Breast reshaping

Breast reshaping

When the breasts have sagged with stretching of the skin, this is called breast ptosis. When they are also large in volume, the term breast hypertrophy is used, whereas when they are small we speak of underdeveloped (small) breasts. This ptosis may be present from puberty or follow weight loss or pregnancy (with or without breastfeeding). The aim of surgery is to achieve two harmonious breasts, nicely contoured and lifted. It can be performed from the end of growth and, thereafter, at any time in life. A subsequent pregnancy and breastfeeding are, of course, possible, but it is advisable to wait at least six to eight months. At your first consultation, Docteur L. SALLAZ, after listening to your wishes and motivations, will examine you carefully to ensure that surgery is appropriate and will explain it to you precisely. He will explain what it can genuinely offer you and what it cannot correct. He will inform you as fully and honestly as possible about this procedure (location of the scars, how they change over time, …). If ptosis is associated with very insufficient breast volume, it may be advisable to place a breast implant as well. This particular situation will be discussed by the surgeon at your consultation. When the breasts are heavy and sagging, this procedure may be partially covered by health insurance. If so, the surgeon will let you know. He will give you an information sheet and a quotation so that you can make a fully informed decision after a reflection period. If you wish to proceed with surgery, you will need breast imaging (mammogram, ultrasound scan) and preoperative blood tests before seeing him again for a second consultation. The surgeon can then answer any further questions before ‘booking you in’ to the clinic and referring you for an anaesthetic assessment.

The procedure

The operation is carried out under general anaesthesia in the clinic’s operating theatre, in a high-tech environment authorised to perform cosmetic surgery procedures by the Haute Autorité Sanitaire (HAS). It lasts about 2 to 2½ hours. The aim is to restore the shape of the breast by reshaping and lifting it (mastopexy), reducing it (breast reduction) or increasing it (breast augmentation) as required, so that it is more harmonious with the rest of the figure. This operation creates a scar, the length of which depends on the exact procedure performed. It will be located around the areola, sometimes extending vertically towards the fold under the breast and, if necessary, horizontally within that fold. The surgeon must find a balance between an attractive breast shape that satisfies you and the smallest possible scarring. This depends on surgical technique, his experience and your own healing. Sutures are placed with fine stitches under the skin (subcuticular running sutures), and a light compressive dressing is applied followed by a support bra.

Aftercare

The postoperative course is usually straightforward, but careful monitoring in the clinic overnight is necessary and you will be able to leave the clinic the next morning. The sutures will be removed two weeks after the operation at your follow-up consultation with the surgeon at his practice. Discomfort is moderate and normal activities can be resumed quickly. No strenuous sport should be undertaken for two months afterwards so as not to create excessive skin tension on the sutures that could cause them to widen. The breast shape will settle after a few months. The breasts will then most often have a harmonious, natural contour, symmetrical or very close to symmetry. You will nevertheless need to wait for the gradual fading of the scar over 1 to 2 years. An operated breast remains natural and sensitive; in the event of hormonal changes, medical treatment, pregnancy or weight fluctuations, changes may therefore occur. Beyond the aesthetic improvement, this procedure generally has a beneficial impact on weight control, sport, clothing options and psychological wellbeing.

Risks

Risks and complications are rare; nevertheless, although performed for predominantly aesthetic reasons, breast reshaping remains a real surgical procedure, which entails the risks associated with any medical act, however minor. In practice, the vast majority of operations proceed without problem and patients are fully satisfied with their result. A haematoma, which slows normal recovery, can occur; it will be anticipated and treated if necessary. To reduce this risk, no medicine containing aspirin or aspirin-like compounds should be taken in the ten days before and after the operation. Breast sensation may sometimes be partially reduced, usually temporarily. Some delays in wound healing can prolong the need for a dressing, notably in the rare event of skin necrosis. Smoking is a significant risk factor for poor healing. Smoking should be markedly reduced, or ideally stopped, 3–4 weeks before the operation to lower these risks. Infection is rare after this type of surgery; to minimise this risk, patients must take preoperative antiseptic showers at home. Sometimes anticoagulants are prescribed to prevent thrombo-embolic risk (DVT, …); anti-thrombosis stockings are necessary and early mobilisation after the operation is recommended. Overall, the risks should not be overstated, but it is important to recognise that any surgical procedure, even an apparently simple one, always carries an element of uncertainty. Choosing a qualified plastic surgeon ensures that he has the training and expertise required to avoid these complications or to treat them effectively if they occur.

Breast reconstruction

In breast reconstruction after breast cancer surgery (total or partial mastectomy, lumpectomy), different surgical techniques can be offered to rebuild the breast. They sometimes use a breast implant with skin and/or muscle flaps taken from the back or abdomen, and often lipomodelling (= fat transfer). The choice of procedure depends on multiple factors, the main ones being the patient’s wishes, age, state of health and the surgical options directly related to previous treatments (surgery, radiotherapy, …). Indeed, some reconstructive techniques cannot be used because of skin damage caused by radiotherapy, for example. Several operations may be necessary to achieve an optimal aesthetic result. At your first consultation, Docteur L. SALLAZ, after listening to your wishes, will examine you carefully to ensure the feasibility of this or that procedure, which he will explain precisely. He will explain what it can genuinely offer you and what it cannot correct. He will inform you as fully and honestly as possible about this procedure (location of the scars, how they change over time, …). He will set out the treatment plan he envisages (number of operations, intervals between each, …). Given the wide range of possible procedures, it is not possible to describe them all here, but this will be done by the surgeon during your consultation.

Inverted nipple

An inverted nipple is a congenital or acquired nipple malformation that may affect one breast or both. Before making the diagnosis, breast disease must always be ruled out. The nipple is more or less buried behind the areola, has a permanently retracted appearance and ‘never protrudes’. A minor surgical treatment consists of releasing the retraction of this nipple so that it ‘pops out’. The surgeon performs, under local or general anaesthesia according to your wishes, a small incision hidden beneath the nipple (therefore almost invisible) to evert it. A discreet suture (absorbable stitches) is then placed and a light dressing applied. This procedure is minimally painful and quickly restores or creates a nipple ‘in relief’ that is more harmonious with the patient’s breast. In some cases, cover may be possible; the surgeon will inform you if this applies during the consultation. The operation is performed in the clinic’s operating theatre, in a high-tech environment authorised to perform cosmetic surgery procedures by the Haute Autorité Sanitaire (HAS). It lasts about 30–45 minutes. Risks and complications are rare; nevertheless, although performed for predominantly aesthetic reasons, this procedure remains a real surgical operation, which entails the risks associated with any medical act, however minor. To reduce the risk of haematoma, no medicine containing aspirin or aspirin-like compounds should be taken in the ten days before the operation. Some delays in wound healing can prolong the need for a dressing, notably in the rare event of skin necrosis. Smoking is a significant risk factor for poor healing. Smoking should be stopped before the operation to lower these risks. Infection is rare after this type of surgery; to minimise this risk, patients must take preoperative antiseptic showers at home. Overall, the risks should not be overstated, but it is important to recognise that any surgical procedure, even an apparently simple one, always carries an element of uncertainty. Choosing a qualified plastic surgeon ensures that he has the training and expertise required to avoid these complications or to treat them effectively if they occur.

Male breast surgery (gynaecomastia)

Gynaecomastia is defined as excessive development of the male breast, on one side or both, symmetrically or not. It is generally slightly or not painful, but may sometimes be accompanied by breast tenderness. In the great majority of cases, gynaecomastia is normal, or ‘physiological’, that is to say no cause is found. However, before this can be confirmed, a full assessment must be carried out to look for a possible pathological or drug-related cause. This includes a medical history, clinical examination, blood tests and an ultrasound scan. Surgery is particularly indicated for forms that are troublesome because of their volume or tenderness, as well as for gynaecomastia that is poorly tolerated psychologically. At your first consultation, Docteur Lionel SALLAZ, after listening to your wishes and motivations, will examine you carefully to ensure that an operation is appropriate and will explain it to you precisely. He will explain what it can genuinely offer you and what it cannot correct. He will inform you as fully and honestly as possible about this procedure (location of the scars, how they change over time, …). He will give you an information sheet and a quotation so that you can make a fully informed decision after a reflection period.

The procedure

Surgical correction of gynaecomastia may sometimes be covered by your health insurance; the surgeon will inform you if this is the case. The operation consists of removing the excess breast tissue, under general anaesthesia, in the clinic’s operating theatre, in a high-tech environment authorised to perform cosmetic surgery procedures by the Haute Autorité Sanitaire (HAS). A 12–24 hour hospital stay is then required. Recovery is usually straightforward and not very painful. The sutures will be removed two weeks after the operation at your follow-up consultation with the surgeon. Discomfort is moderate and normal activities can be resumed quickly.

Risks

Risks and complications are rare; nevertheless, although performed for predominantly aesthetic reasons, surgical correction of gynaecomastia remains a real surgical procedure, which entails the risks associated with any medical act, however minor. In practice, the vast majority of operations proceed without problem and patients are fully satisfied with their result. A haematoma, which slows normal recovery, can occur; it will be anticipated and treated if necessary. To reduce this risk, no medicine containing aspirin or aspirin-like compounds should be taken in the ten days before and after the operation. Some delays in wound healing can prolong the need for a dressing, notably in the rare event of skin necrosis. Smoking is a significant risk factor for poor healing. Smoking should be stopped before the operation to lower these risks. Infection is rare after this type of surgery; to minimise this risk, patients must take preoperative antiseptic showers at home. Overall, the risks should not be overstated, but it is important to recognise that any surgical procedure, even an apparently simple one, always carries an element of uncertainty. Choosing a qualified plastic surgeon ensures that he has the training and expertise required to avoid these complications or to treat them effectively if they occur.

Breast lipomodelling