Breast enlargement, also known as breast augmentation, consists in inserting an inflatable implant (prosthesis) either behind the breast tissue or the chest muscle (on which the breast lies) in order to increase the volume and/or to enhance the shape of the breast.
There are several types of breast implants available and all are made of a soft outer shell filled with either a saline solution or with silicone gel.
The walls of the outer envelope are made of silicone. But let it be well understood it is not silicone gel (see silicone gel). Silicone is a material that is very biocompatible with the human organism. It is used in the fabrication of articular implants, pacemakers and artificial heart valves, condoms, lubricants and certain medications.
The shell has a round shape and may present a high profile (fig. 1) or a moderate profile (fig. 2). The high profile has a smaller circumference and results in breasts with greater projection. We recommend the high profile implants for women with narrow rib cage and breasts.
Please note that the colors Green and Blue are used to differentiate the type of implant. The real implants are transparent.
Saline is a sterilised water solution with a 0,9% sodium (salt) concentration. Saline can easily be reabsorbed by our system. In case of a leak, saline does not cause any harm, because it is similar in composition to the liquid that makes up 70% of our body.
The breast implants that were made in the 1960’s were filled with silicone gel. This type of gel, which is at the heart of the controversy over the safety of these implants, is now, since October 2006, under restricted sale for the following 10 years.
Health Canada allows the manufacturers to sell the silicone gel implants, but subjugates them to these conditions:
It is therefore important to understand that the silicone gel implants are sold in Canada but are constantly submitted to numerous studies.
(See the Health Canada Internet site: http://www.hc-sc.gc.ca/ahc-asc/media/nr-cp/_2006/2006_103bk1-eng.php)
The possible consequences related to ruptured silicone gel implants are not entirely known since they are currently being studied. Nevertheless, there have been cases where the silicone gel had migrated to the chest wall, the armpit, the upper abdominal wall, the arm and the groin. Some studies have shown cases where silicone gel was found in the liver of patients with silicone gel breast implants. There were also reports of silicone gel being found in the axillaries lymphatic ganglions which then caused a lymphadenopathy, even when no implant rupture was detected.
Possible consequences of a silicone gel migration are the following:
In the event of a ruptured silicone gel implant or of a capsular contracture with calcification, the required surgeries are difficult, lengthy and costly.
The current studies concerning cohesive silicone gel implants prove that there is now a lower risk of capsular contracture, but this risk is still higher than the one regarding saline implants. According to the same studies, gel migration risks are also lower, but gel bleed (silicone compounds diffused through an intact shell) may still be persisting. In about twenty years from now we will know for certain if these implants are secure. Do you really wish to be part of these studies?
It is your plastic surgeon’s responsibility to give you detailed and written information concerning silicone gel implants. He must also make you sign a document stating that you have received this information and that you are making an enlightened decision.
There are three types of conventional incisions through which to insert the breast implant. Once the incision is done, the pocket is prepared to receive the implant using specific surgical instruments.
Absence of scar on the breast
Technique by endoscopic surgery Endoscopic surgery consists in operating through short incisions using special long instruments and a small video camera attached to the endoscope which transmits an enlarged image on a monitor. This kind of surgery is very precise and reduces the risk of complications and requires a shorter recovery time;
It is false to think that endoscopic transaxillary surgery:
Caution! Transaxillary incision without the endoscopic camera is not recommended, because of the substantial risk of complications for: excessive bleeding, wrong positioning of implant and loss of sensitivity.
Endoscopic surgery represents the future of the medical world. It is notably used in orthopedics, gynecology, ENT, pediatric surgery, general surgery (intestinal) and plastic surgery. Some plastic surgeons refuse to move forward along with the technological progress, either because of lack of scientific knowledge or because of financial reasons (this technology is an expensive investment and has a high maintenance-related cost).
(subpectoral placement) (Fig. 6)
For patients with minimal breast tissue (AA/A or B- cup size)
For patients with more breast tissue (B+ or C cup size)
For patients with more breast tissue (B+ or C cup size) Same advantages and disadvantages as the submammary placement (see above), but may result in a more natural appearance since the muscular fascia could help conceal the outline of the implant.
Once the incision has been made, special surgical instruments are used to prepare the pocket for the insertion of the empty implant, which is to be placed either under the breast (glandular) tissue or the chest muscle. Once in position, the implant is then filled with saline solution (by aseptic transfer) until the desired size is obtained. The surgery lasts about one hour and a half and is done under general anaesthesia.
