Many women wish to have larger breasts, believing that their breasts have always been too small or have become too small due to pregnancy or weight loss. In any case, the most commonly used approach is the prosthesis or breast implant. According to scientific literature, less than 1% of women who would like to have larger breasts are ready to undergo surgery¹. That said, in the United States, the number of women and girls who choose implants for cosmetic reasons more than doubled between 1997 and 2000.².

Breast implants method

It is by far the most frequent and reliable procedure to give satisfaction to a woman who considers the size of her breasts insufficient. Surgery involves inserting a prosthesis, usually through an incision around the areola of the breast.

Since 2001, surgeons have used a cohesive silicone gel, and silicone gel breast prostheses have regained increasing interest. Other prostheses, containing physiological serum, that is to say a saline solution, are now much less used because the touch of the breast is sometimes less pleasant and the deflation of this type of prosthesis more frequent.

Lipofilling or fat autografting method

This surgical technique³ is often used for breast reconstruction after breast removal surgery, more rarely for cosmetic breast augmentation. It consists of taking fat from the woman’s body (belly, thighs, saddlebags), in order to reinject it into the breasts. The method seems ideal, but presents several difficulties: part of the injected fat is then absorbed by the body. And the rate of fat absorption is difficult to predict, leading to breast asymmetries or insufficient breast volume. This often requires retouching. On the other hand, the fat used in its absorption can sometimes lead to cysts in the breasts. And then, this method is inapplicable or insufficient for women who do not have a sufficient natural stock of fat. New generation silicone implants are therefore much more often used.

A brief history of implants

Very oily silicone gel-filled breast implants were developed in the 60s when there was no legislation controlling the medical device market. In the United States, the government agency Food and Drug Administration (FDA) has had such an authority since 1976, but other devices (heart valves, cochlear implants, prostheses, etc.) have been treated as a priority, breast implants still being, at the time, relatively uncommon.

In 1990, nearly a million American women had such implants, and the FDA still had not, as required by law, required manufacturers to prove their efficacy and safety. However, the media reported more and more anecdotes and opinions according to which serious health problems could be related to these devices. Indeed, like the silicone gel used at that time, always migrated a little through the wall of the implant, being able to cause the production of antibodies which, it was feared, could be at the origin of diseases “auto-. immune ”(polyarthritis, scleroderma, fibromyalgia, etc.).

In 1991, the FDA enforced the law and asked manufacturers to provide relevant studies. These, however, must relate to large populations and identical devices, and be spread over long periods; since none of these conditions could be fulfilled at the time, it was considered to withdraw implants altogether from the market, the time to carry out adequate research. But a powerful lobby opposed it, supported in particular by women with breast cancer. Although their manufacturers have still not succeeded in demonstrating their safety, silicone breast implants remained on the market as “public health needs”, being accessible only to certain clienteles in the context of clinical research. .

Between 1995 and 2001, there was a moratorium, silicone gel being banned in most countries of the world to closely study the effects of implants containing this type of gel. During the entire period of this moratorium, only prostheses with physiological serum or saline solution were put in place.

In 2001, the appearance of cohesive, denser silicone gels enabled the rehabilitation of silicone breast implants. These gels have the advantage of being less problematic in the event of rupture.

Course of the surgical intervention

Before the intervention, a consultation with the surgeon makes it possible to expose the problem and to define the size of the implant. It is chosen according to the desire of the woman, of what she wishes, and it falls within a range: the change must be perceived (it would be a shame to have an operation for an almost unsuspected result), but it do not become handicapped by a too large volume of breasts. It is also necessary that the anatomy of this woman can support this prosthesis and that the chosen form can give a natural result. The surgeon’s advice is therefore essential because he explains what is possible according to the anatomy of each woman. And then, he exhibits pictures of breasts to determine what she wants.

As the placement of a breast implant takes place under general anesthesia, it requires a prior visit to an anesthetist.

During surgery, which lasts about an hour, the operated woman is given antibiotics as an infusion to reduce the risk of infection⁴. The most classic incision to place the implant is made around the areola, in its lower part and concerns one third to half of this areola. The surgeon provides a compartment larger than the implant to put it in place. Indeed, this subsequently allows the prosthesis to move a little in this compartment, and to have a natural behavior during changes of position (lying on the back for example). The surgeon places the prosthesis in front of or behind the pectoral muscle: in front most often, and behind this pectoral muscle if the woman has very little or no breast.

And after the operation for breast implant?

A woman who has just received breast implants is generally hospitalized the night following the operation. She feels stiff when she wakes up in her chest, a bit like after a good gym session. At first, when moving, she may feel pain. She must then allow herself 4 or 5 days of strict rest and 7 to 10 days of convalescence in all. In some cases, a bra may be prescribed by the surgeon.

The appearance of the scar is usually a little red for a month and a half to two months, then it gradually becomes a small, almost invisible white line. The final result is obtained in 3 to 6 months, the time for healing to take place and for the tissues and the implant to take their place. After surgery, the sensitivity of the nipples is affected in a very variable way: it can remain intact after the operation, or be reached and generally return in a few weeks to a few months, even if in rare cases, it can be longer.

Breastfeeding remains possible, the intervention does not concern the mammary glands. Screening for breast cancer was once a little more difficult with implants because they made the radiological image less easy to read, so sometimes cancers less easy to detect and there were concerns about diagnostic delays. Today, advances in radiology make it much easier than before to read mammograms after an implant. To the touch, you can feel that there is a prosthesis, but the touch remains very natural with the cohesive gels currently used.

Research on the safety of implants

There is no link between the placement of a prosthesis and breast cancer. This is why a surgeon places the same type of prosthesis when reconstructing a breast that has been diagnosed with cancer. A breast implant on one side also does not increase the risk of cancer in the other breast.

Side effects of breast implants⁶

• Hematomas may occur: after the procedure, it may require reoperation. But this has no impact on the final result.
• The appearance of cockles has become an exceptional situation. This is a reaction of the body to the implant that forms a rigid area, like a shell around the prosthesis. It is increasingly rare, thanks to the improvement of new prostheses and surgical techniques. Currently, surgeons are careful to do the hemostasis (prevent the area from bleeding during the operation) and leave as little blood as possible around the prostheses, and the texture of the envelope, which considerably reduces this risk of hull. .
• Reduced sensitivity. Between 3 and 15% of women experience permanently reduced sensations in the nipple and breast after insertion of an implant.

  It is common after surgery, and the vast majority of it recovers over the first few weeks or months. However, some women retain a change in sensitivity or even pain.⁷.

• Shift : Implants are placed in front or behind the pectoralis major muscle. The retro-pectoral position can sometimes give rise to displacements of the prosthesis during contractions of this muscle. This can be embarrassing and sometimes you have to intervene if it’s aesthetically embarrassing.
• Aging of the prosthesis. This aging can cause deflation for a serum prosthesis or rupture for silicone prostheses. It should therefore be supervised, especially around the eighth to tenth grade. The surgeon may decide to change the prosthesis or to monitor it regularly for signs of damage. Deflating the prosthesis with physiological serum (sterile salt water) is harmless from a health standpoint, even if it causes aesthetic discomfort. The rupture of a silicone prosthesis requires a change of prosthesis. As current gels are very cohesive (silicone remains well bonded and is unlikely to spread into tissue), they are easy to remove and safe for women.
• Warning : If you have a prosthesis and you notice something strange (displacement, deflation, abnormality, change in touch, etc.), you should contact your surgeon for an examination.