Hypotrophy or hypoplasia of the breasts is a term used for having breasts that are too small in relation to the overall body shape. This can be corrected thanks to the use of breast implants. Hypotrophy may be congenital (from birth) or as a result of a pregnancy, weight loss or a hormonal imbalance. It may be isolated or associated with breast sag (breast ptosis). The patient, who sees this as a violation of her femininity, often resents it. This is generally followed by a decline in self-esteem in social relationships, love and sex life. Breast augmentation by surgically inserting implants restores the breast volume desired by the patient. To some extent, breast augmentation can correct sagging breasts in moderate cases.

Principle of the procedure

Cicatrices-prothses-mammaires-The procedure is performed under general anaesthesia and takes between 1 and 2 hours. The hospital stay is from 12 to 24 hours. The surgeon places the implant on each side in its pocket either directly under the gland (sub glandular or chest position) or under the pectoral muscle (sub muscularly or sub muscular). In some cases, the implant position is both sub muscular at the neckline and sub-glandular on the underside of the breast (dual-plane) in order to combine the advantages of both procedures.

The scar may be located either in the armpit (axillary incision) or around the lower half of the areola (areolar incision) under the breast (inframammary route). For the treatment of ptosis the associated scars are more serious and variable in appearance depending on the degree of ptosis correction.

The range of possibilities (implant position in front or behind the muscle, incision placement, choice of volume and shape of the implant) is such that the surgeon may adapt his technique to suit each patient, thus performing a “tailor-made” breast augmentation.

Implant selection

The implants commonly used are composed of a silicone casing filled with a ‘cohesive’ silicone gel (i.e. a gel which remains intact in one piece even in the absence of a casing).

Saline-filled implants have become obsolete and should no longer be used in routine practice. The saline-filled implants may be the preferred choice of patients because of an unjustified concern about silicone, however the result is less natural, folds or visible waves are frequent and their sudden deflation causes an immediate breast sagging effect. The pre-filled silicone gel implants provide a more natural appearance and consistency and have a longer lifespan.

What type of breast implants should I choose?

PIPIn France now, only implants with a smooth or micgrotextured surface are allowed. Then, only round implants must be used to avoid the risk of rotation of an anatomical implant.

Breast augmentation with implants: what volume for which body-size?

The volume of the implants is determined according to the expectations of the patients but also by the advice of the surgeon who takes into account the actual anatomy of each patient (breast shape, the thorax, silhouette, size of the patient…). During the consultation the patients can test varied sized implants that allows them visualise the effect of the selected prostheses before the operation.

Postoperative effects

  • Complete healing
  • From 2 to 3 weeks

The after-effects can be uncomfortable for the first few days, especially when the implants are large and placed sub muscularly (feeling of painful pressure). If the implants are placed in front of the muscle, the pain is almost non-existent. In all cases, analgesic treatment adapted to the intensity of the pain will be prescribed. Edema (swelling), ecchymosis (bruises) and a hindrance to elevate the arms are frequent in the early stages. A drain is not necessary. The dressings are semipermeable, therefore showers are allowed. Special adhesive dressings will need to be applied to the scars for 2-3 months to improve their appearance.

Returning to work is possible between 5-10 days after surgery depending on the job.
The patient can resume sporting activities after 1 or 2 months.
Complete healing is achieved within 2 to 3 weeks. The stitches are dissolvable and are concealed. A support bra must be worn 24 hours a day for 1 month.

Risk of complications

As with any surgery, a number of complications can occur. But the likelihood of these complications is reduced in the hands of a qualified plastic surgeon and in the presence of a competent anaesthetist. The patient’s compliance to instructions given by the surgeon is also essential and include :

  • stopping smoking 1 month before and after the procedure (reduction of all risks) ;
  • not taking aspirin for 10 days before and after the procedure (reduced risk of hematoma).

Apart from the traditional complications linked with surgical procedures, some complications are more specific to breast implants :

  • The formation of hard scar tissue “capsules” (capsular contracture) is due to a normal reaction of the body against a foreign body. This reaction typically results in the formation of a thin flexible membrane around the implant. Sometimes this reaction is more intense and the membrane becomes thicker. The breast becomes firmer and sometimes even painful. The occurrence of these capsules is unpredictable and can lead to a new procedure to remove or break up the scar tissue (capsulotomy or capsulectomy). Fortunately, advances in the field of implants and surgical techniques have led to a considerable decrease in the rate of capsule creation and their intensity.
  • The implants have a limited lifespan. The membrane wears out and eventually become porous or breaks up. Violent trauma can also cause a rupture. A rupture can go unnoticed or otherwise cause other symptoms (formation of a capsule, breast deformity). Implant rupture is not serious, but must result in changing both implants.
  • Anaplasic Large Cell Lymphoma is a very rare disease may be due to the macro textured surface of some kind of breast implant. Those implants are now prohibited in France although the risk of ALCL is very low (around 57 patients on 500 000 patients with implants in France since 2011) and the treatment is efficient in most of cases.

Frequently asked questions

In principle, the patient must be at least 18 years old, in order to understand the implications of such a procedure.

But in the case of malformed breasts (tuberous breasts, Poland syndrome) or in patients with severe stunting or the absence of breasts (mammary agenesis), the procedure may be considered at the end of puberty.

With breast implants, pregnancy and breastfeeding are possible and are not dangerous to the mother or the child.

The most recent implants are strong and durable. There is no expiration date associated with prostheses therefore it is not necessary to change the implants routinely, even after 10 years.

Monitoring by your surgeon (every 2 to 3 years until the 10th year, then every year after) is recommended to check for any signs of wear and tear on the implants that may justify a replacement (appearance of a capsule, breast deformity…).

Regular Mammograms for all women from a certain age for breast cancer screening also make it possible to check the integrity of the breast implants.

Finally, implants coated with polyurethane foam have a longer average life span than the implants covered only with silicone. This is due to the minimal development of breast scar tissue (capsule) thanks to the polyurethane. The appearance of capsules is the primary cause for replacing implants.

Breast implants and autoimmune diseases.
It has been scientifically established that that breast implants do not increase the rate of autoimmune diseases.

Breast implants and breast cancer.
The risk of breast cancer is unchanged in the presence of breast implants. However, mammography breast monitoring can be made more difficult by the presence of breast implants, especially those in the pre-muscular position (directly under the gland). In some cases, additional monitoring techniques may be required (MRI, ultrasound).

An annual follow-up with your surgeon is recommended when you have breast implants.

Read the press release from the Professional Directory of Plastic Surgeons on recent developments in anaplastic large cell lymphoma.

Fat injections (lipomodelage or lipofilling) in the breast may be a substitute for breast augmentation with implants, or complement it by making it more natural.

Implant Benefits :

  • one initial procedure
  • larger augmentation possible
  • best suited for women with no excess fat

Benefits of fat :

  • more natural (identical to a natural breast in appearance and touch)
  • life-long results
  • nearly non-existent scar
  • associated with liposuction of excess fat (improvement of the silhouette as a whole)

Implant disadvantages :

  • risk of complications specific to implant (rupture, capsules, infections, rotation or malposition)
  • scars

Disadvantages of fat :

  • 1-3 initial procedures
  • need fat reserves from the patient
  • variations in results because of weight change