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Prosthetic breast implants

Prosthetics is the most common method currently used to increase breast size – some 500,000 French women now have breast implants. Doctors have over 50 years of experience with silicone prostheses (even if the material itself has evolved a great deal since the first model in the 1960s) and a good knowledge of their long-term effects.

It is the anti-cancer centreswho are very aware of the cancer risk who have validated this technique and have been able to confirm that breast prostheses or implants do not cause cancer and do not interfere with the detection of breast cancer.

  • Prostheses have no impact on pregnancy and do not interfere with breast feeding.
  • The procedure is reversible: the prosthetic implants can be taken out.
  • Prosthetic implants must be replaced when they rupture. A yearly ultrasound examination is recommended from the 7th year onward, to monitor their condition. Apart from the case of rupture, prostheses should be renewed approximately every 15 years: these are necessary repeat operations that women should be told about when the prosthetic implants are first put in place.

Information about PIP implants

Implants filled with silicone gel raised concerns among the medical authorities a few years ago. Today, the scientific studies have established their reliability and safety.

 

Information about lymphoma and breast implants

In 2011, an anaplastic large cell lymphoma (ALCL) was discovered in reaction to a breast prosthesis. Approximately 140 cases have been reported in the US, and one case in France. These lymphomas are extremely rare and might be caused by the way in which the surface of certain breast implants is textured.

 

Different types of prostheses

The choice and shape of the prosthetic implant is made depending on the anatomy of the thorax (width, height, skin suppleness, breast size before the operation, etc.) and the desired result.

Round implants. The width and projection of the implant are chosen.
Anatomic breast implant. The width, height and projection of the implant are chosen.

Practical details

  • The procedure takes 1 to 1.5 hours.
  • General anaesthesia.
  • The procedure is done on an outpatient basis (the patient leaves the same day) or hospitalisation overnight.
  • Prostheses placed in front of the pectorals can cause some soreness. The pain is slightly more pronounced when the prostheses are inserted behind the pectorals.
  • Dressings are kept on for 8 days.
  • Wearing a sports bra is recommended for 3 weeks to relieve the pain and to ease the tissues that have been operated on from any weight or movements of the implant.
  • Sport is not recommended for around 3 weeks.

This procedure can be covered by social security for French residents in the case of agenesis (lack of breasts), breast asymmetry or malformation.


Scarring

  • Under the breast. The incision under the breast is the easiest and simplest technique, but the scar can be slightly visible when lying down. This is the preferred approach if the areolas are too small or if the breasts droop slightly over the inframammary fold.
  • Under the areola. The scar is barely visible, but the areola needs to be wide enough in order for it to be possible. This method creates a transglandular scar (inside the mammary gland). In the case of multiple procedures (to replace the prosthesis, in particular), the fact of re-opening in the same place can create a fibrous scar in the gland, sometimes responsible for adhesions (tissues 'stick' together).
  • Under the arm. When the implant is inserted through an incision in the armpit, the surgeon may find it more difficult to position the implant correctly. Moreover, it can be difficult to remove the silicone prostheses by this method.
incision under the breast

Inserting breast implants

There are two methods of inserting breast implants :

  • in front of the pectoral muscle (Figure 1); so that the implant is not visible, the gland must be sufficiently developed or there must be enough fat in the décolletage.
  • behind the pectoral muscle (Figure 2); in reality, the prosthetic implant is put in using what surgeons call a 'dual plane' technique. It is not behind the pectoral but in the upper part of the breast. The muscle therefore masks the prosthesis in the décolletage.

Potential complications

As with any surgical procedure, prosthetics can cause some adverse effects.

Postoperative complications

  • The possible risks are hematoma, infection and implant malposition.
  • The patient might notice a decrease or loss of sensitivity in one or both nipples.

Late complications

  • The prosthetic implant is a foreign body that the body will isolate, creating a capsule. Sometimes this capsule is too thin and forms a hard shell around the prosthesis making it too rigid and possibly deforming it.
  • 1. Visible capsule
  • 2. Capsule of prostheses in place for over 40 years..)
  • Breast implants have a limited life span, which varies depending on the prostheses and on the individual. Statistical analyses show that ruptures are very rare before the 7th year. A ruptured implant should be replaced, but this rupture does not have any effects on health and does not constitute an emergency. Wearing breast implants therefore involves monitoring – an ultrasound every year from the 7th year onward – and requires a replacement implant on average every 15 years. Most laboratories 'guarantee' their prostheses for 10 years (replacement of both prostheses and reimbursement of €1000 in clinic fees in the event of a rupture).

An alternative: the Filling technique

This technique involves increasing breast size using fat removed by liposuction on the stomach, thighs or hips of the patient.
Filling can also be used for the following cases: hiding a prosthetic implant or correcting a deformity or asymmetry, for example.