Breast prosthesis– Explanations : Doctor POIGNONEC plastic surgeon in Paris
Breast prosthesis : 3D animation with narration for information purposes
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A breast prosthesis is a pouch of filling product, physiological saline or silicone gel, covered by an elastomer shell. Saline filled implants tend to cause a little more wrinkles in the skin and may gradually deflate over time. Implants can be round or anatomical, and come in a wide range of cup sizes. The variety of implants available allows us to adapt the shape to meet the patient’s wishes.
How to choose the shape and type of breast prosthesis?
Breast prostheses with fixed surface and volume pre-filled with silicone gel. To avoid deformation caused by the displacement of the prosthesis, smooth prostheses are always round. There is no risk of migration of the silicone gel in case of rupture of the prosthesis.
1. The advantages of filling with silicone gel :
— Limits the appearance of folds. Eliminates the risk of deflation Consistency close to a normal breast. Does not spread into surrounding tissues in the event of rupture of the envelope.
2. Disadvantages of the pre-filled silicone gel prosthesis:
— May spread to surrounding tissues in the event of rupture of the envelope. Product not absorbable by the body in case of rupture of the envelope. Firmer, heavier consistency. Risk of retractable “shells” (hardening) a little higher than with saline.
1. The benefits of saline filling :
— Natural absorption by the body in case of rupture of the envelope. Fewer retractable « shells » (hardening).
2. Disadvantages of the pre-filled saline prosthesis :
— Possibility of « folds » appearing. Sealing problem of the filling valve. This type of prosthesis then undergoes partial or total deflation, fast or slow. Early or sudden deflation possible.
Results Before After Breast Augmentation
Résultat Avant Après Augmentation Mammaire
c. What are the forms of breast prostheses?
Moderate breast augmentation with a high profile for a plunging neckline without a bra
Round breast implants are filled with either silicone gel or saline. These prostheses provide the same volume on the upper part of the breast as on the lower part and give a pigeon-like effect more important than pear or drop-shaped prostheses. A breast massage is recommended to keep the prostheses soft and mobile.
1. Which patients can benefit from a round silicone prosthesis?
Young patient with moderate breast size (300cc or less) C cup or small D cup. This prosthesis will give them a natural breast with a young look. This type of prosthesis is also intended for sportswomen because round prostheses can rotate in their dressing room without consequences. The round prostheses of big volumes are addressed to patients who want a very curved breast and a very sexy décolleté because the breast keeps a round shape.
Mammary augmentation with high volume for a natural result
Water drop shaped or round to moderate profile, pear shaped breast Water drop breast implants are filled with cohesive silicone gel that will not leak if the prosthesis ruptures. These prostheses are useful when the result must be as natural as possible that bring more volume to the lower pole of the breast and less on the neckline. Breast massage is not necessary with this type of prosthesis. Water drop prostheses adapt to all morphologies.
1. Who should be offered anatomically shaped silicone breast prostheses?
These are pear-shaped prostheses that draw the natural shape of the breast larger at the bottom and sharper at the top: the result is therefore more natural even for large volumes. The disadvantage of these prostheses is the risk of rotation in the dressing room: they are therefore not recommended for large sports dancers or body builders. In the event of movement of the prosthesis in the dressing room, it will be necessary to propose a repositioning intervention. Anatomical prostheses cost slightly more than round prostheses.
1.3 Round breast prosthesis or anatomical breast prosthesis, what to choose?
When a patient wants a breast augmentation, she asks herself the question of the composition and shape of the implant. Concerning the position the soft silicone breast implants are used by the majority of the European or Atlantic aesthetic surgeons. Indeed, prostheses composed of physiological serum give more aesthetic results often disappointing with formation of folds sometimes visible in the décolleté. The new silicone gels are very reliable, safe, soft and undetectable to the touch, especially when placed behind the muscle or behind the gland whose residual volume is sufficient. These silicone gels are covered with a micro textured envelope that reduces the risk of postoperative shells. In some cases a polyurethane gel can be used which increases the adhesion of the prosthesis to the deep tissues for a better hold.
1. It all depends on the patient’s wishes and what is feasible.
Case 1 : 20-year-old girl with agenesis.
Let us take the case of a young girl of 20 years who presents a complete absence of development of the mammary gland (agenesis), the thorax is flat the prosthesis will be put in principle behind the muscle so that it is completely impalpable. If the girl wants a small volume, a moderate volume (200cc) round prosthesis may be a good choice. If it wishes a very important volume one will opt more easily for an anatomical shape in the shape of pear in order to avoid a too rounded and too unnatural aspect of the décolleté. In any case I advise against a prosthesis with too large a volume for a young girl who has a complete absence of the mammary gland, because this prosthesis will already have a difficult placement given the low elasticity of tissues and on the other hand it will create strong tensions that can give a less natural aspect of the breast.
Moderate breast augmentation with a high profile for a low neckline without a bra
Result Before And After Following Breast Plasty
Cas 2 : 40-year-old patient with 2 children.
Let’s take the case of a 40-year-old patient who had two children and who has a thawing of the mammary gland following breastfeeding. In general it is the superior-external part of the breast which is most often atrophied, if the breast falls a little it can sometimes be judicious to propose an anatomical prosthesis which can give a natural effect and raise very slightly the height of the nipple.
Dr. POIGNONEC’s opinion
We basically insist on adding volume. The shape you choose will depend a lot on your existing anatomy. In general, “water drop” prostheses are used for all cases of breast reconstruction, mastectomy. At this stage, the advice of professionals involved in achieving the best aesthetic result is fundamental, in which it acquires a natural appearance. My choice is the round shape. Some studies show that the shape of the drop is rotary. Textured prostheses, high profile and round shape are, for me, the most appropriate. The drop form I use it in patients who have removed the mammary gland and who need to perform a reconstruction.– Doctor POIGNONEC plastic surgeon in Paris
There are many different prices on some websites, different clinics it is sometimes difficult to find your way: average prices are from 4500 € for round prostheses in outpatient surgery. Sometimes it is necessary to add the cost of hospitalization and anesthesia.
Mammary prosthesis reimbursement and health insurance coverage
How much does breast augmentation surgery with prostheses cost?
€INCL. TAXES Consult us !
Word of mouth, advice from your doctor or gynaecologist is important. A surgeon who is not too far from home should be preferred to be able to have an easy follow-up operation. Checking with the Council of the Order his qualification in reconstructive plastic surgery and his membership in a learned society such as the French Society of Plastic Reconstructive and Aesthetic Surgeon is a guarantee of quality. A specific informed consent is signed prior to the procedure.
Reflection period before the insertion of the breast prosthesis: the law sets a minimum of 15 days but very often I advise to think a little longer before deciding. It is indeed necessary to avoid deciding on a sudden impulse for example after a sentimental break, in the event of temporary depression, or following an external reflection. The decision is eminently personal but it can be interesting to come with your spouse to decide together on the shape of the desired volume. Despite everything, most of the time the patients come alone for consultation because this surgery remains of the intimate order. I advise them to come with pictures of breasts that they like on the Internet or in lingerie magazines for example. A new tool is currently available: the simulation of results using a computer tool: photos of the patient are taken during the consultation and only the chest is photographed.
The patient’s face does not appear in the photos. The photos are immediately sent to a site in order to obtain a model that we can modify on the computer according to the shape of the volume chosen by the patient. Thus the patient can have in real time the expected result.
What to do for a very sporty patient who would like a very natural look and a rather large breast volume?
— Or by the voice of the nipple when the nipple is not too small. The scar will be hidden in the coloured part of the nipple.
— When the nipple is very small and the patient wants a large volume implant, an incision can be made in the submammary fold of about 4 cm. This scar will be completely masked by the natural fall of the breast. This approach is easier to place anatomically shaped implants.
Immediately after the break, the breast will lose 10 to 15% of its initial volume due to postoperative edema, then the volume will be stable and will follow the natural evolution of the breast which is a gland subjected to hormonal variations.
Are breast prostheses permanent?
The prosthesis does not have an expiry date, but over time the breast ages and sometimes the gel may sag slightly inside the prosthesis. For this reason, I recommend a (free) control visit every two years, and in case of major modification, change the implants. In case of doubt, imaging is performed: MRI, ultrasound, mammography.
Many innovations have improved the outer shell of the implant, which is much stronger and more flexible, and prevents any frost from escaping. — Very thin micro textured or smooth envelopes that are more resistant to wear and prevent “perspiration” from the gel towards the outside. — Contents : impalpable soft silicone gel. — Polyurethane to reduce the percentage of hull. Unfortunately, the lifespan of a breast prosthesis cannot be precisely fixed. It would theoretically be guaranteed for life… but we recommend making an appointment with your surgeon every 10 years. These new generation implants, more reliable, offer other advantages, such as the diversity of shapes! Today, they are more anatomical, with drop-shaped profiles, more or less high, more or less wide, more or less projected. The choice of volumes has also increased, almost from customized… It is important to know that techniques, anaesthetic products and monitoring methods have made immense progress over the last twenty years, offering optimal safety, especially when the operation is performed outside the emergency room and in a healthy person. Reaction to anesthesia: The complications associated with anesthesia must be distinguished from those associated with the surgical procedure. Advantages of breast prostheses compared to other breast augmentation procedures: it is a reversible technique. Indeed, if the breast prosthesis does not correspond at all to the patient’s idea, it will be enough to remove the prostheses without any consequences for the breasts except for a small scar that will fade with time. It is therefore a round-trip surgery: the prostheses can be changed if they no longer correspond to the patient’s wishes. After 70 years, some patients request the permanent removal of the prostheses.
What are the warning signs?
Any modification of the breast : pain, hardness, volume, decrease or appearance of a fibrous shell around the prosthesis. The majority of reports report implant ruptures with clinical or ultrasound warning signs. This is a known and serious complication of breast implant implantation, requiring reoperation. The ruptures reported to the ANSM occur on average 7.6 years (standard deviation +/- 4 years) after installation. This average duration does not correspond to the average life of an implant. Indeed, the ruptures declared are often those which are perceived by the declarants as “abnormal” because occurring before the 10 years of implantation considered as the usual median life span of a silicone breast prosthesis. Some women keep their breast prostheses for a very long time, but a prosthesis should not be considered immutable, i.e. the prostheses wear out.
« How long is the breast implant? watch the video or this question is addressed. »
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Even if some women keep their implants without difficulty for more than 20 years, the duration of breast prostheses is on average 7 to 10 years, but never more than 10 years. Today the gels used are very viscous, reducing the risk of migration and complications, it is preferable to remove the prosthesis in case of rupture, which involves one or more other interventions after the initial placement.
Forward breast implant after:
Example photo of a breast augmentation before after :
It is a delicate subject to discuss and one that remains of the order of intimacy and privacy. Patients report that they feel better in their bodies and better in their skin after the placement of prostheses, more feminine and more desirable. This has a definite impact on sexual life: an increase in the quality and frequency of intercourse according to some patients.
It is desirable to wait several months before starting a pregnancy to allow the breast to heal completely. In effect with pregnancy hormones, the breast will undergo an increase in volume in anticipation of possible breastfeeding. There are no contraindications to breastfeeding with breast prostheses. Breastfeeding is therefore quite possible after insertion of the prosthesis. Some of my patients started pregnancies two months after the prostheses were placed without any consequences for the pregnancy or for the baby.
Can we propose lipofilling with a complete greasy feeling instead of a silicone prosthesis?
Many patients come for consultations because they do not want a prosthesis but prefer to use their own fat. This is possible if the patient is relatively young under 35 years of age and without a family history of breast cancer. Very thin patients should therefore be excluded because there is no fat.
Patients should be warned that the breast cannot be increased by more than one cup and that fat retention in the breast is relatively unpredictable with sometimes asymmetric resorptions. In some cases, post-operative mammograms may also be difficult to interpret, so it may be necessary to consult a specialized radiologist and sometimes complete the examination with an M.R.I.
When the patient does not have any breasts and wants to obtain a nice volume, I advise the placement of small prostheses of very moderate volume with a round shape. Over time, anatomical prostheses filled with soft silicone gel tend to become anatomized, i.e. take the shape of a pear, because the gel accumulates at the bottom of the prosthesis, giving a very natural result.
Breast lipofillingcan be offered in addition to a breast prosthesis whose edges are a little visible or to improve the appearance of a décolleté. Or when there is a very small cast iron for example in the upper external dial, and a small amount of fat is needed to obtain the desired result.
Fatty lipofilling combined with a breast prosthesis of small or medium volume allows to obtain a very natural breast and a rejuvenated cleavage.
Source breast prosthesis : Best extract from the book « La chirurgie esthétique, les solutions et les conseils de mon chirurgien » © Ambre Publishing | The author : Dr. Sylvie POIGNONEC - Plastic and Aesthetic Surgeon, located in the heart of Paris, specialized in plastic, aesthetic & reconstructive surgery
However, these risks of complications are rare and may be limited.
With regard to the surgical procedure: By choosing a qualified and competent Plastic Surgeon, trained in this type of operation, you limit these risks as much as possible, without however completely eliminating them.
The use of a qualified Plastic Surgeon assures you that this one has the training and the competence required to know how to avoid these complications, or to treat them effectively if necessary.
If you notice one or more complications, contact the plastic and aesthetic surgeon immediately.
Source: French Society of Plastic Reconstructive and Aesthetic Surgery S.o.F.C.P.R.E
Mis à jour le: 21 June 2018 [MàJ]