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All
intermediate sizes between complete absence of breast volume to breasts
hypertrophy exist. Breasts size is always evaluated in a subjective way
by the person who is endowded with them. It is very usual that the same
size breasts of two persons be judged as being too large or too small by
one or the other, and this despite their similarities in weight, volume
and thoracic girth. Various preferences for breasts size may also be
related to different generations and fashion. Breasts size, featured in
and conveyed by fashion and other women's magasines which could, in
women's unconscious mind, be regarded as satisfactory and of an entirely
normal size in the 1980's are now perceived, in 2001, as very small.
Variations may also be linked to geography, civilizations, social
communities etc.All this to underline that universal volumes are
inexistant and that we surgeons must, in as much as is reasonable, adapt
ourselves to the client's wishes. Evidently the client has her say in
regards to the breasts size she wants. It is also legitimate that the
surgeon's role allow him and imply that he must give his patient advice
concerning the size of her breasts, and in a case of extreme
expectations, bring her wishes back to more reasonable dimensions.
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HISTORY
The history of mammary prostheses goes back approximately fifty years.
The first prostheses were crudely manufactured, be it in shape or in
regards to the type of materials used. With the passing of years they
have improved incessantly along with technological advancement and
clients' demands. Having so profoundly left its mark on the practice of
breast augmentation surgery that now, in popular language, it is said
that if a person has had silicone, it means that she had had breasts
augmentation, the history of the silicone era deserves a brief
recapitulation. Modern surgery has brought about the development of
silicone of such pureness that it is an almost biologically absolute
inert body. In practice, unfortunately, at the end of the 1980's,
silicone has caused us so many difficulties that it was finally
rejected by the different Occidental Medical Societies. So, in our North
American surgical practice, we have totally abandoned silicone since the
1990's. With hindsight we can say that it was for the best. Indeed, all
the drawbacks encountered with silicone (34% of the fibrous capsules
caused some hardening of the breasts), seem to have categorically ceased
to exist with the present prostheses.
POSTOPERATIVE PERIOD
During the first 24 hours following the operation, the pain is due to
the muscular
detachment. Administration of analgesics and muscle relaxants will
attenuate the pain.
The patient leaves the clinic on the same day and convalesces at home.On
the very next day, the patient can move about freely without, however,
exert herself. In our clinic we are in the habit of practicing this type
of operation on Thursdays; this allows the patient to go back to her
normal occupations four days later, the next Monday, while taking great
care to avoid violent or brutal physical efforts.Hypafix, the dressing
put into place in the operating room,, is removed one week later. After,
the patient will be seen at intervals of 1, 3, and 6 months, then one
year later, and once a year when possible without any fees to pay.
Because of the involuntary Pectoralis major muscle contraction the
prostheses, during the first few weeks or even months, will be at a
higher level than the one where they were placed. This is only
temporary. Along with the slackening of the muscular contraction, the
prostheses will go back down to their normal level. If by chance they
don't, they can be brought back by a simple surgical procedure requiring
only a few minutes.
PRESENT PROSTHESES
The only prostheses presently authorized in North America and in most
European countries are physiological water based, that is filled with
saline water (0.9% salt concentration). The bag is made of "tight
molecules" silicone which makes it non-liquefiable, and the saline
water cannot seep out and spread into the tissues as silicone gel could
sometimes do. The eventual possibility that this bag ruptures and the
contents spread into the organic tissues would be an unimportant
incident leaving no sequels nor undesirable effects in the body.
OPERATION
The operation consists in preparing small chambers in the breasts for
the insertion of the
prostheses and thus create
mammary volume according to the size desired.
ROUTE FIRST
The route taken varies from one surgeon to the other and from one
geographical region to the another. Advocates of different routes all
have their reasons for opting for a route. In fact, almost all routes
have their own advantages and inconveniences.
We personally chose the sub-mammary route for different reasons:
THE CHAMBER
In the silicone period, the most popular chamber was made between the
mammary gland and the muscle.
Unfortunately, with the physiological serum prostheses, fitting these
prostheses behind the mammary gland can bring about the appearance of
waves near the surface of the skin. This is why that, since the
beginning of the 1990's, the most usual chambers are the ones made in
the retropectoral space (behind the Pectoralis major muscle). With well
prepared chambers, harmonious, firm, well placed breasts of natural
consistency will be obtained.
LONG TERM RESULT
A breast augmentation well performed, prostheses well chosen, and a
surgical indication well founded (justified), will guarantee a beautiful
long term result. One must be aware that prostheses manufacturing
companies only promise a 10 year lifetime guarentee for them. However,
if no other related problems exist, their replacement can be done by an
extremely simple procedure, and in a very short time (a few minutes).
The postoperative effects are also very simple, all the dissection
required having been done during the first operation. In a general
manner, the companies guarantee the prostheses for life. This means that
one pays only once in her life for the prostheses, even if they have to
be changed 3 or 4 times over a 50 year period on account of, for
example, deflation. If a prosthesis deflates before the 10 year time
limit, the companies replace it without charge as well as its
installation. However, after the 10 year time limit, only the prosthesis
will be free.
Richard Moufarrège, md
F.R.C S.(C)
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Example A |
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Example B
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Example C |
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Example D |
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Example E |
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