Breast augmentation in Tunisia

The intervention of breast augmentation is a cosmetic surgery, which consists in increasing the volume of the chest by the implants or breast implants.

Considering that the size of her breasts, is "too small”, the patient often opt for a cosmetic surgery of the breasts.

This breast augmentation surgery is also indicated in cases of malformed breasts (tuberous breasts) or in the case of asymmetrical breasts.

In case of breast ptosis associated with SGA (small sagging breasts), breast augmentation with implants can be combined with a breast lift.

The breast augmentation surgery is not limited to a certain age; it can be practiced from the age of 18, and can provide a beautiful chest and a good-looking cleavage.

Patients with breast ptosis (sagging, small sized breasts); can combine their breast augmentation surgery with a breast ptosis cure. The latter allows lifting up the areolas, removing the exceeding skin and tightening the remaining skin by adjusting the implanted breast prosthesis. This leads to a satisfactory result with larger and well-shaped breasts.

Breast ptosis cure generates, as consequence, the appearance of scars on the breasts: vertical scars or T depending on the degree of the sagging skin.

When combined with a breast lift, Breast augmentation is called mammoplasty-implants.

The Breast implants currently used consist of an envelope and a filling material.

Having proved their usefulness and safety for over 40 years, these implants are known by their excellent adaptation to the breast augmentation surgery because approximate consistency of natural breasts. And since the end of 1990, the implants have evolved regarding the envelopes as well as the gel itself.

• Product breast implants :
  The content prostheses different from one another, it is the filler included within the envelope: silicone gel pre-filled implants or saline implants.

  

  Most of the currently used implants are rather implants pre- filled with silicone gel. For silicone gels «cohesive», there is a development of their consistency so it is less fluid preventing their dispersion in case of rupture of the envelope: highly cohesive gel.

  

• The breast implants’ case :
  The case is of silicone elastomer. The wall of the casing is solid, thereby preventing the outward “sweating” of the gel (something that caused the shells) and development of high wear resistance. We distinguish textured breast implants and breast implants with a smooth surface.

  

  

• The shapes and sizes of breast implants : The implants have :
  • Diversification of forms: round or anatomical implants.

    

    

  • An availability of several projections and choices of volume, allowing optimization and adaptation of choice an almost "tailor made" prostheses following the morphology of the patient and his personal expectations.

    

As with any surgery, breast augmentation requires the completion of a comprehensive preoperative blood test. In addition, it is necessary to perform a mammogram especially among women aged 35 years or having breast cancer risk factors.

Among the medical guidelines to follow:

• Smoking and oral contraceptives should be stopped, one month before the intervention.
• A ban on any product containing aspirin, anti-inflammatory and / or anticoagulants is mandatory for at least 15 days before breast augmentation in order to reduce the risk of bleeding.
• A ban on oral contraceptives (pills) is required at least one month before surgery to reduce the risk of thromboembolism.
• Avoid pregnancy for one year following breast augmentation to avoid damaging the aesthetic result of the intervention.

As with any surgery, breast augmentation requires forming of a conventional general anesthesia.

In terms of hospital procedures, the procedure requires a postoperative hospital stay of 2 nights in clinic.

Each surgeon has his own technique that he adopted by judging its effectiveness compared to the case that he is treating and for the desired results. However, the principles of the procedure are common among all surgeons:

• Skin Incisions :
  3 ways are possible to address the prosthesis implantation:
  
  • The incision area frame : the incision made in the lower segment of the areola.
  • The inframammary way: the incision made in the crease below the breast.
  • The axillary incision : the incision is made at the axilla .

  

  Each of these three ways has its advantages and disadvantages. The incision procedure is suitable for the patient and the surgeon according to the expectations of the latter and its anatomy.

  These incisions traced by the doctor will match the future scars. This is why the surgeon will place them in natural folds in the junction zones.

• Position of the breast implant:
  
  • Before the pectoral muscle: placed just behind the mammary gland if the patient has a fairly thick skin and mammary gland to make invisible the contours of the denture.
  • Behind the pectoral muscle : preferable in thin patients whose muscle reliefs conceal the prosthesis.

• Drains et bandges
  

  The drain in place is a device that sends blood accumulated around the implants.

  After surgery, a bandage "modeling" accompanied by an elastic bandage will be placed.

  The duration of the intervention lasts from 1:00 to 1:30.

• A feeling of mild pain during the first days especially when the implants are an important volume and placed behind the muscle. A painkiller prescription thus appease these discomforts. At best, the patient will feel a strong sense of tension.
• It is quite common to see the formation of edema (swelling) and ecchymosis (blue) in the treated areas that will disappear in 1-3 months. In addition, the patient will find a difficulty in raising his arms in the first period.
• The drainage device is held for 1 to 3 days after its production.
• The light bandage placed postoperatively will be removed in 1 day after surgery while the bra without reinforcement is doing 24/24 for about one and a half months (6 weeks).

• Le fils est résorbable
• The son is resorbable
• The patient can shower for the first time the day after the drains are removed.
• The patient can always monitor her breasts with mammography in order to detect breast cancer after completion of breast implants. Informing the gynecologist and radiologist will be required, as the completion of a baseline mammogram after a few months of the intervention.
• There must be about to stop work for 8 to 15 days of rest.
• The gradual resumption of sporting activities is possible at the end of the second month after the procedure.
• It is essential to carry out a daily massage for the breasts for one month after surgery. These massages will decrease the risk of hull.
• An appreciation of the final result (volume and shape of the breasts) is estimated possible after 3 to 6 months after surgery. After 12 months, the patient can judge the final appearance of scars.

Pregnancy / Breastfeeding 

After placement of breast implants, the patient can have a safe pregnancy for her and the fetus. However, it is best to wait at least one year after surgery. As for the feeding, it is not dangerous and the patient can breastfeed in most cases.

Autoimmune Diseases

Many scientific work and research has been made on the international level about breast implants. It has been reported that the risk of occurrence of these diseases is the same for patients with implants (especially silicon) than women in the general population.

Prostheses and cancer

So far, it has been proven that the breast implant surgery, including silicone, are not involved in the increased risk of breast cancer reached. It is important to mention that you are with breast implants as part of breast cancer screening.

Life implants

The placement of breast implants should not be considered a definitive thing "for life". Therefore, the patient should expect to change its implants and replace them to maintain the beneficial effect of prostheses. Indeed, the latter have a life that cannot be preset because it varies according to the wear speed of a patient to another. Thus, the life of implants is not guaranteed. It is also mentioned that the new generation of implants has made significant progress in terms of reliability and resistance. Thus the preconception on the obligation to change the implant beyond 10 years is no longer valid and breast implant replacement will be performed in case of problem that justifies its replacement or in case of intent improve the aesthetics of the patient (change the volume or shape, correct ptosis ...).

Fortunately, surgery breast implants has very few complications and a very low degree of risk. Nevertheless, it is never safe from unforeseen complications despite the skills of the practitioner.

• General complications :
  
  • Les accidents thromboemboliques (phlébite, embolie pulmonaire).
  • Thromboembolic events (phlebitis, pulmonary embolism).
  • A very rare risk of infection. It can lead to a reoperation under general anesthesia to try to save the infected implant, which is not always possible. It may indeed be necessary to remove an infected implant, and then wait several months after healing to replace another.
  • A hematoma characterized by bleeding in the operated area. It can be the source of further surgery under general anesthesia.
  • A pneumothorax pleural breach is rare, but possible.
  • The lymphatic effusion, possibility of occurrence within a few weeks after surgery can lead to repeated punctures and / or reoperation for drainage.
  • Risk of disunity (dropping), early scarring that can cause reoperation. In the case where the prosthesis is exposed, it will be necessary to remove it.
  • The occurrence of pneumothorax pleural breach is rare, but possible.
  • Change in sensitivity, numbness, and insensitivity or "weird" sensations in the nipple area. This change is common and usually begins to disappear after a few months after surgery.
  • Risk of partial necrosis at the gland and the mammary fat (fat necrosis) which appears as a hardened nodule that can sometimes be the cause for an reoperation. This is exceptionally extensive necrosis of the mammary gland.
  • A disorder of healing may appear: large scars, hypertrophic or keloid. Each of these disorders the treatment method.
  • Risk of paralysis of the upper limb by stretching of the brachial plexus is rare. Related to the position of the arm during the intervention, it disappears spontaneously over a period of several days to several months.
  • Epidermal cysts may appear on the scar sub-areola scar.
  • Imperfections in the results may appear: asymmetric or insufficient correction. This can cause reoperation few months after the first operation. However, as mammoplasty is performed for aesthetic reasons, it must be admitted that the result can only be assessed a subjective way. Indeed, the final result may not be the desired result. Specifically, the bra size of implanted breast cannot be guaranteed.
• Specific complications to breast implants :
  
  • Occurrence of a pri-prosthetic fibrous shell: the significant risk of this intervention is unpredictable and can occur unilaterally or bilaterally, sometimes months or years after the introduction of the implant. It consists of a reaction of the body around the foreign body that constitutes the implant. In case it is painful and / or unsightly, the shell can cause a reoperation under general anesthesia, which can lead in a worst case to the definitive removal of the implant.
  • Risk of rupture or deflation of the implant: when the cracked prosthesis contains saline, it deflates faster or slower. When it contains the silicone gel, it seeps around the prosthesis, in the fibrous shell (intracapsular rupture), or beyond it. The reoperation is not automatic and depends on each particular case.
  • Folds formation or appearance of waves: mostly this deformation is seen with saline-filled implants more than it is with those who are pre-filled with silicone gel. This phenomenon is more prone to appear in lean patients with small natural breasts.
  • Stretch: This risk can occur on the skin of an implanted breast in the form of stretch marks and / or small veins and is seen when the implant is relatively bulky.

The intervention of breast augmentation by implants is a cosmetic procedure with limited risks. However, do not overestimate but be aware of these risks since they are associated with any surgical medical procedure as simple as it is.

Breast augmentation price in Tunisia proposed by Dr. Chiraz Bouzguenda is:

• Price of breast augmentation in Tunisia: 1900 €.