Breast

De nos jours, suite aux développements de la chirurgie esthétique moderne, la majorité des défauts de la poitrine, qu’ils soient constitutionnels ou liés au temps et aux évènements de la vie, tels les grossesses ou la perte de poids, peuvent être corrigés chirurgicalement dans des conditions de sécurité optimales. Cela concerne tout aussi bien le manque de volume, que l’hypertrophie ou la ptôse.

Breast augmentation by implants

 

In terms of breast augmentation by prosthesis, your personal situation is unique. The analysis states that I will make your figure, your chest will result in a customized solution that suits you, and that offers an esthetic and stable over time, while minimizing the risk of imperfections and of complications.

This is the principle of tailor-made, supported also by the implant manufacturers that offer lines so extensive in terms of shape, firmness of the gel profile, diameter, projection, volume …

It is easy now, thanks to the internet to know everything about breast augmentation by prosthesis. You are right to learn is an important aid to decision for me and a test of motivation.

Unfortunately, there is too much information and this information is sometimes contradictory or incorrect. I think it’s confusing, and can if necessary be a deterrent. I have tried to simplify things in different pages, but know that nothing will replace the consultation.

Each patient is different. What is true for one, is not necessarily for the other…

In practice

The introduction of breast implants is the traditional surgical procedure that increases the volume of a breast deemed too small. 
This is an extremely common response.

This intervention can possibly be supported by social security in some very specific cases: in case of “major asymmetry, breast agenesis or malformation syndromes (tuberous breasts and Poland’s syndrome)”. A procedure for prior approval is required.

In all other cases, it is a cosmetic surgery, which is supported neither by social security, nor by your mutual insurance company.

This increase in breast size is usually done through pre-filled silicone implants.

It should be noted that new breast augmentation technologies have emerged, which can be used in some cases.

 

Before intervention

2 surgery consultations are required before any act of cosmetic surgery. During these two consultations, the desired implant size will be determined through the fitting of test prostheses.
It should be noted that new breast augmentation technologies have emerged, which can be used in some cases.

An anesthesia consultation is required several days before surgery.
Medical photographs are always made.

A compression bra with contenseur will be prescribed. It aims to maintain the breast for 4 weeks.

A preoperative mammogram will be required.

Provide for a professional unavailability period after the procedure, because no sick leave may be prescribed. Depending on circumstances, this period varies from 5 to 10 days.

The most important medical instructions are the following : stop taking aspirin, anti-inflammatory drugs, or oral anticoagulants within 15 days before the surgery, to reduce the risk of bleeding. The cessation of oral contraception before surgery is discussed with the anesthesiologist. Smoking before and after the intervention is strictly forbidden in order to improve healing.

 

Intervention

You are hospitalized the morning of the procedure.
You must be fasting.

The procedure is performed under general anesthesia. It lasts from 1 to 2 hours depending on the case.

For greater comfort, closure is performed with absorbable suture, except for scar in the armpit. A pressure bandage is made.

 

After intervention

Surveillance takes place in the recovery room first, then in your room.

A drainage system (suction drains) may be established. It is kept for the first night. The dressing is removed the day after surgery. It is replaced by the bra in stretch fabric that you purchased prior to surgery.It must be kept on day and night for about 1 month. The shower is allowed immediately after surgery. You can soak the wound in the shower.
Hospitalization lasts one day. Therefore, the output takes place the day after surgery. 
It is recommended that a person be with you when you return home.

Usually, during the first weeks after surgery, you may observe:

Often edema (swelling) of the breasts. Of variable importance, it may be asymmetrical. It fades out in the first weeks.
Sometimes pain, which prevents to raise your arms for several days. More pronounced when the implant is placed behind the pectoralis major muscle, they are relieved by analgesics.
Any intervention may also carry risks of complications.

Surveillance of the breasts by mammography as part of routine screening for breast cancer is not or little affected by the implant. However, you should inform your gynecologist and radiologist.

Control consultations are planned after surgery.

The resumption of sporting activities should be gradual, starting at 2 months.

As far as the volume and shape of breasts is concerned, the final result cannot be observed before 3 to 6 months. It takes at least 12 months to judge the final appearance of scars.

Do not become pregnant within 2 years after surgery to avoid damaging the aesthetic result of the intervention.

 

Scars

This intervention aims to introduce a prosthesis using of the three following incisions:
The areola, through (1) or peripheral (2).
The armpit (3).
The crease under the breast (4).

enpratique_prothese1

Cicatrice placée dans l’aréole

There are 2 types.
Lower hemiperiareolar: the scar follows the lower edge of the areola.
Transareolar: the scar goes through the areola bypassing the lower edge of the nipple.

This approach allows to obtain very discreet scars by placing them in a pigmented area. However, its length necessarily conditioned by the size of the areola limits the use of prefilled large volume implants (over 400 cc).

Scar in the armpit
This approach allows to avoid any scar on the breast area, but can be seen in tank top or swimsuit when you lift the arm. Moreover, it is difficult to use for the development of anatomical prostheses and its use is discouraged in case of a reoperation.

Scar placed in the inframammary fold
This approach allows to hide the scar in a fold. However it can slightly be seen when lying down. It allows the use of all types of prosthesis and the establishment of important prosthetic volume. It also offers the best control the position of the implant during surgery.

 

Implant placement

The prosthesis can be positioned:
Behind the mammary gland, in front of the pectoralis major muscle.
Behind the pectoralis major muscle.

enpratique_prothese2

Prosthesis placed behind the pectoralis major muscle
This implantation site will hide the implant and reduce the occurrence of a capsular contracture. In contrast, the breast may look stiff at rest and mobilize during the contraction of the pectoralis major muscle.

Prosthesis placed behind the mammary gland
This implantation site offers a more natural and dynamic result. However, it poses a greater risk of occurrence of a cpasular contracture and makes it more difficult to perfectly conceal the implant. This site may be used if your breast allows it.

 

Prostheses

All implants currently used are made of an envelope and a filler. The envelope is always in an elastic silicone and can be smooth or textured.
In France, authorized fillers are saline and silicone gel.
Implants may be pre-filled with silicone gel or saline by the manufacturer. Inflatable implants are filled with saline by the surgeon during surgery.

1) Elastic silicone envelope
Whether smooth or textured, the exceptional strength of the silicone casing prevents perspiration of the filler through the membrane, as well as wear and risk of rupture. The smooth wall limits the occurrence of folds and waves on the skin, unlike the textured wall that create a “Velcro” effect. However, it would present less risk of postoperative displacement and less capsular pathology.

2) Filler

Prosthesis prefilled with silicone gel

Silicone gel is a jelly-like substance the use of which prevents the appearance of wrinkles and eliminates the risk of deflation. This substance is not absorbed by the body. All gels used today are called cohesive. That means they do not spread in the body in case of implant rupture.
These gels have the advantage of having a consistency similar to that of a normal breast. However they may be more or less flexible. The more cohesive they are, the firmer consistency they have. Today, manufacturers of breast implants offer different types of silicone gel.

Manufacturers typically offer three types of gel.
– Cohesive-1 (Mentor) – Classical (Perouse) – Responsive (Allergan): the prosthesis is very flexible and discreetly changes shape depending on the position of the patient, which permits a natural result. Unfortunately, these implants cannot suit all patients, especially those for whom it is the breast implant that will define the shape of the breast and those for whom the cutaneous-glandular material is too Small for there is an increased risk of appearance of folds in the periphery of the breast.
– Cohesive-2 (Mentor) – Sensitive (Perouse) – Soft Touch (Allergan): the breast prosthesis is firmer and slightly changes shape depending on the position of the patient. It is used when the cutaneous tissue is weak to prevent wrinkles and waves in the periphery of the implant, and when the prosthesis is necessary to define the shape of the breast.
– Cohesive 3 (Mentor, Allergan) : anatomical shape only.
Manufacturers of breast implants have introduced another parameter to cohesiveness: the rate of filling. With silicone gel equal cohesiveness, a highly filled breast implant will be firmer than less filled; however there will be more risk of waves.

Each type of prosthesis has its indications. The choice of the cohesiveness and the filling rate of breast implants is to be determined in consultation with your surgeon, he alone will be able to tell you if the type you want is adequate.

Today all pre-filled implants available in France are subject to rigorous and precise standards: CE (European Community) + authorization of the AFSSAPS (French agency for food safety of health products).

Saline filled implants during surgery
The saline fluid is a substance composed of water and salt, the concentration of which is close to that of the body. Thus, in case of rupture of the envelope, there is a natural absorption of the solution by the body. The presence of a valve exposes to the risk of sudden and early deflation. There is often a gradual phenomenon of deflation, showing the folds of the skin.

3) Shape

Round prostheses
This round shaped implant has the advantage of offering a more important bulge in the neckline. Round prostheses allow to use both types of fillers and also allow the use of all approaches (areola, axilla and inframammary fold). They do not alter the shape of the breast in case of rotation of the implant, the prosthesis is identical at every point of its periphery. Manufacturers now offer a multitude of different types of round implants. That is what is called the profile. Thus there are four types of profiles for breast round implants:
– Flat profile: the breast prosthesis is not projected and its base is wide. These implants are very useful for patients with a wide chest and a large breast area, or in patients who have almost no chest to avoid the very artificial “balloon” effect.
– Moderate profile: the most classic breast implant. The base is quite wide and the projection is average. This is the breast implant that gives the most natural outcome in patients with low mammary gland.
– High profile: the breast prosthesis is projected forward, and its base is narrow. It gives a very rounded neckline. It allows for larger volumes because of the narrowness of its base.
– Ultra-high profile: The prosthesis is further projected, for an « American star » effect.
Thus, for constant volume, manufacturers typically offer 4 different types of breast implant, for a customized result, from natural to most provocative. The choice of the profile is determined in consultation with your surgeon, for he alone will be able to tell you if the profile you want suits you.

protheses-anatomique-et-ronde

Anatomical prostheses

These anatomical prostheses are designed exclusively with textured envelopes to prevent their rotation and require to be pre-filled with very cohesive silicone gel to maintain their shape. This form provides a very natural appearance, firmness and a youthful feel. This type of prosthesis is primarily used in breast reconstruction after cancer. The prosthesis being not identical at every point of its periphery (teardrop shape), it must be put in place in orientated manner when facing surgery.
There is a risk of secondary breast deformity by rotation of the implant. The great diversity of forms currently available allows individual customization.

Ultimately, the choice of form, filler and volume is determined in consultation, according to your desires and your body. This allows for a customized intervention.

protheses-anatomiques

Prothèses anatomiques

Imperfections

Asymmetries
Volume or height asymmetries may persist after the introduction of implants, even of different sizes. They express a preexisting abnormality increased by prostheses.

Artificial aspect
An artificial aspect, in the top segment of the breast essentially, is encountered in thin patients, or in case of establishment of large implants. Moreover, breast implants may appear more static, less mobile, especially when lying down.

Too important firmness
It is in relation with the cohesiveness of the gel filler used by manufacturers of prostheses. The latest generation prostheses attempt to remedy this problem.

Perceptibility
Perception of implants when palpation may be possible, especially if they are covered by thin tissues. It is also increased for large volume implants. It is normal to feel the prosthesis on the side and in the fold under the breast when not covered by the muscle.

Folds and waves

Flexibility of implants may be the cause fot folds of the envelope that may feel under the skin, and at most for visible waves.

 

Complications

Although breast augmentation is common, some complications may occur occasionally. Only a qualified surgeon can prevent or identify and treat them.

Infections
It is a very rare complication (less than 1%) that requires removing the prosthesis in the operating room. Antibiotic treatment is usually associated. A healing period of several months is necessary before considering to replace implants.

Hematoma
This is an early complication, corresponding to the accumulation of blood around the prosthesis in relation to a resumption of bleeding. A reintervention in the operating room may be necessary.

Coapsular contractures
After introduction of any foreign body, the human body reacts by isolating it through a membrane : this is the periprosthetic capsule. Most often, it is thin, soft, painless and imperceptible. Sometimes this reaction becomes pathological: these are capsular contractures. The capsule thickens and retracts. It is manifested in a firming of the breast. At most, it deforms the breast and becomes painful. The capsular contractures are favored by infection, and hematoma. However, most often no cause is found and these can occur unpredictably, even years after surgery. The means used to prevent them are based on the one hand on surgical technique and on the other hand on the progress of the implant manufacturers (diaphragm, gel). Treatment is based on implant change associated with an capsulectomy.

Envelope rupture
It is secondary to trauma or more often related to wear and is manifested by pores, cracks or gaps. It can lead to leakage of the filling. In the case of saline, it is of no consequence outside the deflation of the breast. In contrast, when silicone gel, it may be the cause of a capsular contracture or go unnoticed. Since the advent of the new cohesive gels, diffusion in the body is exceptional. Treatment is based on a reoperation to change the prosthesis.

Malposition
A bad initial position or secondary displacement of the implants may affect breast shape. Surgical correction may be necessary. The rotation is a special case for anatomic implants. It may also affect breast shape.

Seroma
It corresponds to the accumulation of lymph fluid around the prosthesis. It is manifested by a transitory increase in breast volume disappears spontaneously.

Skin necrosis
It is exceptional. The risk is of making bare the implant. It is favored by tobacco, some types of infection, hematoma, or excessive tension of the skin in relation to an excessive increase. It usually requires further surgery.

Pathological scars
Depending on the patient’s skin type and healing, the scars can expand or shrink and may join the deep plane. They may also present pigmentation disorders and thickening, exceptionally permanently (keloids).

Suppuration of the threads beneath the scar
This is very frequent. It is treated by local care and possibly removal of the responsible threads.

Disturbance of sensitivity
It is either a decrease or an increase in sensitivity, found most around the areolar area. It is generally regressive, but may persist longer.

Galactorrhea
Very rare. It results in a transient secretion of milk.

Pneumothorax
Exceptional. It is treated by drainage.

Lymphome Anaplasique à Grandes Cellules (LAGC)
Le Lymphome Anaplasique à Grandes Cellules associé aux implants mammaires (LAGC-AIM) est une entité clinique très exceptionnelle (moins de 200 cas dans le mondes au total) qui a été individualisée récemment. Cette entité ne doit être recherchée qu’en cas de signe clinique avéré (épanchement péri-prothétique récidivant, rougeur du sein, augmentation du volume du sein, masse perceptible). Un bilan sénologique précis doit alors être réalisé afin de préciser la nature de la lésion. Dans près de 90 % des cas, cette entité est de très bon pronostic et elle guérit habituellement par un traitement chirurgical adapté associant l’ablation de la prothèse et de la capsule péri-prothétique (capsulectomie totale et complète). Dans environ 10 % des cas, la pathologie est plus grave et nécessite une prise en charge par chimiothérapie et/ou radiothérapie au sein d’une équipe spécialisée dans le traitement des lymphomes.

D’après les fiches d’information éditées par la SOFCPRE.

Frequently Asked Questions

Saline or silicone ?
Silicone gel breast implants produce more natural and long-lasting results than saline breast implants.

Anatomical or round implants?
The round implants have a shape which changes depending on the position of the patient. This allows the most natural results. Anatomical breast implants require more cohesive gels to maintain their shapes, which do not change when the body changes position. The result with anatomic breast implants may appear paradoxically less natural…

Smooth or textured envelopes?
The texturing of the envelope showed no advantage over the smooth envelope for the new generation of breast implants, in particular as far as the formation of capsular contractures is concerned. Smooth implants provide more natural results. Textured breast implants are needed in case of anatomical profile to avoid rotations.

How is the hospital?
Following installation of breast implants, one night of hospitalization is usually required, except in case of implementation of breast implants in pre-muscular position, when the patient is discharged the same day.

What is the preoperative evaluation?
It consists of a systematic mammography, blood and anesthetic consultation at least 48 hours before surgery.

Will I have any scars?
The scars are inevitable but very discreet. They are usually placed at the areola, the armpit or under the breast. This decision will be made in consultation regarding the patient’s wishes and morphology as well as the type of breast implant used.

In front of or behind the muscle?
Premuscular position is the most logical and the most natural. However, the gland is often insufficient to properly hide the implant. We then use the retromuscular position.

What about the capsular contractures?
A fibrous casing normally appears around breast implants. In very rare cases, this phenomenon is exaggerated and the capsule thickens and contracts around breast implants. If it is important a new intervention may be necessary.

Does the introduction of breast implants hurt?
The pain is generally moderate with the retroglandular position as opposed with the retromuscular more painful position. The pain subsides with the usual analgesics. Aspirin should not be used 10 days before and after surgery.

What is the life of my new breasts?
The life span of breast implants is not unlimited. Thus, it is recommended to change them every 15 years.

Can I breastfeed?
The introduction of breast implants do not interfere with breastfeeding.

Am I at increased risk of breast cancer?
The introduction of breast implants does not increase the risk of developing breast cancer ; it does not prevent the screening either.

lifting

Breast ptosis cure

 

Avec le temps, les événements de la vie, que ce soit les grossesses, les variations pondérales ou les effets de certains traitements, les seins évoluent, se modifient. Souvent, les seins se vident, mais parfois la peau se distend et les seins tombent.

L’effort physique classiquement recommandé n’est malheureusement pas la solution, car en aucun cas, la musculation des pectoraux ne permettra de retirer l’excès de peau à l’origine de la ptôse et de remettre l’aréole en bonne position.

Il faut donc retirer cette peau excédentaire. Pour enlever de la peau, il faut l’inciser, c’est pourquoi les cicatrices sont systématiques et parfois longues… Ce travail sur la peau s’associe également à un travail sur la glande, qui est remodelée et concentrée. Dans certains cas, elle est en quantité insuffisante, c’est pourquoi il est parfois nécessaire d’y associer des implants mammaires.

Les prothèses mammaires vont pallier le manque de tissu glandulaire tout en participant à donner une forme plus galbée et plus jeune aux seins. C’est donc une procédure qui nécessite une analyse particulière de vos seins afin de déterminer la solution qui vous offrira la poitrine la plus belle possible avec le moins de cicatrices possibles…

In practice

Breast lift is surgery allowing to push up into good position falling breasts.

This is a cosmetic surgery, which is supported neither by social security, nor by your insurance.

The intervention aims to remove the excess skin, to concentrate the volume of glandular breasts, and place the areola and nipple into good position.

The scars

The scar may consist of 3 parts:

  • a circular scar around the areola, constant
  • a vertical scar between the lower pole of the areola and the inframammary fold, common
  • and a horizontal scar in the inframammary fold (inverted T scar).

When the scar under the breast is avoided, the technique is called “vertical”. Sometimes, both the scar under the breast and the vertical scar can be avoided. The scar is thus sheer periareolar, in “round block”.

enpratique_ptose

Before intervention

2 surgery consultations are required before any act of cosmetic surgery. An anesthesia consultation is required several days before surgery. You must go there with the results of your prescribed blood test (blood count).
Medical photographs are always made.

A compression bra will be prescribed. It aims to maintain the chest for 4 weeks.

Preoperative mammography is routine for women over 35 or with risk factors for breast cancer.

Provide for a period of professional unavailability of approximately 10 to 15 days after the operation because no sick leave may be prescribed.

Les consignes médicales les plus importantes sont l’arrêt de la prise d’aspirine, d’anti-inflammatoires ou d’anti-coagulants oraux dans les 15 jours qui précèdent l’intervention, pour réduire le risque hémorragique. L’arrêt de la contraception orale avant l’intervention est à discuter avec le médecin anesthésiste.

L’arrêt du tabac avant et après l’intervention doit être strict, afin d’améliorer la cicatrisation et de diminuer le risque de nécrose des tissus.

Intervention

You are hospitalized the day of surgery.
You must be fasting.
The procedure is performed under general anesthesia.
It lasts from 1:30 to 3:00 hours depending on the case.

For greater comfort, closure is performed with absorbable suture. A pressure bandage is made.

After intervention

Surveillance takes place in the recovery room first, then in your room. No drainage is necessary, except in case of establishment of prostheses in the same time.

The dressing is removed the day after surgery. It is replaced by the bra in stretch fabric that you purchased prior to surgery. It is to be kept on day and night for about 1 month.

For greater comfort, the scars are protected by adhesive dressing type “steri-strips” left in place for 7 to 10 days. The shower is allowed immediately after surgery. You can wet the scars under the shower as well as the steri-strips.. The hospitalization lasts one day. So you leave the hospital the day after surgery.

During the first weeks after surgery you may usually find:

  • Often edema (swelling) of the breasts. Of variable importance, it may be asymmetrical. It fades out in the first weeks.
  • Sometimes pain. It is relieved by analgesics.
  • The mammaplasty may decrease the sensitivity of the areola, sometimes permanently.

Any intervention may also carry risks of complications.

Surveillance of the breasts by mammography as part of routine screening for breast cancer is not or little affected by the mammaplasty. It is advisable to perform a baseline mammogram a few months after surgery.

Control consultations are planned after surgery.

The resumption of sporting activities should be gradual, starting at 1 month.

The final result is not visible before 6 months as far as the volume and shape of breasts is concerned.

It takes at least 12 months to judge the final appearance of scars.

The vertical scar mammaplasty only is unsightly in the early weeks. Do not worry, because the breast retrieves its natural form in about two months.

In case of associated lack of volume, it may be necessary to develop a prosthesis at the same time.

Avoid being pregnant within 2 years after surgery not to damage the aesthetic result of the intervention.

As for breastfeeding, it is often possible after surgery, but cannot be guaranteed.

 

D’après les fiches d’information éditées par la SOFCPRE.

Frequently Asked Questions

What is a breast ptosis?
Breast ptosis is sagging of the breast in relation to a stretching of the skin. It can exist as a teenager or appear after weight loss or pregnancy.

What is the principle of intervention?
The procedure involves the areola back into good position by removing the excess skin and reshaping the gland.

Will I have any scars?
In case of significant drop in breast, the scar is shaped like an inverted T or i (pure vertical scar). If the fall is moderate, it is possible to use a technique with only one scar around the areola.

What about cases of hypertrophy or hypotrophy associated breast?
If the ptosis is associated with hypertrophy, a glandular reduction can be performed during the course of breast ptosis.
If the ptosis is associated with hypoplasia, a breast implant may be introduced during the course of breast ptosis. It is then possible to use a technique with only one scar around the areola.

How is the hospital?
After the cure of ptosis, overnight hospitalization is usually required.

Does the cure for breast ptosis hurt?
The pain is generally very moderate. It yields with the usual analgesics. Aspirin should not be used 10 days before and after surgery.

What is the preoperative evaluation?
It consists of systematic mammography, blood test and anesthetic consultation at least 48 hours before surgery.

When can I resume my work?
Normal work can be resumed 3-7 days after the breast ptosis cure.

When can I resume my hobbies?
You can resume sports 4 weeks after the breast ptosis cure.

Can I breatfeed?
Breast ptosis cure allows breastfeeding, but it is not guaranteed.

Am I at increased risk of breast cancer?
The breast ptosis cure does not increase the risk of developing breast cancer ; it does not prevent the screening either.

Lipomodelling

 
L’augmentation mammaire, certaines femmes en rêvent, mais n’acceptent pas de porter un corps étranger. Les progrès récents de la chirurgie plastique permettent désormais de réaliser ce rêve.

Cependant, cela n’est pas miraculeux, les contre-indications sont multiples, déterminées par l’état de nos connaissances scientifiques, votre âge et votre morphologie.

Ainsi cette technique peut s’adresser, selon les recommandations de la société française de chirurgie plastique, aux femmes de moins de 35 ans sans antécédents personnels ou familiaux de cancer du sein. Par ailleurs, la morphologie doit être adaptée à cette intervention : Zone donneuse de graisse, typiquement lipoaspirable et poitrine pouvant être injectée.

Enfin, les résultats, s’ils sont certes naturels et définitifs, ne sont pas les mêmes qu’avec des implants :
L’augmentation est globalement plus faible : 200 à 300 cc de graisse par sein maximum par séance, mais la prise de la greffe est de l’ordre de 60 à 80%, ce qui veut dire que le volume de la poitrine va diminuer lors des premiers mois post-opératoires.

La graisse ne donne pas de nouvelle forme au sein contrairement à l’implant.
Cette technique implique également une surveillance particulière et prolongée des seins, car l’état actuel de nos connaissances scientifiques ne nous permet pas d’affirmer à 100% l’innocuité de la technique quant au risque de développer une pathologie maligne du sein plus tard.

In practice

The reinjection of autologous fat (lipofilling or lipostructure) consists in filling the breasts with fat taken from the patient herself.

This is a real graft of fat cells.

enpratique_injection

We can roughly summarize the indications and lipostructure:

Aesthetic indications:

– Increase the volume of the breasts:

The principle involves removing fat by liposuction. This fat is then processed and reinjected in the breast. In addition to the benefits of liposuction, the scar is almost zero and the outcome natural and final.

You should know that the graft does not take at 100 %.

To secure engraftment, a device can be worn for 4 weeks before surgery, the BRAVA system. This avoids to use a second injection.

It is important to know that injecting fat into the breasts has become controversial in France. This procedure is performed in other countries in Europe and the United States.

The actual state of scientific knowledge on this subject report that standard imaging tests are normal with not suspect image, and this at 4 years.

Indications in reconstructive surgery :

– Treatment of breast asymmetry and breast deformities.

– Improved results of breast reconstruction after cancer.

In these indications of reconstructive surgery, lipostructure can be supported by health insurance under certain conditions.

Before intervention

2 surgery consultations are required before any act of cosmetic surgery.

For any breast lipomodelling, specialized imaging will be prescribed.

An anesthesia consultation is required several days before surgery.

Medical photographs are always made.

Provide for a period of professional unavailability after the procedure, because no sick leave may be prescribed. Depending on circumstances, this period varies from 10 to 15 days.

The most important medical instructions are the following : stop taking aspirin, anti-inflammatory drugs, or oral anticoagulants within 15 days before the surgery, to reduce the risk of bleeding.

Smoking before and after the intervention is strictly forbidden in order to improve healing.

Intervention

You are hospitalized the morning of the procedure.

You must be fasting (including water and tobacco).

The procedure is performed under general anesthesia and lasts from 2 to 4 hours.

After intervention

Surveillance takes place in the recovery room first, then in your room.

The hospitalization lasts one day.

Get someone so that he accompanies your return home.

A bra and a jacket will be required before surgery.

The jacket compresses lipoaspirate areas for fat sample./p>

In general, a contention of the graft is necessary. It takes the form of dressings left in place for 3-6 days or BRAVA.

The first shower is allowed the day after surgery.

Variably, the days following a lipofilling there may be:

  • A swelling that disappears within the first 2 weeks.
  • Bruises, often asymmetric for ten days.
  • A feeling of uncomfortable tension.

There is very rarely pain, which is then relieved by simple analgesics.

Any intervention may also carry risks of complications.

In some cases, localized imperfections can be observed (not that they are real complications): local undercorrection, mild asymmetry, and irregularity.

Control consultations are planned after surgery.

After two to three months, there may be a good idea of the final result.

Most often, we get a significant augmentation, which is still very natural and final.

You should know for the future that re-injected fat that took as fat grafting is sensitive to changes in weight, so if weight loss or weight gain, breast that received lipostructure decreases or increases volume.

 

D’après les fiches d’information éditées par la SOFCPRE.

reductionmammaire

Reduction mammaplasty

 

Que ce soit constitutionnel, lié au temps ou aux événements de la vie, les grossesses, les variations pondérales ou les effets de certains traitements, l’hypertrophie de la poitrine est une pathologie invalidant aussi bien physiquement par les dorsalgies qu’elle génère que psychologiquement.

Les régimes classiquement recommandés ne sont malheureusement pas suffisant, car ils ne viennent jamais à bout de l’excès glandulaire, et ne permettent pas de retirer l’excès de peau à l’origine de la ptôse souvent associée ni de remettre l’aréole en bonne position.

Il faut donc retirer cette peau et cette glande excédentaire. Pour enlever de la peau, il faut l’inciser, c’est pourquoi les cicatrices sont systématiques et parfois longues…

Ce travail sur la peau s’associe également à un travail sur la glande qui est remodelée.

C’est donc une procédure qui nécessite une analyse particulière de vos seins…

In practice

The reduction mammaplasty is a surgical procedure that reduce the volume of hypertrophic breasts by removing both the skin and the mammary gland in excess.

The position of the areola and nipple is raised by the intervention.

Reduction mammaplasty is supported by the Health Insurance when you take away more than 300 grams per breast. Otherwise, it is a cosmetic surgery (breast lift).

Know that it is not necessary to apply for prior agreement with the insurance.

The scars

The scar may consist of 3 parts:

  • a circular scar around the areola, constant
  • a vertical scar between the lower pole of the areola and the inframammary fold, common
  • and a horizontal scar in the inframammary fold (inverted T scar).

When the scar under the breast is avoided, the technique is called “vertical”.

enpratique_hypertrophie

Before intervention

2 surgery consultations are required before any act of plastic surgery.

An anesthesia consultation is required several days before surgery. You must go there with the results of your prescribed blood test (blood count). br/>
Medical photographs are always made.

A compression bra will be prescribed. It aims to maintain the chest for 4 weeks.

Preoperative mammography is routine for women over 35 or with risk factors for breast cancer.

Provide for a sick leave of approximately 10 to 15 days after the operation.

The most important medical instructions are the following : stop taking aspirin, anti-inflammatory drugs, or oral anticoagulants within 15 days before the surgery, to reduce the risk of bleeding. The cessation of oral contraception before surgery is discussed with the anesthesiologist.

Smoking before and after the intervention is strictly forbidden in order to improve healing and reduce the risk of tissue necrosis.

 

Intervention

You are hospitalized the day before surgery.

You must be fasting.

The procedure is performed under general anesthesia.

It lasts from 2:00 to 3:00 hours depending on the case.

For greater comfort, closure is performed with absorbable suture.
A pressure bandage is made.

 

After intervention

Une surveillance a lieu en salle de réveil d’abord, puis dans votre chambre.

Aucun système de drainage n’est nécessaire.

Le pansement est retiré le lendemain de l’intervention. Il est remplacé par le soutien-gorge en tissu élastique que vous aurez acheté avant l’intervention. Il est à conserver jour et nuit pendant 1 mois environ.

For greater comfort, the scars are protected by adhesive dressing type “steri-strips” left in place for 7 to 10 days. The shower is allowed immediately after surgery. You can wet the scars under the shower as well as the steri-strips.

The hospitalization lasts two days. So you leave the hospital the day after surgery. It is recommended that a person is with you when you return home.

During the first weeks after surgery you may usually find:

Often edema (swelling) of the breasts. Of variable importance, it may be asymmetrical. It fades out in the first weeks.
Sometimes pain. It is relieved by analgesics.
The mammaplasty may decrease the sensitivity of the areola, sometimes permanently.
Any intervention may also carry risks of complications.

Surveillance of the breasts by mammography as part of routine screening for breast cancer is not or little affected by the reduction mammaplasty. It is advisable to perform a baseline mammogram a few months after surgery.

Control consultations are planned after surgery.

The resumption of sporting activities should be gradual, starting at 1 month.

The final result is not visible before 6 months as far as the volume and shape of breasts is concerned. It takes at least 12 months to judge the final appearance of scars.

The vertical scar mammaplasty only is unsightly in the early weeks. Do not worry, because the breast retrieves its natural form in about two months.

Avoid being pregnant within 2 years after surgery not to damage the aesthetic result of the intervention.

As for breastfeeding, it is often possible after surgery, but cannot be guaranteed.

 

D’après les fiches d’information éditées par la SOFCPRE.