Breast augmentation: Should breast prostheses be changed?

Advice from Dr. Smarrito, a breast augmentation specialist, on the subject of changing prostheses.

There are two cases and two configurations to differentiate when it comes to changing breast prostheses.

You wear breast prostheses. Patients with breast prostheses must ask themselves the question of changing breast prostheses. If we look back at the history of breast prostheses, the instructions have changed over time. About fifteen years ago, changing breast prostheses was compulsory.

In fact, the breast prosthesis is made up of a pocket with several thicknesses, generally made of silicone and a content which at present in many cases is cohesive silicone gel, in the past however, this gel was liquid and in the event of rupture it spread to the breast. The fact that a liquid silicone gel spreads into the breast creates inflammation of the breast. Dr. Smarrito at the beginning of his career experienced this phenomenon which often resulted in difficulty when changing pierced prostheses. This phenomenon no longer occurs at all today.

In practice, if the prostheses are more than 15 years old, it is relatively imperative and urgent to change the prostheses because the risk of rupture is high and the silicone effusion can lead to a siliconoma which is quite difficult to manage during the operation. . If the prostheses are less than 10 years old, it is interesting to know what material is inside the prostheses as well as the reference of the prostheses. A simple annual ultrasound check-up is required. In the event of breakage, a change of prostheses must be organized in conjunction with your cosmetic surgeon. If the change is made fairly quickly (a few weeks to a few months) it is easy, in fact it is enough to clean the compartment and change the prosthesis.

On the other hand, in the event of an old rupture, the prosthesis compartment may have hardened and created a peripheral tissue which requires an additional procedure known as opening the pocket (coquotomy) during the intervention. If your prosthesis was installed between 10 and 15 years old, you should consider a change, in fact, the risk of breakage on prostheses after 7 years is increased. We also recommend changing the prostheses even if they are made of cohesive silicone gel to avoid the phenomenon of sweating through the wall of the prostheses. The change can be easy and the cost is often the same as a simple breast augmentation.

Furthermore, you will benefit from new technologies in prosthetics, particularly in terms of the quality and safety of the content but also in terms of touch.

You can directly consult a new cosmetic surgeon for this change who will analyze the breast and probably offer you in a 1^er time to do an ultrasound before scheduling a prosthesis change procedure. A change of prostheses can be carried out under local anesthesia. For reasons of comfort, a short general anesthesia may however be offered to the patient.

Your breast prosthesis installation is recent.

For several years, we have advised patients who have benefited from short-term breast augmentation using cohesive gel prostheses not to systematically change the prostheses but to monitor them. This notion has been modulated recently, in fact, the notions of safety and quality of the prosthesis have been re-discussed and we again advise patients to change their prostheses around the age of 10. The advantage of this change is to have a prosthesis which has much less risk of rupture during an impact.

You should know that a prosthesis is extremely strong. Numerous publications have highlighted the resistance of prostheses even after several years and several cases have been published in the literature of protection of the thorax during an accident or attack using prostheses.

But a new prosthesis will allow you to benefit from the latest technologies in terms of gel quality, safety but also will allow you to have a less porous texture. The porosity of the prostheses causes slight sweating of the silicone outside the compartment.

Wear or breakage of prosthesis.

The first stage of prosthesis wear is intra-capsular rupture of the gel. That is to say for surgeons (the discourse may be different for a radiologist) we know that a prosthesis begins to wear out when in radiology there is a split between the wall of the prosthesis and the gel. In some ways, the gel inside the prosthesis is no longer adherent to the membrane. This does not indicate a breakage but a wear of the prosthesis.

The rupture is easier to identify by a radiologist but also by the patient, in fact, often the breast is more flexible and the radiologist can easily see a slight bump of silicone on the outside of the prosthesis or a silicone spread without a pre-established shape if the rupture is total.

In this context, you must consult your surgeon with a view to changing your prostheses over the next few weeks.

The particular case of serum prostheses.

Serum prostheses have been largely abandoned given their often quite rigid and unfavorable feel. Furthermore, these prostheses, due to the fragility of the inflation valve, deflate. This often involves a total flattening of the prosthesis and progressive deflation.

The perfectly physiological serum is then reabsorbed by the body but the breast flattens. In this context, it is necessary to change the prosthesis to serum like other prostheses to regain the aesthetic appearance. Serum prostheses, on the other hand, which are not ruptured, can be kept longer from a medical and physiological point of view, in fact, serum prostheses have rather an on/off effect, that is to say either they are inflated and they can remain in place because only the wall is made of silicone, or they are deflated and the change must be considered mainly from an aesthetic point of view.

That is to say, if your prostheses are old but in serum, a change is not obligatory.