The installation of breast implants is the most widely performed procedure globally, with nearly 1.8 million procedures in 2019 (source ISAPS). Around 400,000 women have already taken the plunge in Turkey, and demand remains high for what you need to know before getting started.
Breast implants are never an easy task; you have to be sure of the type of breast you want and its volume and accept the idea that you will be operated on.
At least another time to replace them, two to three times if you go there at 25, Because an aesthetic operation is never harmless despite advances in anesthesia and safer technical gestures. And the question of security remains central.
WHAT IS A BREAST INCREASE?
A surgical procedure consists of placing breast prostheses to increase the breast. Breast increase can also correct slight breast ptosis, especially when the loss of volume is following limited pregnancy or weight loss. When the relaxation is essential, the surgeon will advise doing a breast-plasty simultaneously. “When the nipple goes lower than the submammary groove, you also have to go up the breast,” says Dr. Bertand Mattéoli, cosmetic surgeon. Lip modeling is sometimes considered when the desired increase is minor, around a bra cap (see below).
THE FIRST CONSULTATION
- The surgeon will ask you about your medical and surgical history to rule out contraindications such as coagulation disorder and cardiac disorders.
- The surgeon will examine the silhouette, bust, size, shape, and positioning of the breasts and the place of the areolas. If he discovers an asymmetry, he will report it because it will likely be noticed more once the breast implants are in place. The tone and thickness of the skin are essential and will guide the choice of implants: if it is of poor quality, they should not be too large, therefore too heavy, not to accentuate the natural sagging of the breast.
- The surgeon asks you which breast you would like and what size: an essential point to define to be satisfied with the result.
- He explains which implants are best suited and how he will put them in place: he will choose the access route according to his experience and different morphological criteria: the way can be areolar, axillary (incision in the armpit), or, more rarely, submammary (the surgeon incises in the fold under the breast, the only solution to introduce polyurethane prostheses). Thus, the scars will be located in the armpit, around the areola, or in the submammary fold. It also specifies whether it will place the prosthesis in front of the pectoral muscle or behind it, i.e., retro-muscular, or partly in front and behind, a technical decision taken according to criteria such as thinness or quality of the skin.
- The surgeon then describes the procedure, the exams to do before (mammography and ultrasound), and the precautions to be taken: no aspirin, the previous days, or tobacco which increases the risk of complications and poor healing. It provides information on the risks and possible complications, from the slightest (folds, waves, hypertrophic scar) to the most troublesome (loss of sensitivity, infection, shell, rupture), to the most exceptional, phlebitis, embolism (see below). Finally, he gives you the quote, including the cost of the implants, operating room, anesthesia, fees, and informed consent. Two documents to bring back signed during the second consultation or the day of the intervention.
THE DIFFERENT BREAST PROSTHESES
The majority of them consist of a silicone shell, more rarely polyurethane foam, and a filling product. The surgeon explains the parameters to consider to choose the model most suited to the desired result. “The choice is complicated because there are more than a dozen possibilities for the same volume depending on the shape, the projection, the texture,” says Dr. Mattéoli. In agreement with his patient, the surgeon will therefore choose:
- Implants filled with a more or less cohesive silicone gel (= hard in expert language) are the most used because they give a more natural result than those filled with physiological saline, both by sight and touch. If the implant ruptures, the viscosity of the gel limits the leakage of silicone into the body. The advantage of physiological serum: it is entirely harmless if the prosthesis breaks.
- Round prostheses, more rarely anatomical prostheses, have the projected shape of a breast. “They are more used in reconstruction or women with very flat breasts,” notes Dr. Mattéoli. Their disadvantage: if they move, they will have to operate again.
The texture of the silicone shell: it can be smooth, micro-textured, textured, or micro-textured.
- The projection: an implant generally exists at three different points.
THE RIGHT VOLUME FOR BREAST IMPLANTS
It’s not easy to imagine what a “300 cc” prosthesis can give; the average volume placed in Turkey. “You have to think honestly about the kind of breast you want,” warns Dr. Mattéoli. Otherwise, you risk being disappointed, either with breasts that are too large or with breasts that are too small once the post-operative edema is deflated. “Dr. Volpeï insists:” The woman must ask herself if she wants something classic, elegant, or if she is ready to assume a result that is not “natural.” Most surgeons have test implants to slide into the bra to see the result. It is best to bring a white V-neck T-shirt, which will give a good idea of the increase and its impact on the neckline and figure.
HOW DOES THE OPERATION GO TO DO BREAST IMPLANTS?
- Under general anesthesia, The anesthesiologist must be consulted at the latest 48 hours before the procedure.
- Generally count two days of hospitalization, including the night following the intervention.
HOW ARE WE JUST AFTER BREAST IMPLANTS?
It hurts, especially when the prosthesis is placed behind the pectoral muscle, especially during specific movements, so we take painkillers to relieve the pain. The chest remains swollen for 15 to 20 days and remains sensitive for several weeks. There may be bruising, especially scars, which will fade within a month. Drains, dressings, bandaging, in terms of post-operative care, each surgeon has their habits, but generally, we wear a sports bra for a month to a month and a half. The loss of breast tenderness is usually transient, rarely permanent, but it may not come back ultimately. The sutures are removed between the tenth and the fifteenth day unless they are absorbable. We see the surgeon again at 3 or 6 months than at one year to verify that everything is going well. Then, we follow the recommended and essential monitoring rhythm according to his age, generally once a year: the best is to follow the recommendations of the ANSM.
SHOULD YOU TAKE A LEAVE AFTER BREAST IMPLANTS?
Yes, from a few days to two weeks, depending on the scope of the intervention and its profession. You have to wait a good month before resuming sport; sometimes two: common sense invites you to take your surgeon’s advice. Be careful, whatever the physical activity, you wear a suitable sports bra from the first session.
CAN WE SEE THE RESULT OF BREAST IMPLANTS FOR HOW LONG AFTER?
Right after, the breasts are swollen so bigger than they will be once the edema disappears within a month. You have to wait 3 to 6 months to assess the final result and one year for healing.
HOW MUCH DOES IT COST?
From € 4,000 to € 7,000, including taxes.
REPLACEMENT OF BREAST PROSTHESES
You never know when to change them 10 to 15 years later. This replacement must be carried out well in advance in the event of a problem, for example, a rupture of the implant or a shell.
THE HULL PROBLEM
According to studies, this complication is not uncommon: according to studies, the risk is assessed from 2% to 20%. The trouble seems lower with micro-textured prostheses (2% to 5%) or polyurethane: the latter, widely used in South America, is not used in the United States and not very often in Turkey, mainly because they make a very firm chest.
- In stage 1, “the capsular contraction is only detectable by the surgeon.
- in stage 2, “the defect is palpable but not visible. “
- in stage 3, “the hull is visual and becomes troublesome. “
- “in stage 4, the shell is painful. In this case, there are several possibilities that all require reoperation, either to remove the prosthesis and replace it with another of a different texture, remove the shell, or modify or enlarge the compartment in which the implant is placed. “
BREAST PROSTHESES AND CANCER
Several studies have shown no increased risk of breast cancer in women with breast implants. Complete information is available on the ANSM website, the National Agency for the Safety of Medicines and Health Products.
The recent disclosure of the risk of anaplastic large cell lymphoma associated with a breast implant (LAGC-AIM) has been the subject of several expert meetings. To assess “the possible imputability of certain prostheses in the appearance of LAGC”, the ANSM created a temporary specialized scientific committee as part of the action plan coordinated by the Ministry of Social Affairs.
Data are lacking on this sporadic type of cancer (19 cases out of 400,000 carriers of breast implants to date) and on the type of implants that could be involved in its occurrence: it seems that the micro-textured enveloped models are micro-textured more numerous in the declared cases. But in the absence of formal evidence of their involvement, no ban is planned at the moment. The Professional Directory of Plastic Artists published a press release on March 17 on plasticiens.fr, the Sofcep website. “If the subject is worrying, we must keep the sense of measure and not unnecessarily worry the population. The frequency of LAGC is so low that the risk is still complicated to quantify. (…) This risk is so low that it does not justify any preventive explantation, regardless of the type and age of the implant. However, surgeons are now required to educate patients about this risk and all serious, even infrequent, risks associated with anesthesia and the procedure.
More information on the ANSM website and on the Ministry of Social Affairs, Health and Women’s Rights website.
THE QUALITY OF THE IMPLANTS FOR BREAST IMPLANTS
Even if the P.I.P. is fraudulently filled with silicone gel that did not comply with the legislation had not taken place, any candidate for breast augmentation necessarily wonders about the quality of the implants that she will receive. She must be able to ask all the questions that concern her on this point to the surgeon, from why he chose this implant to why a model of this brand was there. Since 2011, the ANSM has been increasing the controls of manufacturers and distributors and has just announced an enhanced surveillance campaign, notably due to the risk of LAGC-AIM (anaplastic large cell lymphoma associated with a breast implant).
WHAT DOES LIPOMODELING WORK?
This involves removing fat from the belly, thighs, or the inside of the knees, centrifuging it and then injecting it drop by drop into the chest; that’s why we talk about “fat grafting” or fat micro-grafts or lipofilling. “A technique currently reserved for patients under 35 and without a direct history of cancer,” says Dr. Volpeï. This lipomodelling allows an increase that does not exceed a cup size. Touch-ups are sometimes necessary six months later to correct an asymmetry of result or an insufficient result because part of the grafted fat melts. Therefore, it is occasionally required to add more. This technique is also used in addition to breast prostheses. “It is an anti-small defect weapon, specifies Dr. Volpeï; one can put grease to soften the cleavage, reduce the space between the two breasts, or mask wavelets and imperfect.”s.” To hide, for example, the edge of implants visible in a skinny woman.
THE RIGHT INFORMATION ABOUT BREAST IMPLANTS
A first meeting must provide the elements necessary to decide fully about the facts. With the legal mandatory reflection period of fifteen days, the date of the intervention will be set beyond that, often during a second consultation. It’s always best to consult a double surgeon for another opinion. Softcore, the French company for reconstructive and aesthetic plastic surgery, and Sofcep make a detailed file on breast prostheses available on their website.
THE GOOD SURGEON FOR BREAST IMPLANTS SURGERY
- He has competence in plastic, reconstructive and aesthetic surgery. To be checked in the directory of the Bar Council.
- He operated on a friend or acquaintance, delighted with the result. Unless the current does not pass with it, you must know how to trust your intuitions
- He inspires you with confidence, listens, and understands what you want, a sign that he will also be able to respond and reassure you after the intervention, including in the event of complications.