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22.09.2015
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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.
It is characterized by breast of small volume, usually without a significant degree of asymmetry even though a slight asymmetry is almost always present. 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. In this case the volume is generally suitable and may have a greater or lesser degree of asymmetry. 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.
Treatment: Normally, this type of breasts need the implantation of an anatomical or round breast implant. 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. The nipple and areola are located above the sub-mamary fold (the lower limit of the breast). In my practice, most women with this particular form of breast shape had an adequate volume before and during lactation. The simplest treatment is a breast enhacement and breast lift with a particular breast implant.
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. 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 goal of this document is to bring all the elements necessary and essential to inform you about this surgical procedure. Breast hypoplasia is characterized by breast of insufficient volume compared to the morphology of the patient.
With exception of certain reconstruction procedures, breast implants are not cover by any health insurance. A breast enlargement or breast augmentation consists in correcting the volume considered insufficient by the placement of implants (prostheses) behind the mammary gland. 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.
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 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. 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. 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.
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. Pain may be present immediately after the surgery and generally is well tolerated and treated with painkillers for few days.
Dressings: The first dressing is change after 24 to 48 hours and is replaced by a lighter one. Patients are generally very pleased with in immediate result, however the shape improves with time.
A prosthesis, that it is filled with cohesive of silicone or serum solution has lifetime that cannot be estimate precisely.
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 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.
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. Rupture and deflation can occur following a deterioration of the envelope of the implant, following a violent traumatism or as a manufacture defect. Breast implants placed behind the mammary gland does not seem to have a repercussion on breast feeding. Breast cancer incidence in patients with implants is the same as in the general population.
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.
You can decide which point of entry {Periareolar or Inframamamary) and which position you prefer the set point of the implant {Subglandular or Submuscular} Submusculara is more painful and a bit longer to heal. 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.
In fact, giving more volume to the chest causes a reshape in the abdomen and waist, positively changing the entire body silhouete.
For this reason, I use implants that have a certain consistency, to ensure a pleasant tactile sensation after the surgery. Typically patients consult because of a certain degree of dissatisfaction with their volume.
The breasts have a natural shape and the implant is well protected behind the mammary gland and the pectoral muscle. 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. 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).
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. 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. 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.
This insufficiency can be present from puberty or it can appear secondarily, following an important weigh loss or after nursing.
Sometimes, in order to avoid the collection of blood or any liquid, a drain in left in place and removed after 24 hours.
In some cases patients will fill some tension in the area where the implants have been placed. Two to three days later the it is replaced again by a sports bra for 4 weeks during nights and day. Today’s technology allows the practice of anaesthesia under the best safety conditions for the patient and the surgical team. The cohesive silicone remains confined to the capsule around the implant and only a slight deformity. However, the presence of an implant can modify the capacity of x-rays to detect breast cancer. Having a qualified surgeon ensures you that these complications can be identified and treated effectively.
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. The upper pole of the breast (decolte) is small in volume causing great dissatisfaction when dressing due to the lack of contact between the clothes does and the body. Finally, the breasts may be reduced in size and projection as the result of the normal aging process. However the areola and nipple are located at their adequate site,  above the sub-mammary fold.


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. 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. In addition to the usual preoperative examinations, a mammography can be required in certain cases. Decrease of the sensitivity, in particular in the nipple area, however the normal sensitivity generally reappears within 6 to 18 months. 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.
However, a disruption of the capsule as a result of a puncture can produce a leakage of silicon with potential formation of granulomas. 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). 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. I prefer to insert the implant via a sub-mammary fold incision but I can adapt to the preference of the patient. The lower pole contains a small quantity of  breast tissue causing the skin to hang in front of the fold under the breast. Due to the loss of mammary gland, the nipple and areola complex are located at the same level as the sub-mammary fold. The excess skin in the lower pole causes the skin to sag significantly, completely covering the sub-mammary fold. The volume is somehow important and the implant’s base  MUST have the same diameter as the mammary gland.
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. Thus, in the absence of a complication, the implant can be preserved as long as the patient wishes.
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. The frequency of this complication cannot be generally estimated since it varies with the surgical indication, the type of the prosthesis and the procedure.
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. 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 . 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. 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). 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.
I have been placing anatomical implants for years now and I believe that generate the best results.
The skin covering the breasts is usually very firm making it difficult to treat with large implants. 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.
Personally, I generally prefer silicone implants with anatomic shape because I find they give a more natural result. I have had very good results only with a prosthesis implant and a re-evaluation after 6 months.



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