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, moderate PLUS or a moderate profile. 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.
Saline is a sterilised water solution with a 0,9% sodium (salt) concentration. Saline can easily be reabsorbed by our system. In case of 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,since October 2006, has been under restricted sale for the following 10 years.
Health Canada allows the manufacturers to sell the silicone gel implants, but subjugates them to the following conditions :
- Annually review the results of clinical trials for the next 10 years
- Conduct a large, long term post-approval study following tens of thousands of women for 10 years after receiving breast implants
- Pursue implant retrieval and analysis studies – from all available sources – to further characterize the potential types and causes of implant failure
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)
Possible Consequences to a Ruptured Silicone Gel Implant
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:
- Nerve damage
- Appearance of granulomas
- Breakdown of tissues in direct contact with silicone gel
- Hardening of the breast tissues
- Alteration of the size or shape of the breast
- Fibrous capsule calcification
In the event of a ruptured silicone gel implant or of a capsular contracture with calcification, the required surgeries are difficult, lengthy and costly.
In short, cohesive silicone gel implants:
- Require a 5-6 cm incision (2.,5 cm transaxillary incision for a saline implant)
- Increase the mammary implant folds palpability (thicker implant shell)
- Require Magnetic Resonance Imaging (MRI) screenings to assess their condition. The U.S. Food and DrugAdministration (FDA) recommends that a woman should have her first MRI three years after her initial implant surgery and then every two years thereafter. The cost of MRI screening over a woman’s lifetime may exceed the cost of her initial surgery and may not be covered by medical insurance.;
- Require patients to be at least 22 years of age (while saline implants is for women 18 years of age and older)
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 compound 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
The Intervention: …Surgical Incision and Placement of Implant
There are three types of conventional incisions through which to inserting the breast implant. Once the incision is done, the pocket is prepared to receive the implant using specific surgical instruments.
Transaxillary (under the armpit)
Absence of scar on the breast
Technique by Endoscopic Surgery. Endoscopy – also called Breast Enlargement – 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;
- Technique usually used for the majority of Dr Bernier’s patients
- An almost invisible scar of 2,5 cm long in the armpi
- No scar on the breast
- Low risk of excessive bleeding
- Low risk of nipple sensitivity loss because the nerves are visible
- Massages can be started the day following the surgery
- No higher risk of complications
- Breast-feeding is possible after the surgery
- In case of complication, it is always possible to operate through the first axillary incision
- Since 1994, Dr Bernier had never reported a case of breast infection.
- The distance between the breasts is directly related to the pectoral muscle insertion. The incision site, whether it is transaxillary, inframammary or periareolar, does not alter the distance between the breasts. However, placing the implant directly behind the breast tissue (submammary placement) can help reduce the distance between the breasts.
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).
Periareolar (around the areola)
- Technique that can be combined with a breast lift surgery
- Scar might be visible on some patients
- High risk of excessive bleeding and nipple sensitivity loss caused by a poor visualisation of the nerves and blood vessels
- High risk of infection caused by the implant insertion through the mammary glands
- Possibility of mammographic abnormalities caused by scar formation in the mammary gland
- Possible difficulty breast-feeding
Inframammary (in the fold under the breast)
- Scar is longer (4 to 6 cm) and visible
- Risk of inappropriate positioning of the scar if the implant goes down or up (scar above or under the mammary fold)
- High risk of excessive bleeding
- High risk of nipple sensitivity loss caused by a poor visualisation of the nerves
- High risk of infection caused by the contamination of the operating field by the surgeon while he is looking in the breasts
- Possible difficulty breast-feeding
Placement of the Implant
Behind the Muscle
Subpectoral placement for patients with minimal breast tissue (AA/A or B-cup size)
- Better covering of the implant
- A natural appearance
- Lower risk of implant folds palpability
- Better for patient with minimal glandular tissue
- Better view of breast tissue when undergoing a mammography
- Breast-feeding is possible after the surgery
- May be more painful
- Higher risk of lateral implant displacement
- Possible deformation of the breasts when contracting the pectoral muscle
- Does not alter the distance between the breasts (the distance remains the same before and after the surgery)
Behind Breast Tissue
For patients with more breast tissue (B+ or C cup size)
- May be less painful
- Can help reduce the distance between the breasts
- No deformation of the breasts when contracting the pectoral muscles
- Lessened risks of implant displacement
- Unnatural appearance of the breasts in the long term
- Difficult imaging during mammography exam
- More visible and palpable implants
- Breast-lift surgery is impossible after this surgery
- Greater likelihood of capsular contracture
- Possible difficulty at breast-feeding
Behind the Muscular Fascia
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. The downtime for recovery is approximately 1 week.
Every plastic surgeon’s ultimate dream is to be able to whisk away all traces of surgery or scarring with a magic wand. At present, their wish has partly become true thanks to endoscopy.
Endoscopy consists in making a small incision several millimetres long through which surgical instruments and a minuscule camera are inserted. The camera then transmits an enlarged image of the body’s internal structures to a monitor, enabling the surgeon to see clearly on screen the work he is performing. Thus, long incisions for a direct view are no longer necessary. Aesthetic surgery performed with endoscopes at Dr. Bernier’s Clinic includes breast augmentation and tummy tuck surgery (abdominoplasty).