Breast enlargement is the operation carried out most frequently by Artemedis. Young girls usually have this operation done because they are dissatisfied with their small cup size. Later in life this operation is often done to fill out an upper breast that has become flatter. A mild degree of breast sagging can also be remedied by inserting an implant. Women who do not want an implant at all can have their breasts enlarged using Macrolane. This is a naturally injectable gel which is almost entirely absorbed after two years. Enlarging the breasts using the body's own fat (see lipofilling) is a controversial treatment that may involve significant risks. Artemedis has therefore decided to wait until more data and guidelines are published in this area.
There are many techniques and types of implants and these will be discussed at a preliminary consultation.
Dr. De Meyere usually fits the implants via an incision below the breast and in front of the pectoral muscle.
The main purpose of the preliminary consultation is to find out the patient's wishes and to what extent they can be achieved. Of course a lot depends on the starting point. Some patients wish to enlarge their breasts only slightly, just enough to give them a slightly fuller upper breast. Others want their breasts to be as large as possible, as long as the result looks natural. Still others want their breasts to be as rounded as possible.
Until the late 1980s all breast implants had a smooth, even exterior. As a result there was a very high risk of capsular contractures. To reduce this risk as far as possible the implants were always inserted behind the pectoral muscle, so that the implant was floating in a large pocket due to the movements of the muscle and the capsule could not gain any purchase on the implant. Inserting an implant behind the muscle, however, has a number of major disadvantages and the smooth-walled implants regularly gave rise to severe capsule contractures, resulting in rock-hard, deformed, painful breasts.
All this changed dramatically with the discovery that our bodies respond quite differently to a textured implant. These implants have an irregular texture on the outside with a specific pore size. As a result our bodies have the opportunity to attach to the implant and the result of a capsular contracture is hugely reduced.
Virtually all breast implants are now textured.
There are a number of major disadvantages to inserting implants behind the muscle:
First of all it is much more painful. That is because the pectoral muscle has to be released from the ribs and therefore comes under tension.
The breasts are further apart. This is because the pectoral muscle also attaches to the breastbone, and it cannot be released from it completely. If the implant is inserted behind the pectoral muscle, it obviously cannot extend past that attachment. Certainly if the patient does not have much breast tissue of her own, the breasts will inevitably be a long way apart.
The breasts change shape when the pectoral muscles are tensed. This is because the pectoral muscles flatten the implant in the middle and it balloons at the sides. That looks very unnatural.
It is not usually possible to create as much space behind the muscle as in front of it. That is because skin and breast tissue are much more elastic than muscle. If the breast was larger beforehand and is smaller afterwards, it is not always possible to fill the breast optimally using an implant behind the muscle.
Finally, an implant behind the muscle creates a curve in the rib cage, so that over the years the breast sags downwards. This sometimes causes an unnatural doming of the upper breast, while the lower breast remains loose and poorly filled.
Due to all these disadvantages, Artemedis inserts implants in front of the pectoral muscle wherever possible. Inserting an implant behind the muscle is the only solution if the patient has absolutely no breast development at all.
Implants filled with saline water are rounder than implants containing silicone gel.
They are also much more mobile, similar to a plastic bag filled with water. They are therefore almost always inserted behind the pectoral muscle. The muscle causes them to become flattened and their mobility is rather restricted.
An implant behind the muscle, however, has a number of major disadvantages. Silicone gel implants are therefore usually preferred.
Some patients absolutely refuse to have silicone. If this is the case, a saline-filled implant is a valid solution.
These days all gels are cohesive, which means that they are not fluid.
In other words, if an implant is cut, a lot of pressure has to be applied to make the gel bulge out, and when it is released the gel plops back in. With highly cohesive implants, the implants can even be cut in half without changing shape. Teardrop-shaped implants are always filled with a highly cohesive gel because it allows them to retain their shape.
Clearly a highly cohesive gel feels more like a rubber block, does not move with the breast in the same way and is easier to feel within the breast. The upper edge can very often be easily felt and is sometimes even visible.
Patients therefore usually choose a less cohesive, flexible implant.
Teardrop-shaped implants are always filled with a firmer, cohesive gel, which has the following disadvantages: the upper edge of the implant can be easily felt or even seen, the breast is not mobile and feels too hard.
One great misconception is that round implants result in round breasts. That is absolutely not true. When standing upright, round implants also become teardrop-shaped. As a result the breast feels more natural and moves in a natural way.
Round implants are available in different shapes, from very flat to very round.
The choice will depend on the width of the breast, the space available and the desired projection of the breast.
When changing from a round shape (lying down) to a teardrop shape (standing up), ripples will inevitably form on the surface of the implant. The implant must therefore always be covered with a minimum amount of the patient's own tissue. If it is not, the skin will follow these ripples as well.
The term for this is "rippling".
Until a few years ago, if the patient had no breast tissue of her own, the only possible solution was to insert the implant behind the muscle.
The McGhan Style 510 implant has changed this. This implant is filled with a flexible gel at the base (the back) and a firmer gel under the nipple. The upper edge is thin compared with traditional teardrop-shaped implants, and the back is slightly concave so that it maintains better contact with the rib cage.
This implant can still be inserted in front of the muscle, even if the patient has little breast tissue of her own. If this type of implant is chosen, the size is determined by measuring the height and width of the breast and the thickness of the breast tissue that is present. The result looks very natural but women who like a rounded upper breast may find the top of the breast rather too flat.
During the consultation the size of the implant required to achieve the desired result is estimated. (For anatomical or teardrop-shaped implants the breasts are measured).
Based on this estimate it is possible to offer some idea of the future size of the breast. A template may be placed over the breast to visualise the effect as far as possible.
In all procedures carried out by Artemedis, a test implant is inserted first.
The operating table is then elevated to a sitting position to see whether this volume creates the desired result. Frequently the partner comes to have a look (wearing overshoes, a cap and mask) to assess whether the size and shape are what the patient wants.
The elasticity of the breast tissue and skin cannot be determined beforehand. This is why it is important to use a test implant. If the upper breast is too rounded, a smaller implant will ultimately be chosen. If the top of the breast is not full enough, a larger implant will be selected.
If an anatomical or teardrop-shaped implant is chosen, the focus is on dimensions rather than volumes. For example, it makes no sense to insert an implant that is wider or narrower than the base of the breast.
The breasts are therefore measured precisely beforehand and during the procedure the width and height of the pocket created are carefully checked.
Breast enlargements at Artemedis are always done under total intravenous anaesthesia. The operation takes about one hour and most patients are dressed and on their way home a quarter of an hour to half an hour later.
Every surgical procedure involves risks of bleeding and infection.
These are particularly small in the case of a breast enlargement.
A much more important risk which is specific to a breast enlargement, is capsular contracture.
Our body forms a membrane around everything that is inserted into it, including a breast implant. If this membrane becomes thicker than normal and contracts, this is called a capsular contracture. It results in the breast being harder, less compressible and less mobile. It is not yet fully known why this sometimes happens. It is almost always only one breast that is affected.
At Artemedis the risk is approximately 1%. If it occurs, it is almost always within the first year. The treatment consists of a short surgical procedure in which multiple incisions are made in the capsule. This operation is carried out free of charge at Artemedis.
Due to the movement of the body, an implant is constantly subject to frictional and tensile forces. This inevitably causes slow wear and tear to the wall of the implant. It is therefore recommended to replace the implant every 10 to 15 years. More and more manufacturers are offering "lifetime guarantees". This is simply a sales gimmick and in no way means that the implant will remain intact for a lifetime.
It is very important for the body to be able to grow into the irregular texture of the implant. It is therefore recommended to wear a good supportive bra for four weeks, even at night for the first two weeks. It is also recommended not to raise the elbows above shoulder height for four weeks. Lifting heavy items is not a problem in itself.
Inserting an implant in front of the muscle causes much less pain than behind the muscle. The pain is mainly related to stretching of the skin and above all the nerves. The vast majority of patients experience little or no pain.