Breast surgery

DEFINITION :
Gynecomastia is defined as an enlargement of the male breast volume.
It can appear as unilateral or bilateral hyperplasia. In some cases it may be related to abnormal hormonesl production, or to certain medications. A mammography or ultrasound can be requested to analyze the density of the gland.
The increase in breast tissue volume in men, especially during adolescence, is often poorly experienced and can cause many psychological disorders.
A surgery may be advised if there is no explanation and the patient feels embarrassed. This surgery is called a « gynecomastia ».

PRINCIPLES :
The goal of corrective surgery is to restore the normal anatomy as well as possible, with the following aims:
• Reduction of the mammary volume by direct surgical removal (subcutaneous mastectomy) for the glandular forms, or by fat removal for the fat shapes. In the case of mixed shapes, the surgeon will have to combine both techniques.
• Reduction the skin surplus; usually, the decrease in the gland volume will enable the skin to retract. This cutaneous retraction is favored by liposuction. After surgery, some practices such as massages will help the skin retraction.
In some cases, when the skin is too loose, dermal reduction plastie can be performed.
Medical examination in search of a cause to gynecomastia is done systematically. In obese or overweight men, a regimen associated with physical exercises are introduced which can help reduce or even make disappear gynecomastia .

A pre-operative assessment is performed in accordance with the usual requirements.
The anaesthetist will be seen for consultation before surgery.
No medication containing aspirin should be taken within 10 days preceding the intervention.
Stop smoking is essential.

TYPE OF ANAESTHESIA AND HOSPITAL STAY

Type of anaesthesia
This is a classic general anaesthesia during which you sleep completely.

Hospital stay
Hospitalization for 24 to 48 hours is usually required.

THE OPERATION :
During the surgery, an incision is made in the lower edge of the areola. After this incision, the plastic surgeon can remove the mammary gland and the fat surplus. Often, the plastic surgeon can also perform a liposuction at the periphery of the glandular surplus in order to obtain a harmonious result. If the gynecomastia is important and the skin is too loose, a liposuction can then be performed.

AFTER THE OPERATION : FOLLOW UP
Painkillers will be prescribed according to the pain intensity.
Swelling (edema) and ecchymosis (bruises) in the breasts, and pain on elevation of the arms are frequently observed during the first days.
Often, a pressure bandage is made first, and then, quickly, replaced by a lighter dressing, a kind of support waistcoat to wear day and night for a while. This shall help the skin to retract and make the healing harmonious.
A work leave of 5 to 20 days should be considered. It is advised to wait one to two months to resume a sports activity.

THE RESULT :
However, the final result can not be appreciated before two to three months.
The breast reduction in the tissue volume provides physical comfort, especially when getting dressed. In fact, the result often has psychological benifits.

DEFINITION :

Mammary hypoplasia is defined as a breast volume which is insufficiently developed in proportion to the patient’s morphology. It can be a pre-existing condition (small breasts from puberty) or appear later, after substantial weight-loss, a pregnancy followed by breast-feeding, or hormonal problems. It can occur alone or be associated with ptosis, that is sagging of the breasts .

In some cases, it is now possible to increase or restore the breast volume by fat transfer. This technique was initially developed in reconstructive breast surgery where it has made considerable progress.

It is derived from the fat transfer technique performed at the region of the face, which is also called lipostructure or lipolling or lipofilling.
In addition, modern fat grafting techniques allow a harmonious distribution of adipocyte grafts, hence decreasing the risk of oily cyst formation or poor grip (cytostecnosectic) formation.

It should be emphasized that this technique can not be performed in all cases of breast augmentation surgery. The implants keep their place in the therapeutic arsenal.

Hence, this kind of surgery has different aims :

• Implant breast augmentation is suitable for patients who wish to have breasts with more volume and to have a radical transformation of their breasts.
• Aesthetic lipofilling of the breasts only allows a moderate augmentation and is better suited for patients who want to regain a “previous state” (after weight loss, pregnancy, breastfeeding) and / or desire a more “natural” solution, without a prosthetic foreign body. Moreover, this technique is only possible if the patient has a sufficient fat-donor site.

THIS TECHNIQUE HAS TWO MAIN ADVANTAGES :

• It allows a breast augmentation in terms of volume, although moderate, but completely natural, without foreign body, and not giving the appearance of an artificial breast.
• It allows possible treatment at the same time of any disharmonious localized excess load of fat (fat extraction site)

BEFORE THE OPERATION :

The therapeutic choice will be determined wity a common agreement by the surgeon and the patient.

A pre-operative assessment is performed in accordance with the usual requirements.

The anaesthetist will be seen for consultation before surgery.

No medication containing aspirin or anti-inflammatory should be taken within 15 days preceding the intervention.

TYPE OF ANAESTHESIA AND HOSPITAL STAY

Type of anaesthesia
Aesthetic breast lipofilling usually requires general anaesthesia.

Hospital stay
This surgery requires a stay in hospital for 1 to 2 days.

THE OPERATION :
Each surgeon adopts his/her own technique that adapts to each case to obtain the best results. However, there are some common basic principles :
The surgeon begins by accurately identifying the sites from which he will extract the fat, as well as the recipient sites
The atraumatic fat extraction is carried out by small incisions hidden in the natural folds by means of a fine suction cannula.
Fat transfer is made from incisions of 1 to 2 mm using micro-cannulas.
Since it is a case of transplant of living cells (whose intake is estimated at 60 to 70% according to the patients), the grafted cells will remain alive. Aesthetic lipofilling is therefore a permanent technique.

AFTER THE OPERATION: POSTOPERATIVE CARE AND FOLLOW-UP
Pain is usually mild.
Swelling (edema) in extraction sites and in the breasts are observed for the 48 hours following the surgery and usually need 1 to 3 months to fade.
Bruises appear during the first hours in the site extraction : they usually fade 10 to 20 days after the surgery.
The regions operated should not be exposed to the sun or the U.V before 4 weeks at least. The result begins to appear within 1 month after the intervention, but the result close to the final result requires 3 to 6 months.

THE RESULT :
The result can not be appreciated before 3 to 6 months after surgery: the operated breasts generally have a bigger volume and a more harmonious curve. The silhouette is also improved thanks to the liposuction of the extraction areas (hips, abdomen, breeches, knees).

A second session of lipofilling is possible a few months later if necessary.

After reconstructing the volume and shape of the breast, it is advised to suggest a reconstruction of the nipple-areola complex in order to fully restore this symbol of femininity which is the breast.

AIMS :

The surgery aims to reconstruct a coloured areola as well as a central relief as nipple

PRINCIPLES :
The operation can be performed when the volume of the reconstructed breast is considered as stable. There are several techniques for reconstruction of the areola:
The skin is ideally taken from the genito-femoral (groin) crease.

• TATTOOING : These tattoos tend to fade. There are also several techniques to reconstruct the nipple including:
• THE CONTRALATERAL GRAFT  : This is the technique of choice if the nipple is sufficiently projected and generous. This technique leaves virtually no trace and does not alter the sensibility of the areola.
• LOCAL FLAPS : A local flap of skin is lifted and rolled on itself to reconstruct a central relief as nipple.

BEFORE THE OPERATION

It is not necessary to conduct a new assessment procedure.
A new anaesthetic consultation is not required if a light sedation is to be used.
Smoking cessation is recommended.
No medication containing aspirin should be taken within 10 days prior to surgery.

TYPE OF ANAESTHESIA AND HOSPITAL STAY

TYPE OF ANAESTHESIA
It is a simple local anaesthesia. Sedation may be offered to the most anxious patients.

HOSPITAL STAY
This surgery is most often done as an outpatient.

THE PROCEDURE
The operation usually lasts half an hour. At the end of surgery, a light dressing is made.

POSTOPERATIVE CARE AND FOLLOW-UP
The postoperative course is simple and does not require a work leave. The pain is usually mild and rapidly relieved by the usual analgesics.
It is advisable to wait for healing before wetting the graft (conservative showers).

THE RESULT :
After healing a pink and much more flexible nipple gives the breast its natural and complete aspect, the bosom again becoming a symbol of femininity.
The goal of this surgery is to provide a significant improvement, and not to achieve perfection. If your wishes are realistic, the result should give you great satisfaction.

DISAPPOINTING RESULTS :
It is unfortunately impossible to reconstruct a perfect breast, symetrical to the other breast.
The reconstructed nipple has lost all possibilities of contraction (size difference) and erogenous sensitivity.
There is often a difference in colour between the two areolas. In addition, tattoos tend to fade but their renewal is always possible.

POSSIBLE COMPLICATIONS :
Complications of areolar reconstruction are actually rare.The failure of graft take is still possible. In this case, a new skin graft can be tried again.In total we should not overstate the risks and in the vast majority of cases, the reconstructive surgery if performed correctly, will give a very significant result, even if the scarring is inevitable.

You can be assured that if you are operated on by a qualified Plastic Surgeon, he will have the experience and skill required to avoid these complications, or to treat them successfully if necessary.

DEFINITION

Mastectomy is the removal of the mammary gland, a certain amount of skin and the areola.It is unfortunately necessary in some forms of breast cancer. The demand of breast reconstruction after mastectomy is completely legitimate.
The reconstruction by latissimus dorsi flap uses skin harvested from the back, the latissimus dorsi muscle (thin and extended muscle of the back) and often one prosthesis to recreate the breast volume.

AIMS :
This surgery aims to restore the volume and contour of the breast with skin and muscle taken from the back. An implant is often needed to complete the internal reconstruction whenever the transferred volume is insufficient.
This technique applies mainly to cases where the residual skin of the chest is insufficient or weakened by radiation and cannot, by itself, protect an internal prosthesis.
.

PRINCIPLES :

The procedure is usually done remotely. Hence, it is called secondary reconstruction.

The intervention consists in placing in the thoracic region , skin and latissimus dorsi muscle taken from the back in the chest.This flap is slid under the skin of the lateral wall of the chest and inserted between the mastectomy scar and the inframammary fold as an insert.

The implantation of an internal prosthesis under the skin and muscle is usually used for the restoration of a sufficient volume.

The symmetrisation of the other breast and the reconstruction of the nipple-areola complex are most often realized subsequently, when the volume of the reconstructed breast has stabilized.

BEFORE THE OPERATION :
A pre-operative assessment is performed in accordance with the usual requirements.

The anaesthetist will be seen for consultation before surgery.

In all cases, the surgeon should check the breast imaging (mammography, ultrasound) of the other breast.

No medication containing aspirin should be taken within 10 days preceding the intervention.

Stop smoking is essential.

TYPE OF ANAESTHESIA AND HOSPITAL STAY

Type of anaesthesia
This is a classic general anaesthesia during which you sleep completely.

Hospital stay
Hospitalization for several days is usually required.

The operation can take 3 to 4 hours. At the end of surgery, a modelling bandage, shaped like a bra, is made

POSTOPERATIVE CARE AND FOLLOW-UP
The postoperative course is generally quite painful at the back for a few days and may require strong painkillers.

Swelling (edema), ecchymosis (bruising) of the reconstructed breast is possible in the postoperative period.

Wearing a bra (night and day) is necessary for several weeks.

It is advisable to wait one to two months to resume sport activities.

THE RESULT :
The appearance of the reconstructed breast will gradually evolve. it takes two to three months so that your surgeon can appreciate the result and in particular the symmetry.

DÉFINITION

La mastectomie correspond à l’ablation de la glande mammaire, d’un fuseau de peau et de l’aréole. Elle reste malheureusement nécessaire dans certaines formes de cancer du sein. Une demande de reconstruction mammaire est tout à fait légitime après mastectomie.

Dans les cas où la qualité de la peau et du muscle pectoral sous-jacent le permet, le mode de reconstruction le plus simple reste la reconstruction mammaire par prothèse.

OBJECTIFS

L’intervention chirurgicale a pour but de reconstituer le volume et les contours du sein par la mise en place d’une prothèse interne au dessous du muscle pectoral. Elle ne constitue que l’un des temps de la reconstruction mammaire complète qui comporte en outre selon les désirs de la patiente, une reconstruction de l’aréole et du mamelon et éventuellement une intervention sur le sein controlatéral pour améliorer la symétrie.

PRINCIPES

L’opération peut être réalisée en même temps que la mastectomie, on parle alors de reconstruction immédiate, ou à distance des traitements complémentaires qui ont été nécessaires, on parle alors de reconstruction secondaire. L’intervention consiste à mettre en place, le plus souvent sous la peau et le muscle pectoral, une prothèse permanente.

Dans certains cas une prothèse temporaire d’expansion tissulaire destinée à accroître la quantité des tissus de couverture (peau, muscle) de la prothèse permanente ce qui peut donner un aspect plus naturel au sein reconstruit.

DEFINITION
Mastectomy or mammectomy (the terms are synonymous) corresponds to the removal of the mammary gland, a zone of skin and areola.
It is unfortunately necessary in some forms of breast cancer.
A demand for breast reconstruction after mastectomy is legitimate.
In the cases where the quality of the skin and underlying pectoral muscle allows it, the easiest mode of breast reconstruction is the breast reconstruction by prosthesis.

AIMS :
The surgery aims to restore the volume and contour of the breast by the placement of an internal prosthesis below the pectoral muscle.
It is just a time of the complete breast reconstruction, which according to the wishes of the patient also comprises a reconstruction of the nipple and areola and possibly an intervention on the opposite breast to improve symmetry.

PRINCIPLES :
The operation can be realized at the same time as the mastectomy, it is called immediate reconstruction, or remotely after complementary treatments that have been necessary have been done, then is called secondary or delayed reconstruction. The intervention consists of the placement, usually under the skin and pectoral muscle, of a permanent prosthesis
This can be in some cases a temporary prosthesis for tissue expansion to increase the amount of covering tissue (skin, muscle) of the permanent prosthesis, which may give a more natural appearance to the reconstructed breast.
Tissue expansion has the disadvantage of requiring two surgical times..
The nipple-areola complex (areola + nipple) will be rebuilt more often in a second time, when the volume of the breast is stabilized.
Breast reconstruction does not affect the oncologic surveillance.

BEFORE THE OPERATION
A pre-operative assessment is performed in accordance with the usual requirements.
The anaesthetist will be seen for consultation before surgery.
In all cases, the surgeon should check the breast imaging (mammography, ultrasound) of the other breast.
No medication containing aspirin should be taken within 10 days preceding the intervention.
Stop smoking is essential.

TYPE OF ANAESTHESIA AND HOSPITAL STAY
Type of anaesthesia

This is a classic general anaesthesia during which you sleep completely.

Hospital stay

Hospitalization for several days is usually required.

THE PROCEDURE
The intervention may take one to two hours. A modelling bandage with elastic bands shaped like a bra is made up in at the end of surgery.

AFTER THE OPERATION : FOLLOW UP

The immediate postoperative period is generally quite painful for a few days, may require strong painkillers.

Swelling (edema), ecchymosis (bruising) of the reconstructed breast is possible in the postoperative period.

Wearing a bra (night and day) is necessary for several weeks.

Consideration should be given to a recovery time of two to three weeks. It is advisable to wait one to two months to resume sporting activity.

THE RESULT :
AFTER IMPLANTATION OF A PERMANENT PROSTHESIS :
The reconstruction by prosthesis immediately restores volume and shape permitting the patient to dress normally with a low cut.
Patients will wait for two to three months to appreciate the result of the reconstruction and the eventual symmetrisation.

AFTER IMPLANTATION OF A EXPANSION PROSTHESIS :
The inflation of the prosthesis is made usually once a week with saline (salt water).
In 4 to 8 weeks, a large volume is achieved, up to exceed the volume of the other breast.
At the end of inflation, it will be necessary to wait at least another three months to avoid a secondary retraction of the skin.
The second operation occurs between 4 and 6 months after the first. It allows the replacement of the temporary expander prosthesis that gives a tense look for the permanent prosthesis.

DEFINITION :
Mammary hypoplasia is defined as a breast volume which is insufficiently developed in proportion to the patient’s morphology. It can be a pre-existing condition (small breasts from puberty) or appear later, after substantial weight-loss, a pregnancy followed by breast-feeding, or hormonal problems.

It can occur alone or be associated with ptosis, that is sagging of the breasts and skin stretching and a lowered areola.

The procedure can be carried out at any age above 18.

NEW GENERATION PRE-FILLED SILICONE GEL IMPLANTS

The great majority of implants used currently in France and elsewhere in the world are pre-filled silicone gel implants.

They are made of soft silicone gel inside a strong impermeable envelope of silicone rubber which can be rough or smooth.

In addition to the classic round implants, anatomic ‘teardrop’ shapes which can be higher, wider or more pointed.

This diversity of shape, associated with a range of volumes means that the choice of implant can be tailored to the figure and the expectations of the patient.

BEFORE THE SURGERY

• A thorough preoperative examination with blood tests will be carried out.
• An anesthesiologist will see you in consultation before the operation.
• A preoperative medical imagery examination is prescribed, (mammography, echography).
• Smoking cessation is strongly recommended
• No aspirin-based medication should be taken during the 10 days preceding the operation.

TYPE OF ANAESTHESIA AND HOSPITAL STAY

Type of anaesthesia:
This is general anaesthesia, during which you sleep completely.

Hospital stay:
Usually is required a hospitalization of one to two days.

The position of the implant

Two placements are possible:

– Pre-muscular: in this case, the prostheses are directly put behind the gland, on the front of the pectoral muscles.

– Retro-muscular: in this case, the prostheses are positioned more deeply, at the back of the pectoral muscles.

The choice of position will have been determined in consultation with the surgeon.

AFTER THE OPERATION

There can be pain for the first few days after the procedure, particularly when the implant is large and placed behind the muscle. In this case pain medication of the strenth necessary to dull the pain, is prescribed for several days.

Swelling and bruising of the breasts, and difficulty in raising the arms are frequent immediately after surgery.

The original dressing is removed a few days after the procedure and is replaced by a lighter dressing, then a bra can be recommended to be worn night and day for a few weeks.

Five to 10 days convalescence is necessary before returning to work.

Patients are advised to wait for one to two months before practising any sports.

THE RESULT

Two or three months are needed to appreciate the final result.

This can be truly seen from two to three months after surgery, the time necessary for the breasts to become softer and for the implants to settle.

FREQUENTLY ASKED QUESTIONS
Pregnancy/breastfeeding

After having this procedure there is no problem regarding pregnancy either for the mother or the child, but it is advisa¬ble to wait for six month safter surgery.

Breastfeeding is still possible in most cases.

Life-span of the implants :
It should be noted however that the new generation implants are far more hardwearing and reliable. Starting from the 10th year, if a problem is detected, or the patient wishes to change their size or shape , the question can be raised.

Follow up
It is important to keep the appointments with your surgeon during the weeks and months following the operation.

A specific visit concerning the implants is advisable every two to three years.

DEFINITION

Mammary ptosis is defined by a sagging of the gland and a distension of the skin surrounding it. The position of the breast is too low and is often “empty” in its upper part. Ptosis may exist in any case but in most cases occurs after major slimming or as a result of pregnancy with breastfeeding.
It may be isolated : in case of pure ptosis. It may also be associated with a certain degree of mammary hypertrophy.
Conversely a mammary ptosis may be observed in the context of too small a breast (mammary hypoplasia or hypotrophy).

AIMS :

The purpose of the surgical operation is to restore the areole and the nipple to their correct positions, re-concentrate them, “lift” the gland and remove the excess skin in order to achieve harmonious breasts.

PRINCIPLES :

When the ptosis is more severe the scar takes on the appearance of an inverted T the peri-areolar ,the vertical and the horizontal.
In most cases, if the mammary ptosis is minor, a so-called “vertical” method can be used which makes it possible to eliminate the transverse scar in the mammary groove and to reduce the cicatricial ransom to its peri-areolar and vertical components
If the mammary ptosis is very mild, it is possible to use a technique which makes it possible to effect the correction of the sagging only with a scar around the areola.

Finally, if the ptosis is accompanied by a mammary hypotrophy (insufficient breast volume), it is possible to proceed with fitting a prosthesis during the same operation to enable the breast to regain an appreciable volume.

A breast lift is an operation which can be carried out once the breast has stopped growing, then any time throughout life. It is then quite possible to become pregnant and give milk, but the patient must then wait six months after the operation.This surgical procedure by no means increases the risk of the incidence of cancer.

BEFORE THE OPERATION

A preoperative assessment is normally conducted as required.

The anaesthesiologist will be seen in consultation before surgery.

A radiological breast study is prescribed (mammography, ultrasound).

Smoking cessation is strongly recommended.

Stopping a possible oral contraceptive may be required.

No medication containing aspirin should only be taken within 10 days prior to surgery.

TYPE OF ANAESTHESIA :

This is general anaesthesia, during which you sleep completely.

HOSPITAL STAY :

Usually is required a hospitalization of one to two days.

THE PROCEDURE

Each surgeon adopts his/her own technique that adapts to each case to obtain the best results. At the end of surgery, a modelling bandage, with elastic bands, shaped like a bra, is made.

AFTER THE OPERATION: POSTOPERATIVE CARE AND FOLLOW-UP

The postoperative course is usually less painful, requiring only simple analgesics.Swelling (edema) and ecchymosis (bruises) in the breasts, and a slight pain on elevation of the arms are frequently observed.

It is recommended to wear the bra day and night during the first month. The suture, if not resorbable, is withdrawn between the eighth and the twentieth day after surgery.

A convalescence and a work stoppage of 7 to 10 days should be considered. It is advised to wait one to two months to resume a sports activity.

THE RESULT :

It cannot be judged until one year after surgery: it just needed to have the patience to wait the time required for the improvement of scars .

The operated breast is natural and sensitive, especially to hormonal changes and weight.

DEFINITION :

Mammary hypertrophy is defined by a breast size too large, particularly in relation to the morphology of the patient.

This excess volume is generally associated to sagging breasts (ptosis) and sometimes to a certain degree of asymmetry.

The breast enlargement almost always involves a physical and functional impact (pain in the neck, shoulder and back discomfort for sports, clothing difficulties).

There is also a frequent significant psychological impact. These disorders justify the assumption by health insurance under certain conditions.

AIMS :
The surgery aims to reduce breast size, correction of ptosis and a possible asymmetry in order to get both breasts harmonious in themselves and in relation to the morphology of the patient (both breasts reduced and lifted, symmetrised and remodelled).

PRINCIPLES :
The procedure performs the removal of excess glandular tissue. It preserves a volume consistent with the silhouette of the patient and with their desires. This residual glandular volume is lifted, concentrated and redesigned.

A subsequent pregnancy is of course possible as well as breastfeeding, but we recommend waiting at least six months after the intervention.

The risk of developing breast cancer is not increased by this intervention.

BEFORE THE OPERATION

A preoperative assessment is normally conducted as required.

The anaesthesiologist will be seen in consultation before surgery.

In addition to the usual pre-operative examinations, a radiological breast study is prescribed (mammography, ultrasound).

Smoking cessation is strongly recommended.

Stopping a possible oral contraceptive may be required.

No medication containing aspirin should only be taken within 10 days prior to surgery.

TYPE OF ANAESTHESIA AND HOSPITAL STAY
Type of anaesthesia:

This is general anaesthesia, during which you sleep completely.

Hospital stay:

Usually is required a hospitalization of one to three day

THE PROCEDURE

It exists some common basic principles to apply: the tissues removed are systematically sent to a specialized laboratory for examination under a microscope (histology).

At the end of surgery, a modelling bandage, with elastic bands, shaped like a bra, is made.

AFTER THE OPERATION: POSTOPERATIVE CARE AND FOLLOW-UP

The postoperative course is usually less painful, requiring only simple analgesics.

Swelling (edema) and ecchymosis (bruises) in the breasts, and a slight pain on elevation of the arms are frequently observed. The first dressing is removed after 24 hours and replaced by a bra ensuring good retention. It is recommended to wear the bra day and night during the first month.

THE RESULT :

It cannot be judged until one year after surgery: then the breasts have usually a smooth curve, are symmetric or very close to the symmetry, and natural looking.

It just needed to have the patience to wait the time required for the improvement of scars .