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.
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 physiological saline implant is inflatable while the silicone gel implant is pre-inflated. There are several types of breast implants and all consist of a soft outer shell.
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.
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 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
- Pain
- 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.
- Require a longer 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.
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. 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 armpit
- 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).
Non recommended surgery
- 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
Non-endoscopic surgery
- Scar is longer (4 to 6 cm) and visible
- Risk of inframammary scars migration when an inferior implant displacement occurs
- High risk of excessive bleeding
- High risk of nipple sensitivity loss caused by a poor visualisation of the nerves
- Without endoscopic camera, the surgeon will have a poor visualization of anatomic structures, and could conduct of higher risks of complication
- Possible difficulty breast-feeding
Whether submuscular, subglandular or subfascia, check out the pros and cons of implant placement choices.
Subpectoral placement for patients with minimal breast tissue (AA/A, B or C-cup size)
Advantages :
- 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
Disadvantages :
- 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)
For patients with more breast tissue (B+ or C cup size)
Advantages :
- 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
Disadvantages :
- 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
For patients with more breast tissue (B+ or C cup size).Same advantages and disadvantages as the submammary placement (see above). Ten years ago, it was a very popular technique, but we have noted that there was no advantage and the same risks of complication compared to the behind breast tissue.
In the majority of cases, plastic surgeons prefer to position breast implants in the subpectoral plane (behind the pectoral muscle), for a more natural appearance. Experience has shown that retroglandular positioning (in front of the pectoral muscle), or under the pectoral muscle fascia, increases the risk of contracture and calcification of the fibrous capsule. This risk is higher with silicone implants and lower with saline breast implants. However, the main disadvantage of the subpectoral position, regardless of the type of breast implant used, is the increased risk of breast implant displacement. This is all the more frequent in patients with highly developed pectoral muscles, or when using larger-volume breast implants. The term “internal bra” is unscientific and is mainly used for “marketing” purposes. During breast augmentation, we create a type of internal support to stabilize the position of the implants over the long term. Using an endoscopic axillary approach, I perform an inferior disinsertion of the pectoralis muscle, preserving a muscle band of around 2 cm and limiting lateral dissection of the pectoralis muscle. As a result, the muscle band stabilizes the implants over the long term. Also, in cases of slight breast ptosis (slightly drooping breasts), I proceed with a partial median section of the pectoral muscle, creating an internal and external band of muscle that stabilizes the breast implant over the long term. In the infra-mammary approach, some surgeons use absorbable sutures to attach the infra-mammary fold to the ribs. Because the suture is absorbable, in some cases tissue that is too thin will not support the weight of the implant against gravity over the long term, or the tissue may tear.The technique of capsulorrhaphy with sutures has been used for decades in the case of secondary revision for displaced breast implants. This involves closing with sutures, a space that has become too large. In addition to being technically difficult, recurrence and breast deformity were frequent.
The constant evolution of medicine
The latest trend, according to a scientific article by Dr. Bradley Calobrace (Aesthetic Surgery Journal, 2020), is the “Popcorn” technique, which stabilizes the position of breast implants over the long term with a low complication rate. The technique involves using thermal energy (cauterization) to reduce and redefine the space inside the fibrous capsule, ultimately repositioning the breast implant. With this technique, the use of sutures is no longer necessary. In certain cases of multiple recurrence, where the fibrous capsule is very thin, or in cases of severe thoracic deformity, biological (Alloderm) or synthetic (Galaflex) membranes can be used to reinforce the fibrous capsule.Inner bra, the miracle solution?
Although the name suggests total support, the internal bra has its limits. It would be wrong to assume that one of these techniques will have the same effect as a breast lift. Whichever technique you use, it won’t give you the look of a “push-up” bra. It’s up to your surgeon to discuss your expectations with you, versus the reality, and determine the most appropriate surgical alternative for you.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. Breast surgery performed by endoscopy at Dr. Bernier’s clinic and not the least; is exclusively breast augmentation.
Endoscopic surgery is the future in the medical world. Endoscopic surgery is practiced in orthopedics, gynecology, ENT, pediatric surgery, general (intestinal) surgery and plastic surgery.
Some plastic surgeons refuse the technological advancement of endoscopic surgery for lack of scientific knowledge or for financial reasons since this technique requires a significant investment and high maintenance costs.
Here is an overview of before and after photos of patients who have had a breast addition at Dr. Mario F Bernier’s clinic.
by axillary approach by endoscopy
310cc
by axillary approach by endoscopy
330cc
I had a breast augmentation. The technique and professionalism of Dr. Bernier and his entire team is incredible. The result was beyond my expectations, the scar under the armpit was barely visible. But above all, a breast that looks like what I had always dreamed of having. A big thank you because in my case it's more than a surgery, it's a daily trust.
Céline Enea
24/07/2021
I had a saline breast augmentation in December 2001. It took me a long time to comment VERY POSITIVELY: throughout the process (consultation, surgery, follow-up) A1. My choice was made with Dr. Bernier's professional advice regarding my choice of implants, their size and the consequences. I was a little disappointed that I did not have much leeway on the volume. The maximum for my physiognomy was the 2nd size of the smallest implants... I was a little disappointed but so convinced when he told me "if you want bigger, I won't do them. It's about aesthetics, not size." What sound and knowledgeable advice!!! It gives a good indication of the surgeon's conscientiousness and professionalism. I have never regretted it! Thanks again Doc 🙂
Annie Olivier
08/02/2018
Breast augmentation
Clinical and surgical fees (breast augmentation without scar on breast) anesthesia fees, postoperative bra, and postoperative follow-ups. Sale taxes non-included. *Only a medical evaluation with Dr Bernier can determine if you are an ideal candidate for the surgery. **Price may vary, a medical evaluation with Dr Bernier is required.
Price upon request
Mastopexy (breast lift)
Clinical and surgical fees (3 to 4 hours surgery), anesthesia fees, postoperative bra, postoperative follow-ups. Sale taxes non-included. *Only a medical evaluation with Dr Bernier can determine if you are an ideal candidate for the surgery. **Price may vary, a medical evaluation with Dr Bernier is required.
Price upon request
Breast reduction
Clinical and surgical fees (4 to 5 hours surgery), anesthesia fees, postoperative bra, postoperative follow-ups. Sale taxe non-included. *Only a medical evaluation with Dr Bernier can determine if you are an ideal candidate for the surgery. **Price may vary, a medical evaluation with Dr Bernier is required. ***250g and less per breast (breast reduction for breasts over 250g is covered by the Régie de l’assurance maladie du Québec (RAMQ) and performed by a plastic surgeon in a hospital setting).
Upon request
Inverted nipple(s)
This surgery is only available in conjunction with a breast augmentation.
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Are you considering breast augmentation surgery? Do not hesitate to contact us for more information or make an appointment for a consultation at our clinic in Laval!