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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.
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.
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.
- 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.
- 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.
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.
As with any surgical procedure, prosthetics can cause some adverse effects.
- The possible risks are hematoma, infection and implant malposition.
- The patient might notice a decrease or loss of sensitivity in one or both nipples.
- 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.
- 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.
Summary of the PIP Study by the Paris Breast Centre
Dr I.Sarfati ; Dr K. B. Clough. Dr E. Massey
Presented to the Société Française de Chirurgie Plastique Reconstructrice et Esthétique (French Society of Plastic, Reconstructive and Aesthetic Surgery) November 2012
Between 2000 and 2009, surgeons at the Paris Breast Centre implanted 770 PIP prostheses in 500 patients. 70% were cases of reconstruction after breast cancer and 30% were cases of aesthetic augmentation.
All patients were called for follow-up in January 2012. 111 patients did not remain in contact with the centre. With an average follow-up period of 4 ½ years, 375 prostheses have been removed. A histological analysis in search of cancer in contact with the prosthesis was systematically carried out.
10.9% of prostheses were ruptured (which represents 22.5% of the prostheses that were explanted). The shape of the prosthesis (round or anatomical) did not influence the risk of rupture. In the case of rupture, ultrasound was predictive (made the right diagnosis) to 70% and MRI predictive to 90%.
In terms of oncological events: no patient developed anaplastic large cell lymphoma (ALCL). One of the patients (out of 119 patients) who had undergone an augmentation for aesthetic reasons subsequently developed breast cancer. Among the reconstructions after breast cancer, there were 10 recurrences, 4 cancers affecting the other breast and 13 patients had metastases. These are the expected figures for a comparable population without prostheses, i.e. "normal".
The rupture rate of PIP implants of 10.9% at 4 ½ years of follow-up is comparable to that of other published studies. After 10 years of follow-up, one team published a rupture rate of 24% (Maijers MC, Nielsen FB, Prevalence of rupture in PIP silicone breast implants recalled from the European market in 2010. Plast Reconstr Surg 2012).
This rate is comparable with the rupture rate of other brands :
- Allergan, 3.8% at 6 years (Maxwell GO, Van Natta BW, Murphy DK et al. Natrelle Style 410 Form-Stable Silicone Breast Implants: Core Study results at 6 years. Aesthet Surg J 2012) .
- Mentor, 2.9% at 6 years (Hammond DC, Migliori MM, Caplin DA et al. Mentor Contour Profile Gel Implants: Clinical outcomes at 6 years. Plast Reconstr Surg 2012; 129(6): 1381-91).
The combined rupture rate of all brands is 8.5% at 5 years (Clough K.B., O’Donoghue J.M., Fitoussi A.D. et al. Prospective evaluation of late cosmetic results following breast reconstruction: I. Implant Reconstruction. Plast Reconstr Surg 2001).
PIP prostheses have an abnormally high rate of rupture, of between 11% at 4 ½ years, and 24% at 10 years.
There is no increased risk of cancer associated with PIP prostheses.