Breast Surgery

The skin, the glandular mammary tissue and the fat give the breasts their shape; since these elements vary from one woman to the other, breasts take on different shapes and sizes-in proportion to the body’s profile or not.

Breast surgery helps harmonize the profile

Breast reduction also brings relief of the pain caused to the back and shoulders by excessive weight. Lifting (mastopexy) provides a feeling of rejuvenation and harmony, besides relieving irritation under the breasts. 

This document aims at giving you a general idea of the different breast procedures available, their indications, limitations and expected results. Dr. Bernier will discuss with you in detail the type of surgery that is most appropriate for your particular needs. It is very important not to hesitate to ask all the necessary questions and to check if you have understood well all the explanations given.

Are you a suitable candidate?

Any woman of any age in good health sincerely wishing to augment, lift or reduce her breasts is a possible candidate. By helping you to determine properly your expectations and objectives, your surgeon can—after reviewing your medical history and your health condition—recommend, if surgery is an option, the type of procedure most appropriate for your condition. 

It is important to have realistic expectations about this procedure since it will bring an improvement—not perfection. Wishing to obtain perfect symmetry is an example of unrealistic expectation. Most women normally have asymmetric breasts and can expect, after surgery, to have some residual asymmetry. The surgeon will first aim at observing historic and general standards of body harmony. He or she must take into account the limitations of each individual, which means it would be unwise to compare the results of one woman with those of others. Each breast has an individual morphology; each person has individual healing capacities, which are determined by their health condition, age and tissue biology. One must beware of public idols, which are sources of disappointment. Sometimes a surgeon will be asked to show photos of results obtained with other patients. Dr. Bernier deems more constructive to work with the patient’s own photos or drawings made on her and by trying different augmentations.

Are there risks associated with these procedures?

Plastic breast surgery is one of the procedures most in demand by women. Nevertheless, as with any such procedure, there is a certain amount of risk associated with it (infection, bleeding, unsightly scarring). Even if complications with this type of surgery are infrequent, they do exist and they can occur. Your surgeon and her team will make sure you get all the necessary explanations and information concerning this type of procedure so as to minimize the risk of complications. The final cosmetic result will not be influenced by these complications if they are treated early and adequately. Hence the importance of diligently observing the follow-up visits planned with the surgeon as well as the precautions indicated before and after the procedure (e.g. no alcohol intake at least 2 weeks before and 1 week after the procedure, no medication that could modify coagulation, no smoking 1 month before and 1 month after the procedure). 

Breast surgery

Breast surgery is performed on an external basis in a specialized centre with the assistance of an anaesthesiologist . Depending on the type of procedure, general or local anaesthesia will be required. You will need to be accompanied by an adult to return home and to help you for a few days. 

Duration of the procedure

The usual time for a breast augmentation procedure is about 1 hour. A breast lift takes about 2 hours but that can be prolonged if it is also associated with a reduction. 

Is there increased risk of cancer?

No matter what the breast surgery type—augmentation with implant, lifting or reduction—serious investigation has demonstrated that there is no increased risk of developing breast cancer in the future. You will be able to continue self-examination of your breasts after the procedure. 

It is important, and also your responsibility, that you have your breasts examined yearly by an informed physician. The X-rays will be done as is prescribed for your age group and medical history. 

About pregnancy

It is recommended to wait 1 year following breast augmentation before having a pregnancy. This is to allow the skin to recover some of its elasticity and to avoid, during lactogenesis, the formation of stretch marks on a skin that has already been stretched by the implant. In cases of reduction and/or augmentation followed by early pregnancy, especially if there is feeding, the breasts could then take a “deflated” look. 

Will I be able to breast-feed?

Current breast procedures (augmentation or reduction) should not influence your capacity to feed. Whether a woman has undergone or not breast surgery, it is a fact that breast-feeding attempts have a 10% rate of failure. 

About nipple sensitivity

Modern procedures (augmentation or reduction) usually do not alter innervation of the areola-nipple complex. Rarely (1%) will individual anatomical variations compromise innervation viability. Nevertheless, the nerves can be stretched or compressed and therefore produce inappropriate sensitivity, thus creating what is called dysaesthesia. This phenomenon is felt by the patient as a painful increase of breast or nipple sensitivity, especially when scraping, or as small electric shocks, which are felt worse during some movements of arm elevation. This is a normal phenomenon and usually of a temporary nature. 

Augmentation through implants

This procedure is aimed at women with under-developed breasts and women having lost their gland after a pregnancy or loss of weight. It consists in introducing through a small opening (located under the breast, under the areola or in the armpit) a prosthesis that will go under the gland or under the pectoral muscle. This prosthesis can be filled with a saline solution or silicone. There again, a good assessment of your condition will allow you, after discussion with your surgeon, to determine the access route, implant site, type and volume of the prosthesis matching best your expectations. You further need to understand that your effort does not end on the day of the procedure: you also need to assume the responsibility of observing afterwards the recommendations of your surgeon and of going through regular checkups.

Breast implants, although now highly sophisticated, will never imitate with accuracy mammary tissue. You have to be aware of this and accept its limitations. They are not a permanent solution; they undergo aging and need to be later replaced (approximately 10 to 15 years). Rejection also occurs in a small number of cases. Hardening of the breast is then observed. Finally, for each year following the surgery, 1% of these implants will break down prematurely. 

Where will the incision be made?

The most frequent sites for incisions are the periareolar region, the inframammary fold and the armpit. Incisions have their particular features. 

  • Periareolar region : This is an area where the skin is thin and allows fine and near-invisible scarring since it is located in a natural colour-transition site. This area also allows superior juxtaposition of the tissues, which reduces the risk of exposing the implant. Some studies report sensitivity alteration while others do not confirm such findings.
  • Armpit : This area is preferred by those who refuse to have a scar on the thorax; the incision heals well and leaves hardly any trace. But there are drawbacks with this particular area: longer surgery time, occasional difficulty reaching a vessel that bleeds with the risk of having to resort to a counter-incision, higher risk of altering the areola’s and the arm’s internal side sensitivity, as well as the sometimes slightly too high position of the prostheses in relation to the breasts.
  • Under the breast : This is the classic site for an incision because the scar will be relatively well concealed in the natural fold under the breast. However, the scar will in general be of an inferior quality compared to the areola or armpit areas; it is also the most visible for the spouse.

 

Where can implants be inserted?

There are two possible positions: under the gland or under the muscle. 

Behind the pectoral muscle :

This procedure is usually necessary when physiological saline implants are used that could be too visible (small waves) or palpable under a gland and a limited skin thickness (under 2 cm). The muscle covering the upper position of the implant provides, when relaxed, a milder and more natural transition between the thorax and the breast. Please note that the use of the pectorals produces visible mobilization of the prostheses, which is nevertheless beneficial because it reduces the risk of Baker grade (capsular contraction). When your natural breasts will tend to droop with age, there could appear a double contour since the prostheses will remain under the muscle in high position. 

Behind the mammary gland (in front of the muscle) :

For this position it is possible to use local anaesthesia and preferably silicone implants. The breast will have a rounder look at its upper pole but, with aging, the implant and breast will tend to droop together, which may prove more natural over time. However, the risk of Baker grade is higher.

Silicone or saline implants?

What is the option: an implant filled with a silicone or saline solution?

Silicone prostheses are again available. They had been removed in 1992 following legal pressures demanding studies that would prove their innocuousness for the health of women in general. Several major serious and independent studies have confirmed this innocuousness. There is no risk increased by generalized diseases such as rheumatoid arthritis, lupus or other autoimmune diseases. There appears to be less breast cancer in women with silicone implants. 

Both implants have their own advantages and disadvantages. Silicone prostheses have a texture that matches closest the breast’s texture; they do not form, so to speak, the folds that occur with saline prostheses. However, they have a slightly higher rate of firm-shell formation. Seven percent of patients will see the formation of a firm shell as opposed to 1% for saline prostheses when placed behind the muscle. 

A thorough discussion with your surgeon will help you make the right decision.

Breast lift

Also known as mastopexy, a breast lift is appropriate in cases of sagging or drooping breasts. 

This procedure is used for remodelling and repositioning the breast. It consists in removing the excess skin surrounding the areola and under the breast so as to lift the skin and obtain a more wrapping skin and maintain the breast in a more natural and young-looking position. This type of surgery is strictly cosmetic in nature and is adapted to each woman; it also aims at minimizing the extent of scars. It can further be associated with the insertion of an implant if extra volume or firmness is required. 

Reduction

This procedure is for remodelling breasts and reducing their size. It consists in removing excess mammary tissue. There usually is excision of some skin and a portion of the breast, which results in a reduction and a lifting. Although in use for several years, this procedure has undergone improvements with enhanced results. Sometimes, when a patient’s breasts have elasticity and minimum sagging, it is preferable to resort to liposuction, thereby minimizing scarring. The Health Insurance Board insures some reductions that cause functional disorders and that go beyond minimal weight. These procedures are performed by a surgeon in a hospital environment. 

Convalescence

Bandages will protect your incisions. The sutures will be removed 4-7 days after the procedure. You can expect some swelling and ecchymoses. The pain felt varies from patient to patient and also depends on the implant site. In all cases the prescribed analgesics will offer relief. A few days later, you will be able to attend to your personal care and light activities. Physical exercises and heavy activities should be avoided for 2-3 weeks. It is also preferable to avoid driving vehicles and operating heavy machinery and tools for a few days (2-5 days). 

Your new look

It is important to understand that the healing process is gradual and that a few months will elapse before you will be able to fully appreciate your new figure. Your breast surgery, once the healing process completed (which can take up to 1 year), will bring you overall satisfaction about its symmetry as well as better proportioned and more normal breasts. This will enhance your self-esteem and femininity. 

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