MAMMARY PROSTHESIS

The Surgery of Mammary Prosthesis

The purpose of this type of surgery is to increase breasts volume by inserting implants over or under the major pectoralis muscle. Three techniques may be used to introduce implants : either through a short incision on the lower part of the areola, or with an incision in the undermammary fold, or finally, with an incision in the axillary region.

Two types of prosthesis are proposed : either filled with physiological serum or with gel silicone. Their shapes are round or anatomical with more or less important volumes according to cases.

If, in the case of hypotrophy (breast too small) a mammary ptosis is associated (sagging breast
and or low areola position), more than a simple insertion of a prosthesis it is better to perform
an act of reduction of the skin envelope.

The result will be more extensive scarring.

A pre-op evaluation is necessary before surgery as well as a mammagraphy and or echography.

Classical general anesthesia is performed. An anaesthetist doctor must be consulted at least 48 hours before surgery.

A one day hospitalization is usually sufficient.

About the surgery of Mammary Prosthesis:

The operation may last from one to two hours if a complementary associated surgical act is necessary.

− Incisions are made either on the lower part of the areola, or in the undermammary fold, or in the axillary region.

− The pocket in which the prosthesis is placed may be detached over or under the major pectoralis muscle.

− Once the implant is set, resorbable thread is used for suture of deeper parts and skin.

− So that blood and collected secretions may be evacuated, it is usual to leave a drain (Redon drainage) in each breast
until the day after surgery.
− A shaping bra is used after surgery.

Post surgery effects:

When implant is placed under the major pectoris muscle, it is possible, during the first 48 hours, to feel a pain associated to heavy tightening in the breasts.

Antalgic treatment during a few days is mandatory. It is usual, at first, to note edema, ecchymosis and pain when raising arms.
A bra giving a good support (sports bra style) must be worn for a month.

A one week convalescence must be considered and it is recommended to wait one or two months before going back to sports activities.

Result will be final only after a span of two to three months. This delay is necessary for the suppling up of breast and stabilization of implants.

Complications

After any kind of surgery, complications may occur, some due to the medical and / or cosmetic act itself, others particular to mammary plasty.
Good security practices can limit risks but do not suppress them.

Some risks, very exceptional hopefully, cannot be anticipated and may endanger the vital or functional prognosis (emboly, paralysis, septicemy…).

Anesthesia carries its own complications which will be explained to you when you meet with the anaesthetist doctor.

Surgery risks:

Even if the post surgery effects are usually very simple, some of the possible complications linked to mammary implants must be known:

Haematoma: post surgery bleeding is almost unavoidable and gives way to ecchymosis (bruises) on the skin for one to two weeks. It may cause an haematoma with swelling and painful tightening. Sometimes there is the need for additional intervention to evacuate the haematoma and treat its causes. If bleeding is important, a blood transfusion may be necessary.

Alteration of sensitivity: is almost unavoidable, it will gradually get back within a few months. 

Bad evolution of scars: it is normal that scars get thicker and redder during the first months. This aspect, linked to the inflammatory reaction of any closing up, takes twelve to eighteen months to get better and stabilize. Closing up may
follow an abnormal evolution with thickening and swelling going on over a year. We speak of hypertrophic, even cheloid scars (they occur more often on black skins). They may occur in an unpredictable fashion and require specific treatment. It must be known that scars usually fade away and get less visible but don’t disappear.

Infection: occurs very scarcely. In case of infection it might me necessary to remove the implant.

Risks specific to mammary implants:

– Creases or “wavy” aspect:

It may happen that the implant envelope takes the aspect of “waves” palpable or visible in the lower part of the breast. This is because the prosthesis, to remain supple, is never fully filled up. This situation is most often noted when the initial glandular and skin envelope is weak.

– Capsular contracture and fiber capsule:

Any kind of implant may cause the formation of a fiber capsule. This fiber membrane which forms around a foreign body to protect it may get thicker or recede, forming a capsular contracture (fiber capsule around the implant). Four grades of firmness, from normal unnoticeable aspect to severe distortion (breast is hard, round, stiff and sometimes painful) may be noted. Additional surgery can correct the distortion.

– Rupture and deflation:
It may happen, after violent trauma or without any reason that the implant breaks or deflates. In this case, it is necessary to change it.

There is no “life time” for mammary prosthesis, the better is to re-operate only
when a problem with the implants occurs.