The breast implant fitting is certainly the most popular and the best known cosmetic surgical procedure in the world and in Switzerland. The patient’s motivation and expectations are very important to consider in this type of surgery. Thanks to the Crisalix® software, a preview of the result is possible even before the procedure. An ideal solution to refine one’s project.
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DEFINITION AND OBJECTIVE OF SURGERY FOR A BREAST AUGMENTATION WITH IMPLANTS IN MONTREUX, LAUSANNE AND GENEVA (SWITZERLAND)
Mammary hypotrophy affects femininity and can have significant physical and psychological repercussions. It is sometimes the cause of a serious complex responsible for a loss of self-confidence. The aim of the intervention is to achieve a breast augmentation, thanks to the implantation of breast implants. The result must be as natural and harmonious as possible.
The breast implants that are used in Geneva, Montreux or Lausanne (Switzerland) and around the world are mainly filled with medical gel silicone.
These breast implants have been used since the 1960s to increase the volume of the breast. Over the decades, scientific studies have demonstrated their safety and their appearance very similar to a normal breast palpation. Since the beginning of the 2000s the breast implants have been modified to be even more resistant and to have a longer life. As with all medical devices, their manufacture is subject to very strict rules.
The breast implants consist mostly of a very resistant textured envelope, elastic and composed of three layers. The envelope is filled with a medical silicone gel whose flexibility and consistency are close to those of a real breast. The technical modifications made to the new implant relate to:
- The implant’s capsule: this very solid envelope, prevents any diffusion of the silicone gel outside the implant and allows the latter to have a longer lifetime.
- The medical silicone gel: also called “cohesive”, flexible and firm at the same time, its consistency is close to that of the mammary gland. In case of traumatic rupture of the envelope, the gel remains inside the implant.
In addition to these technical modifications that make breast implants much more reliable, there are now several forms of round or anatomical breast implants (drop-shaped). These implants are differentiated by their diameter at the base, their projection or profile (low, moderate and high) and their height (for anatomical implants).
The wide variety of implant shapes and volumes allows each patient to make a personalized surgical decision, depending on their body features.
For Dr. Jean-Charles BAYOL, each patient is unique. The consultation will begin with a thorough questioning in order to know your background, your wishes and your motivations. Clinical examination will inspect and examine the breast, it will end with the measurement of the breast and the chest.
After the questioning and the physical examination, Dr. BAYOL will determine with you, the shape and volume of the desired implants, the seat of the future scars, the location of the implants compared to the pectoral muscle in order to obtain the best aesthetic results that will fulfill your expectations.
A three-dimensional computer simulation of the expected result can immediately be achieved through a touch pad (iPad) equipped with a scanner, or after the digitization of photographs taken after the clinical examination. The Crisalix software makes it possible to simulate the breast augmentation with various types of implants and compare the results.
Beyond the age of 35, or if there is a family history of breast cancer, a mammography and / or an ultrasound will be prescribed.
Four medical prescriptions will be made regarding the surgical procedure: one for a preoperative assessment, one for a compression bra, one for stockings, and a last one for a homeopathic treatment that will have to be taken 10 days prior to surgery in order to minimize, Edema and postoperative hematomas.
An appointment for a consultation with an anesthetist should be made.
Since tobacco has a deleterious effect on the healing process, it is strongly recommended to stop smoking at least one month before the procedure.
Taking aspirin (which promotes bleeding) should be prohibited in the 15 days before surgery.
It will be necessary to be fasting (not to eat, to drink and smoke) at least 6 hours before surgery.
This procedure will be performed under anesthesia in the operating room, during which you will be deeply asleep.
It is required to stay for a day and night at Laclinic in Montreux. Most often the patient checks in the morning, is operated and is monitored the rest of the day and the night that follows. Then the check-out takes place on the following morning.
Each aesthetic surgeon has his own technique that he adapts to each patient in order to achieve the best result. However, it is useful to explain some common surgical principles:
- Incisions of the skin, the possible approaches:
There are several possible skin incisions (Figure 1). The design of these pathways corresponds to the seat of the future scars, which will be hidden in junction zones or natural folds. Each approach has its advantages and disadvantages.
- The axillary approach: the scar is hidden under the arm. This approach allows the placement of the implants behind the pectoral muscle which avoids any scar on the breast itself. Doctor Jean-Charles BAYOL often chooses this technique for young patients who have little or no breast at all. However, this approach cannot be reused in the event of a change of implant.
- The peri-aerolar approach: the incision is made on the lower hemi-circumference of the areola. This is the most common approach used for breast implants in pre-pectoral situations. It allows direct control of the implantation area (dissection, hemostasis). Dr Jean-Charles BAYOL performs this approach on patients who have had variations in breast volume due to pregnancies or variations in weight and also when the breasts fall slightly. Nevertheless, this transglandular approach severs some galactophoric ducts (likely to compromise a future breast-feeding).
- The under breast approach: the scar is located in the fold under the breast. This approach aims patients with a well-defined sub-mammary fold and a nice ptosis, in order to place the breast implant in a pre-retro-pectoral position with direct control of the implantation area (dissection, hemostasis). However, since the scar can sometimes be located above the sub-mammary fold and thus more visible, some patients criticize this technique. That is why, Doctor Jean-Charles BAYOL rarely performs this approach.
- Positioning of the implants: After having created the path of approach, the space that will receive the implant can be made in front or behind the pectoralis major muscle:
-In front of the muscle or pre-muscular (figure 2): the implant is positioned behind the mammary gland and in front of the pectoralis major muscle. This is the best anatomical position but the upper pole of the implant may sometimes be visible, especially in the case of a thin patient.
– Behind the muscle or retro-muscular (Figure 3): the implant is positioned behind the muscle. The upper pole of the implant is less visible in a patient with a lean body. However, the postoperative pain is greater and there is a possible flattening risk during the contraction.
The implant is placed in a dual plane position when it is covered by the muscle at the level of its upper half and when it is covered by the mammary gland, spread out in front of the muscle at the level of its lower half.
The decision of the implants positioning depends on the morphological characteristics of the patient with whom Dr. BAYOL will determine the best solution.
- Possible associated surgical acts:
If the breast falls too much before the procedure (breast ptosis), it will be necessary to associate the installation of the breast implants with a breast lift or mastopexy (lien vers “breast lift”). This lifting consists in diminishing the excess of skin to bring up the breast and the areola. The scars are more important: a scar around the areola, a vertical scar under the areola, +/- a scar in the sub-mammary fold.
- Drainage and dressings:
A drain is put in place to evacuate the blood. It can be kept for 1 to 5 days and does not prevent from returning home.
At the end of the procedure, a simple dressing is placed on the scars. It is associated with a compression bandage. The restraint bra, prescribed during the preoperative consultation, is set up immediately after surgery in the operating room.
Depending on the cosmetic surgeon, the technique of appproach and the possible need for complementary gestures, the procedure can last from one hour to two and a half hours.
There is sometimes pain when the breast implant is placed behind the muscle and / or when the prosthesis is too voluminous. These pains can last a week; they will be efficiently calmed by a prescription of an analgesic treatment.
The first few days the breasts are bruised, swollen (edema) and it is sometimes difficult to lift the arms.
In order to limit the importance and the duration of the surgerical follow-ups, you will be systematically taken care of by the physiotherapy department for postoperative care. From the next morning, gentle massage of the operated area and LED care will ensure lymphatic drainage and will promote the healing process.
The first dressing will be removed the day after the surgery. Simple local scar treatments must be performed daily for a period of 10 to 15 days. Wearing a bra without armature night and day is mandatory for about 2 months.
A convalescence of one week is necessary, the practice of sport can be resumed after 6 weeks.
THE RESULT OF SURGERY FOR A BREAST AUGMENTATION WITH IMPLANTS IN MONTREUX, LAUSANNE AND GENEVA (SWITZERLAND)
It will take 6 months to get an idea of the final result. During this period, the breast implants will take their definitive position and the breasts will progressively soften.
The scarring result takes much longer, since it will take sometimes from one year to a year and a half to get a definite result.
The increase in the volume of the breast modifies the patient’s silhouette, this morphological modification improves the psychological well-being of the patient and often gives her more confidence.
Evolution in time:
Apart from weight loss or weight gain, the volume of the breast will not move in time and the result will remain stable. However, over time, the breasts will fall gradually. This will of course depend on the age of the patient, the elasticity of her skin, but also on the size of the implants.
Resulting imperfections may occur:
- Asymmetry: If the breasts are not symmetrical before the intervention, this asymmetry may persist after the intervention even if the breast implants with different volume are put in place.
- If the breast implants are voluminous, they can be more firm on palpation and give a lesser natural appearance. Likewise, voluminous implants will promote the development of a secondary ptosis of the breast.
- If the patient is thin, the implants will be more visible and may be perceived on palpation, even if they are placed behind the muscles.
These imperfections can sometimes be corrected a few months after the installation of the implants, particularly by a lipostructuring of the breast (reserves of fat will be necessary).
- Breast-feeding and Pregnancy
Outside the areolar pathway, where the galactophoric ducts are severed, breast-feeding is still possible after a breast augmentation surgery. Pregnancy is also possible without problems for the patient or the baby. If the patient wishes to be pregnant, it is preferable to observe a delay of 6 months after surgery.
- Immune diseases
Numerous studies have shown that compared to the population of women without breast implants there is no additional risk of an autoimmune disease appearance after a breast implant surgery.
- Breast Implants and Breast Cancer
A breast augmentation surgery with implants does not increase the risk of developing breast cancer.
However, breast implants can interfere with the performance and interpretation of mammograms and / or ultrasounds used for breast cancer screening. It is therefore necessary to warn the radiologist and always have your carrier of implants card.
If necessary, other techniques such as MRI can be performed.
- Breast implants’ length of life
As with any implantable medical device (such as heart valves, hip prosthetics, etc.), breast implants can wear out and their installation is not guaranteed for life.
The recent breast implants have a much stronger envelope and more solid gel. Although they are not guaranteed for life, they do not need to be changed every ten years as it was the case before. Breast implants will only be changed if there is a problem or if the patient wants a larger volume, another shape…
- Postoperative follow-up
In general, the first postoperative consultation takes place one week to ten days after surgery. The patient is examined again one month later, then 3 months, 6 months and after one year. These postoperative appointments are paramount even if everything goes well.
Beyond the first year it is necessary to consult every 2 or 3 years. One should not hesitate to consult in case of the slightest problem or the slightest doubt about an anomaly. For it is better to see his aesthetic surgeon for nothing (and be reassured) than to let a problem evolve.
Although breast augmentation with implant is considered as an act of cosmetic surgery, it is primarily a surgical procedure, which may involve risks even if they are low:
- Complications related to anesthesia:
The risks associated with anesthesia will be discussed with the anesthesiologist during the preoperative appointment.
However, any surgical procedure, even cosmetic surgery must be carried out in a strictly surgical environment in the operating room. As a result of the evolution of anesthesia and resuscitation techniques in recent decades, complications related to anesthesia are now exceptional.
- Complications related to surgery:
The use of a qualified, competent, and serious cosmetic surgeon reduces these risks, but does not completely eliminate them.
- Hematoma: A blood collection around the operated area is an early complication that may require a surgical procedure to evacuate the hematoma, clean and cauterize the responsible vessel, if there is one.
- Serous effusion: a lymph collection can appear around the implant. This will cause a transient increase in the size of the breast and will disappear spontaneously without resorting to a surgical gesture.
- Infection: an infection is rare but may require an antibiotic treatment and a new surgical procedure to remove the implants. It will be possible to put them back in place only after several months of healing.
- Skin necrosis: This risk is widely favored by the tobacco consumption hence the need to stop smoking 6 weeks before the procedure. Necrosis of the skin may expose the breast implants and require new surgical act.
- Healing disturbances: The healing process is a natural and unpredictable phenomenon, hence the need to wait a year to a year and a half to judge its final appearance. The scar can sometimes be hypertrophic or even keloid. Also, a hypo or hyperpigmentation may appear.
- Sensitivity disorders: Sensitivity disorders are frequent during the first weeks, most often they disappear spontaneously. Sometimes a small decrease in sensitivity may persist.
Complications related to breast prostheses:
- Wrinkling of the skin: Folds can be observed at the level of the envelope or seen on the lateral, medial or lower part of the breast. These folds are rarely visible.
- 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 “shell”. 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. Although the new implants have allowed a reduction of these “shells”, it is sometimes necessary to remove them surgically.
- Rupture: A rupture of the implant can be the result of its aging, or more often linked to a major trauma such as a car accident and more specifically due to the use of seat belts. It is advisable to consult your cosmetic surgeon in the case of the slightest doubt, a pain or a modification of the shape of the breast. In case of a rupture, the breast implant must be surgically changed.
- Bad positioning or movement of the implant: An error in the original position of the implant or an implant which “moves” can affect the shape of the breast and require corrective surgery.
- Turning: Although it happens rarely, the rotation of an implant is possible and may affect the shape of the breast. If the shape of the chest is altered, this rotation may also require re-intervention.
The aim of this surgical procedure is to improve the volume and shape of the breast. If your expectation is justified and reasonable, you will be fully satisfied with the outcome of the procedure.