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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.
This insufficient breast volume is often a source of physical and psychological distress for the patient. Breast
augmentation with implants is the solution to these problems.
The procedure can be carried out at any age above 18, below this age the procedure is not advisable.
The implants used at present are composed of a shell and a filler. The shell is always made of silicone rubber, but the filler can vary. The implant is termed ‘pre-filled’ when the filler was inserted during the manufacturing process (gel and/or saline solution). The different volumes are therefore fixed by the
manufacturer. Implants filled with saline solution are filled by the surgeon who can adapt them to the patient to a certain extent during the procedure.



These implants, which have now been used for over 40 years have been proved to be safe and to be the best product for this procedure since they are very close to the consistency of a normal breast. There has been great progress in this domain since the late 1990’s, any weak points have been eliminated.
They are made of soft silicone gel inside a strong impermeable envelope of silicone rubber which can be rough or smooth.
The most important points concerning the new generation of implants, which ensure their safety, are the new improved envelopes and the gel itself.
The shells, which are now stronger, prevent any leakage of gel (which was a cause of capsule formation) and have much greater resistance over time.
Cohesive silicone gel which has a thicker consistency will not spread in case of rupture of the envelope.
Added to this increased reliability is the fact that this new generation of silicone implants exists in different shapes, making it possible to adapt them to individual needs. Thus we find, in addition to the classic round implants, anatomic ‘teardrop’ shapes which can be higher, wider or more pointed.



After discussion between the patient and the physicien who will have clearly explained the different options the best choice for each case is agreed on during the preoperative consultation taking into account all the relevant parameters ( height, weight, pregnancies, breast feeding, body shape, body fat, size of the existing breasts, muscle tone..).
After studying these parameters and anatomic features of the patient, the surgeon will determine the plan for the operation.
This will also take into account his preferred technique and the expectations of the patient and the positioning of the scars, the type and size of implants, and the position of the implants above or below the muscle.



Type of anesthesia

This is usually classic general anesthesia, you will sleep throughout the operation. Rarely ‘twilight’ anesthesia is used (local anesthesia with intravenous sedation), this can be discussed with the surgeon and anesthesiologist.

Hospital stay

One day in hospital is usually sufficient.


The incisions

  • Peri-areolar approach (around the areola) the incision is either below the circumference of the nipple or horizontal to the nipple (1&2).
  • Axillary approach
    The implant is inserted through a small incision situated in the armpit (3), or in
  • The inframammary approach
    The incision is in the inframammary fold (4).
    These incisions correspond of course to the position of future scars which will thus be hidden in natural folds or lines.

The position of the implant

This can be in a pocket made in the breast tissue behind the mammary gland and in front of the pectoral muscle, or
behind both the mammary gland and the pectoral muscle.

Additional surgery

In case of ptosis (sagging breasts, a lowered areola), it is
appropriate to associate a breast lift (mastoplexy) in general the operation lasts one to two hours.



There can be pain for the first few days after the procedure, particularly when the implant is large and/or placed behind the muscle. In this case pain medication of the strenth necessary to dull the pain, is prescribed for several days.
Even if there is no pain there will be a strong sensation of tightness.
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 an elasticised 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.


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. The procedure will have improved not only the volume but the shape of the breasts. The scars are usually hardly visible.

Duration of results
The implants have their own life-span, but without taking this into account the result of this procedure concerning volume, is long-lasting.


The following problems can occur occasionally:

  • asymmetry of the final volume in spite of the use of different sized implants to correct the problem.
  • Stiffness with insufficient softness and mobility (especially with larger implants).
  • An artificial appearance especially for very slim patients, the upper limit of the implant is visible.
  • The implant can be detected when touched especially when the thickness above the implant is reduced (skin + fat + gland) and when the implant is large.

In cases where the patient is not satisfied with the result certain problems can be corrected by revision surgery after a few months.


After having this procedure there is no problem regarding pregnancy either for the mother or the child, but it is advisable to wait for six month safter surgery. Breastfeeding is still possible in most cases.

Auto-immune disease
Many international research papers published on the subject have shown that there is not a higher risk of contracting this type of rare disease with implants compared to the general female population.

Implants and breast cancer
To our knowledge at present we can affirm that breast implants, including those filled with silicone, do not increase the risk of breast cancer. However, during screening techniques clinical examination and palpation can be affected, especially in case of siliconoma or capsular contraction. The presence of the implants can also make it difficult to carry out and read routine mammographies.. It is necessary to explain beforehand that you have implants.
Other radiological techniques can be used; echography, MRI etc.
Furthermore, if there is doubt as to a diagnosis of breast cancer you must be aware that more invasive exploratory techniques may be used in order to be sure of the result.

How long will the implants last ?
Although it is true that some patients can keep their implants for decades without major changes, an implant, whether filled with silicone gel or saline, cannot be said to last for a specific time, this is not a permanent life-long prothesis. A patient with implants must expect them to be replaced at some point
in time, if the initial effect is to be maintained. It is impossible to predict the life-span of an implant, of whatever type, as this depends on wear which is variable.
This means that no guarantee can be given regarding their life-span.
It should be noted however that the new generation implants are far more hardwearing and reliable. The notion of replacement after ten years is no longer justified, they only need to be replaced if a problem is detected, or the patient wishes to change their size or shape or to correct ptosis

Follow up
It is important to keep the appointments with your surgeon during the weeks and months following the operation. After this stage regular medical visits with, for example your gynecologist, or for routine mammography will continue this follow up. You must tell each physician that you have breast


Breast augmentation with implants, although essentially an aesthetic procedure, is nevertheless an operation, and this implies that the risks inherent to any surgery apply here.

  1. Possible complications inherent to all breast surgery
    A hematoma : blood can surround the implant shortly after surgery. In case of heavy bleeding it is necessary to return to the operating room to drain the blood and put a stop to the bleeding.
    Serous effusion : this means an accumulation of lymphatic liquid around the implant. It is a frequent complication often associated with considerable swelling., It gives rise to a
    temporary increase in the volume of the breast or breasts. It decreases gradually and disappears.
    Infection : rare after this procedure. It can require more than one course of antibiotics and the removal of the implant for several months following drainage. After this time interval
    another implant can be put in place.
    Abnormal scar : formation the healing process is unpredictable, and scars can be less discreet than expected.
    They can be widened, retractile, hyper- or hypo-pigmented, hypertrophic, or rarely, cheloid.
    Sensory changes : this is frequently found in the first few months but usually diminishes over time; Rarely however, a certain degree of dysesthesia (heightening or diminution of
    sensitivity) can persist around the areola and the nipple.
    Galactorrhea/milk secretion : very rare cases of unexplained postoperative hormonal stimulation have been reported, giving rise to milk secretion which sometimes collects around
    the implant.
    Pheumothorax : very rare, has specific treatment.

  2. Specific implant-related risks
    Wrinkling or rippling : the implant is soft and natural, and for this reason the outer envelope of the implant can form creases, which can be palpable or visible in certain positions under the skin, giving a ‘ripple’, effect.
    Capsular contractures : it is a normal physiological reaction that a fibrous shell should develop around an implant. A normal reaction to the presence of a foreign body in the organism is to isolate it from the foreign body with a hermetic membrane called a ‘periprosthetic capsule’.
    Normally this membrane is thin, supple and imperceptible but the reaction can increase and the capsule can thicken, become fibrous and contract exerting pressure on the implant, it is
    then known as a ‘capsule’ There are four stages of hardening that range from a normal undetectable aspect to severe forms giving hard, round, immobile breasts which can be painful.
    Capsular contraction can follow infection or a hematoma, but often has no determined cause, resulting from unpredictable organic reaction.
    Surgical techniques have made great progress in recent years, but especially the design and products used for the implants are much improved, this means a considerable reduction in
    the number of cases of capsular contraction and their seriousness.
    If necessary, he capsule can be incised in a surgical procedure (capsulotomy).
    Rupture : we have seen that implants have a limited life-span.
    An implant can become porous and the silicone rubber envelope of the implant can deteriorate. It can become porous, have tiny leakages or split. This can be rarely after an accident, a puncture with a needle or because of a manufacturing flaw. Much more often, however this is due to deterioration of the implant over time.
    If the implant is filled with physiologic solution or resorbable hydrogel the implant will deflate partially or totally, either suddenly or slowly.
    With silicone gel (non-resorbable) this will remain inside the membrane surrounding the implant.
    This can cause capsule formation or can remain un-noticed.
    Rupture of the implants usually requires an operation to change them.




Dr. Roland Tohme MD