moratorium, silicone gel being banned in most countries of the world to study closely the effects of implants containing this type of gel. During the entire period of this moratorium, only physiological saline or saline prostheses were put in place.

In 2001, the appearance of cohesive silicone gels, denser allowed the rehabilitation of silicone breast implants. These gels have the advantage of being less problematic in case of breakage.

Procedure of the surgical intervention

Before surgery, a consultation with the surgeon will expose the problem and define the size of the implant. It is chosen according to the desire of the woman, of what she wishes, and it fits in a fork: it is necessary that the change is perceived (it would be a pity to be operated for an almost unsuspected result), but do not become disabled by too much breast volume. It is also necessary that the anatomy of this woman can support this prosthesis and that the chosen form can give a natural result. The advice of the surgeon is therefore essential because it explains what is possible according to the anatomy of each woman. And then, he exposes photos of breasts to determine what she wants.
As the implementation of a breast implant is done under general anesthesia, it requires a prior visit to a doctor anesthetist.

During surgery, which takes about an hour, the woman, receives antibiotics operated infusion to decrease the risk of infection. The most classic incision to implant the implant is practiced around the areola, in its lower part and concerns a third to half of this areola. The surgeon provides a box larger than the implant to set it up. Indeed, it allows the prosthesis to move a little in this box, and to have a natural behavior during changes in position (lie on the back for example). The surgeon places the prosthesis in front of or behind the pectoral muscle: in front of most often and behind this pectoral muscle if the woman has very little or no breast.

And after the operation for breast implant?

A woman coming to benefit from breast implants is generally hospitalized the night following the intervention. She feels aching on awakening at the chest, a bit like after a good workout. At first, during movement, she may feel pain. She must then give herself 4 or 5 days of strict rest and 7 to 10 days of recuperation in all. In some cases, a bra may be prescribed by the surgeon.
The appearance of the scar is usually a little red for a month and a half to two months, then it gradually becomes a little almost invisible white line. The final result is obtained in 3 to 6 months, the time that the healing is done and that the tissues and the implant take their place. After the surgical procedure, the sensitivity of the nipples is very variable: it can remain intact after the operation, or it can be reached to return generally in a few weeks to a few months, even if in rare cases it can be longer.
Breastfeeding remains possible; the intervention does not concern the mammary glands. Screening for breast cancer was once a little more difficult with implants because it made the radiological image less easy to read, so sometimes cancers were less easy to detect and there was fear of delayed diagnosis. Today, advances in radiology make it much easier than before to read mammograms after an implant. To the touch, we can feel that there is prosthesis, but the touch remains very natural with the cohesive gels currently used.

Research on the safety of implants

There is no link between the placement of a prosthesis and breast cancer. This is why a surgeon places the same type of prosthesis in case of reconstruction of a breast that has been diagnosed with cancer. A breast implant on one side does not increase the risk of cancer in the other breast.

Is there a risk of autoimmune disease?

This risk could only concern silicone implants, since the silicone has been suspected of disturbing the metabolism by spreading throughout the body. There are dozens of searches on this topic, which can probably be attributed to the very costly prosecution threats that have weighed on implant manufacturers until recently. The data published until 2011 and endorsed by the main control or monitoring bodies (and widely reported by the media) conclude that these devices would not have relationship with autoimmune diseases. “

Side effects of breast implants 

  • Hematomas can occur: after surgery, they may require re-intervention. But this has no impact on the final result.
  • The appearance of hulls has become an exceptional situation. This is a body reaction to the implant that forms a rigid area, such as a shell around the prosthesis. This is increasingly rare, thanks to the improvement of new prostheses and operative techniques. Currently, surgeons are working to do good hemostasis (prevent the area from bleeding during the operation) and leave as little blood around prostheses, and the texture of the envelope, which significantly reduces this risk of hulls.
  • Reduced sensitivity Between 3% and 15% of women experience permanently reduced nipple and breast sensations after implant insertion.
    It is common after surgery, and it recovers in the vast majority over weeks or months. However some women retain a change of sensitivity or pain.
  • Displacement: The implants are placed in front of or behind the pectoralis major muscle. The retro-pectoral position can sometimes lead to movement of the prosthesis during contractions of this muscle. This can be embarrassing and sometimes it is necessary to intervene if it is embarrassing aesthetically.
  • Aging of the prosthesis. This aging can cause deflation for a serum prosthesis or rupture for silicone prostheses. It must therefore be supervised, especially around the eighth to tenth year. The surgeon may decide to change the prosthesis or monitor it regularly for signs of alteration. The deflation of the saline prosthesis (sterile salt water) is harmless in terms of health, even if it causes discomfort. The rupture of silicone prosthesis imposes the change of prosthesis. As the current gels are very cohesive (the silicone remains well agglomerated and is unlikely to spread in the tissues), they are easy to remove and without risk for the woman.
  • Warning: if you have prosthesis and you notice something weird (displacement, deflation, abnormality, change of touch, etc.), you must contact your surgeon for an examination.

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