Breast augmentation in Geneva – Switzerland.

 

New: Breast augmentation under sedation and local anesthesia, less invasive, safe, quick to recover.

1. The types of augmentations
2. Type of implant
3. Position of the implant
4. Incision (axilar, submamarian, areolar)
5. Contact, make an appointment
6. Price and financement
7. Photos
8. Information about ALCL

 

Author: Dr Xavier Tenorio. Breast surgery is the second most common surgical procedure in my practice preceded by liposculpture (liposuction or fat transplantation). As a plastic surgeon passionated for breast enhancement,  I have been expose to treat a large number of patients who consult for various reasons, including always problems  related to breast volume and shape. Most of these problems arise from a variety of situations such as a lack of development during adolescence, excessive decrease of volume after pregnancy, abnormal development with asymmetric malformations, deformations or as reconstruction as part of treatment of cancer.

Below I have grouped the most common types of breast shapes, a small technical explanation and different treatments. You can see the different morphological types and view the before and after results based on photography.

 

1 – mammary hypoplasia. Breast of small size

It is characterized by breast of small volume, usually without a significant degree of asymmetry even though a slight asymmetry is almost always present. The mammary gland is usually fibrotic to touch (a little hard). The upper pole of the breast (decolté) is small in volume causing great dissatisfaction when dressing due to the lack of contact between the clothes does and the body. The nipple and areola are usually small. The lower pole of the breast is also very small. The distance between the nipple and the bottom edge of the breast is usually not greater than 4 cm (being the normal distance of 6 cm on average). The skin covering the breasts is usually very firm making it difficult to treat with large implants. Treat ment is relatively simple, a primary breast augmentation can be performed with breast implants or fat transfer. Depending on the patient’s desires, the implant can be round or have the anatomic shape of a breast. Personally, I generally prefer silicone implants with anatomic shape because I find they give a more natural result.

 

The results are impressive, the silhouette change radically. In fact, giving more volume to the chest causes a reshape in the abdomen and waist, positively changing the entire body silhouete. Most of my patients classify the procedure as something that changed their lives.

It is important to mention that, performing a breast augmentation with implants in a thin person involves the risk that the implant can be felt in the lower pole. For this reason, I use implants that have a certain consistency, to ensure a pleasant tactile sensation after the surgery.

2 – Breast of normal size.

In this case the volume is generally suitable and may have a greater or lesser degree of asymmetry. Typically patients consult because of a certain degree of dissatisfaction with their volume. It is important to consider that the breasts volume may change during the menstrual cycle. On the other hand, it is difficult to judge properly whether the volume is adequate or not, because the perception of breast volume can be somewhat subjective and depends on the ethnic and cultural background of the patient. From my perspective, when examinating a patient with breast of normal volume I listen carefully to the motivations that lead the patient to opt for  breast augmentation.

Physically adequate breast volume have a generous upper pole of at least 3 cm of thickness, the areola is between 3 and 4 centimeters in diameter and the lower pole is about 6 to 8 centimeters long. Breast of  normal volume should not present an excess of mammary gland and skin under the sub-mammary fold (the fold that mark the lower limit of the breast), that might colloquially be described as ‘saggy breasts’.

Treatment: Normally, this type of breasts need the implantation of an anatomical or round breast implant. The base of the implant should not exceed the breast’s base. The projection is moderated depending on the skin’s elasticity. I prefer to insert the implant via a sub-mammary fold incision but I can adapt to the preference of the patient.

The results are generally very satisfactory. The breasts have a natural shape and the implant is well protected behind the mammary gland and the pectoral muscle. That makes it unlikely that the implant can be felt as being artificial from the outside.

3- Mamamary ptosis (sagging breast)

In general, the breasts become ptotic (saggy) due to a normal increase in volume during pregnancy and lactation followed by a significant breast atrophy of the mamarian tissues during the months that follow nursing. Women who have lost a significant amount of weight, especially obese patients who have been successful with diets, exercise or weight loss surgery can also lose mamary gland tissues that determines the formation of ptotic breast. Finally, the breasts may be reduced in size and projection as the result of the normal aging process.

There are three types of breast ptosis depending on the place where the areola and nipple are located:

Breast ptosis Grade I (breast lifting with anatomical implant alone)

The nipple and areola are located above the sub-mamary fold (the lower limit of the breast). This type of breast is characterized by having a small amount of  volume in the upper pole (less than 1 cm of breast tissue can be pinched). However the areola and nipple are located at their adequate site,  above the sub-mammary fold. The lower pole contains a small quantity of  breast tissue causing the skin to hang in front of the fold under the breast. In general the distance between the nipple and the sub-mamarian fold  is 7 to 9 cm.
In my practice, most women with this particular form of breast shape had an adequate volume before and during lactation. That volument progressively decreased followed by a lose weight.

The simplest treatment is a breast enhacement and breast lift with a particular breast implant. I use  anatomical, pre-shaped silicone implants with full-projection in order to fill the skin excess in the lower pole and lift the areola and nipple complex. The breast implant is usually placed in position called ‘dual-plane’ which means that is placed in a pocket covered by the pectoralis muscle in the upper pole and the mammary gland in the lower pole.  This procedure is a process of breast restoration, the results have a high degree of satisfaction. In all cases it is probable that the implant is palpable in the lower pole after surgery.

Breast ptosis Grade II (breast augmentation/lifting with anatomical implant alone):

The nipple and areola are located at the same level as the sub-mammary fold. This type of breast is characterized by having a small amount of volume in the upper pole (less than 1 cm when pinched), which forms a flat chest. The areola and nipple are not at an adequate site. Due to the loss of mammary gland, the nipple and areola complex are located at the same level as the sub-mammary fold. The lower pole of the breast contains a small quantity of mammary tissue with a skin excess hanging significantly in front of the sub-mammary  fold . In general the distance between the nipple and the sub-mammary fold is from  9 to 11 cm.

The treatment consists, as in the previous case, of a breast enhancement and breast lifting with an  anatomical, pre-shaped silicone implant with full-projection in order to fill the skin excess in the lower pole and lift the areola and nipple complex. The breast implant is usually placed in a position called ‘dual-plane’ which means that is located in a pocket covered by the pectoralis muscle in the upper pole and the mammary gland in the lower pole. The choice of the implant depends on the degree of ptosis. The post-operative period in these patients is longer than in the previous cases because there remains an excess of skin at the lower pole after the implantation, but a few months later the implant is integrated into the lower pole and the skin adjusts to the new breast shape preventing the need do make further scars. The results are impressive and there are no visible scars (see photos before and after).

Breast ptosis Grade III (treated by anatomical breast implant and skin reshaping):

The nipple and areola complex are located below the sub-mammary. This type of breast is characterized by a significant excess of skin to the point where the areola and nipple are situated below the sub-mammary fold usually pointing downwards. The breast upper pole usually contains very little breast tissue. The excess skin in the lower pole causes the skin to sag significantly, completely covering the sub-mammary fold.
In summer, the patients complain of skin irritation and the skin excess makes difficult to fit bras, because the skin can exit the  lower edge of the bras. The treatment is more complex than in the previous case. I start by placing an silicone pre-shaped anatomical breast implant with extra hight and extra-full projection in order to fill the upper and lower pole and raise the areola and nipple complex. The volume is somehow important and the implant’s base  MUST have the same diameter as the mammary gland.  Unfortunately, the lift induced by the anatomical implant will not be sufficient in all cases to obtain the desired effect. For this reason in some cases it is imperative to excise some skin in order to place the areola – nipple complex at the right level and the reshape the breast. The skin can be removed through an incision around the areola allowing discrete scars, but in other cases it must be removed from the lower pole and submammary fold as in the treatment of a traditional breast lift or breast reduction. I prefer to divide this treatment in two operations in order to lower the risk. I have had very good results only with a prosthesis implant and a re-evaluation after 6 months.

Types of breast augmentation / enhancement

Looking for a safe and professional breast augmentation in Geneva Switzerland?  This is the site where you will find all the information. Small breasts (breast hypoplasia) might be genetically determined, but may also be caused due to breast-feeding or result from significant weigh lost. The objective of a breast augmentation or breast enhancement procedure is to achieve the desired breast size/volume. This is done by :

– adding silicone implants, using the most appropriated incision.
– by fat graft or fat transplantation harvested from another part of the body
– injecting gels (Macrolane®)

Modern implants are filled with cohesive silicone or saline. Their shape and size can be chosen based on the patient’s necessities.

There is little or no interference with future breast-feeding and mammography controls.
The goal of this document is to bring all the elements necessary and essential to inform you about this surgical procedure.

 

Definition: Breast augmentation or breast enhancement.

Breast hypoplasia is characterized by breast of insufficient volume compared to the morphology of the patient. This insufficiency can be present from puberty or it can appear secondarily, following an important weigh loss or after nursing. Breast hypoplasia can be isolated or associated with an excess of skin (ptosis).

With exception of certain reconstruction procedures, breast implants are not cover by any health insurance.

 

Objectives: Breast enhancement

A breast enlargement or breast augmentation consists in correcting the volume considered insufficient by the placement of implants (prostheses) behind the mammary gland.

Principles: Breast augmentation and type of implants

For your information I have NEVER USED PIP IMPLANTS, I only use high quality implants. Currently, all the breast implants used today are composed of an envelope, and a product of filling. The envelope always consists of elastic silicone (silicone elastomer). It can be smooth or textured. Implants are  filled by a physiological solution (salty water) or silicone.  Implants filled with physiological solution are inflatable and their volume can adapt to the result desired during the surgery. Silicone filled implant have pre-determine volume.
The shape of the implant is very important:

ROUND IMPLANTS: Have been used for a very long time, are very safe in give good results, however in thin patient this implants produce round upper poles which is less natural than a progressive upper pole or « decolté ».

ANATOMICAL IMPLANTS: Where first conceived for breast reconstruction. Anatomical implants already have the shape of a breast. they have a thinner upper pole and they give more projection in the lower pole. These are my favorite implants since I found that the result is far more natural. Since these implants have an stable form, your surgeon must be sure about the right size and position, which demands extra skills from those of a standard breast augmentation. I have been placing anatomical implants for years now and I believe that generate the best results.

Before the surgery: Breast augmentation

During an appointment with Dr Xavier Tenorio, specialist in plastic & aesthetic surgery, based in Geneva, Switzerland, a full evaluation and examination will be done. The fees of this first consultation will be completely deducted from the surgical fees. Breast augmentation

The site of the scar, the situation of the prosthesis in relation to the muscle location, and the type and the size of the prosthesis will be decided according to the anatomical context and desires expressed by the patient. Breast augmentation

A usual preoperative assessment is carried out in accordance with the federal regulations. The anaesthetist will make a consultation at the latest 48 hours before the surgery. In addition to the usual preoperative examinations, a mammography can be required in certain cases. Any drug containing Aspirin must not be taken for at least 10 days prior to the surgery.

Type of anaesthesia: Generally this procedure is performed under general anaesthesia, however in some cases it can be avoid by performing a sedation associated with a nerve bloc.

Hospitalisation: A single day of hospitalisation is usually sufficient.

 

The surgery: breast augmentation

 

Some points about the technical aspect of the surgery are clarified in the following lines:

Cutaneous incision:

The implant is placed by a short incision that can be located either around the areola (the dark skin around the nipple),the axila area or in the submammarian fold (lower limit of the breast).
I prefer to place the incision in the submammarian fold because it allows to create a perfect pocket, to control any possible bleeding and to create a new fold. The scar is almost invisible after few months.

Position of the implant: Two positions are possible either behind the mammary gland or either behind gland and the pectoral  muscle.

Associated procedures: In the case of breast ptosis (sagging of the breast) an excision of the redundant skin can be performed at the same time. Sometimes, in order to avoid the collection of blood or any liquid, a drain in left in place and removed after 24 hours.

At the end of the surgery, a modelling bandage, with elastic bands is made. Under normal conditions the surgery takes 1 to 2 hours.

Follow-up of a breast augmentation:

Pain may be present immediately after the surgery and generally is well tolerated and treated with painkillers for few days. In some cases patients will fill some tension in the area where the implants have been placed. Oedema (swelling) last only few days.

Dressings: The first dressing is change after 24 to 48 hours and is replaced by a lighter one. Two to three days later the it is replaced again by a sports bra for 4 weeks during nights and day.

Time out of work: It is advisable to consider a convalescence time from 8 to 10 days. Complete physical activities and sports can be resumed after two months.

The results:

Patients are generally very pleased with in immediate result, however the shape improves with time. Beyond the aesthetic improvement, the psychological repercussion is generally beneficial.

Duration of the implant:

A prosthesis, that it is filled with cohesive of silicone or serum solution has lifetime that cannot be estimate precisely. A priori, an implant of quality theoretically does not have a limited lifetime. There is no expiration date after which the change of implant is mandatory. Thus, in the absence of a complication, the implant can be preserved as long as the patient wishes.

Possible complications:

Breast enlargement, although primarily realised for aesthetic motivations, is indeed a true surgical procedure, that implies some risks as any (however tiny) medical act.

It is necessary to distinguish the complications related to the anaesthesia from those related to the surgical act.

Concerning the anaesthesia: The anaesthesiologist will explain the risk and answer the patient’s questions during a pre-op consultation. Today’s technology allows the practice of anaesthesia under the best safety conditions for the patient and the surgical team.

Concerning the surgical act: Choosing a qualified surgeon, trained with this type of surgery, limits at maximum any risk, without however removing them completely.

Rare but possible complications: Infection requiring an antibiotic treatment and sometimes a surgical drainage. Haematoma formation requiring a drainage (evacuation). Decrease of the sensitivity, in particular in the nipple area, however the normal sensitivity generally reappears within 6 to 18 months. Troubles of the wound healing process are seen in heavy smokers and diabetic patients.  Hypertrophic scars and even keloids can be found in the scars of patients with unfavourable wound healing process.

Specific Risks of breast implants: They can be classified in three groups according to the nature of the filling product of the implant.

Folds, can be sometimes be seen under the skin and are more associated with saline implants in a retroglandular position. This condition may require a simple surgical correction.

A capsular formation around an implant will appear. It consists of a fibrous membrane that envelops any foreign body. In certain cases, this membrane thickens, retracts and forms a true fibrous capsule around the implant that can deform the breast shape and be painful. The frequency of this complication cannot be generally estimated since it varies with the surgical indication, the type of the prosthesis and the procedure. The treatment consists of releasing tension around the implant by incising the capsule. (capsulotomy).It seems that texture implants and those placed behind the muscle have an overall lower rate of capsule formation.

Rupture and deflation can occur following a deterioration of the envelope of the implant, following a violent traumatism or as a manufacture defect.

Rupture of a cohesive silicone implant may pass unnoticed. The cohesive silicone remains confined to the capsule around the implant and only a slight deformity. However, a disruption of the capsule as a result of a puncture can produce a leakage of silicon with potential formation of granulomas.

The rupture of a saline implant results in a fast deflation. In these cases, replacement of the implant is mandatory.

http://www.social-sante.gouv.fr/IMG/pdf/QR_Implants_mammaires_LAGC_17_mars_2

 

Important questions

What you must know about breast implants

Is it possible to nurse?

Breast implants placed behind the mammary gland does not seem to have a repercussion on breast feeding.

 

Does implants increases the chances of breast cancer?

Breast cancer incidence in patients with implants is the same as in the general population. No correlation has been demonstrated.

 

Is cancer monitoring possible with implants?

The clinical monitoring is simple when prosthesis are placed behind the mammary gland. However, the presence of an implant can modify the capacity of x-rays to detect breast cancer. For this reason, those with an implant must specify it to radiologist who will be able to use specific and adapted methods (echography, digitised mammography).

To resume, there is no need to overestimate the risks, but it is important to become aware that any surgical operation, even apparently simple, always comprises a small share of risks. Having a qualified surgeon ensures you that these complications can be identified and treated effectively.

I advise keeping this document, to read again it after the consultation. Perhaps this reading will bring out new questions, that our team will be ready to answer.