Doctor Masson is a cosmetic surgeon specializing in breast enlargement (also known as a “boob job”) in Paris. A former intern at Paris hospitals, top of class in plastic surgery, recipient of the gold medal of surgery award and former head of clinic at the Saint Louis Hospital in Paris he answers your questions and gives you his expert opinion on breast implants.
How many breast enlargement operations are performed each year?
More than 350,000 patients actually have breast implants in France. 85% of the operations that are performed are for aesthetic purposes and 15% for restorative purposes (the after-effects of cancer, malformations etc.). The number of breast enlargements carried out in France in 2017 was estimated to be around 45,000 cases.
What is the current trend?
According to different studies, 80% of patients say they are dissatisfied with their breasts and would like to change something. It is estimated that there is a 6% increase in the number of cosmetic breast operations performed each year. Numerous internet discussion groups and specialized forums are also being created every year on this specific subject which is affecting more and more patients.
What is the average age of the patients?
I have noticed a peak between 20 and 35 years of age.
Is there a particular patient profile?
No, we find both young women who have never given birth (nulliparous) complexed by a very small volume of mammary glandular tissue as well as post-pregnancy patients (often with associated breast ptosis or sagging). There are also cases of malformations (especially tuberous breasts and asymmetry) and massive weight loss as well as post mastectomy reconstruction for breast cancer.
Where do your breast augmentation patients come from?
Fifty percent come from Paris and the Paris region, 25% from the French provinces (Nantes, Bordeaux, Lille, Nice, Marseille, Lyon, Toulouse, Nancy, Montpellier) and overseas departments (Martinique, Guadeloupe), and the final 25% from abroad (Belgium, Morocco, Italy, Spain, Quebec, Switzerland, England, USA, Hong Kong, Dubai, Australia) with a high proportion of French expatriate patients who return to France to undergo treatment.
Do the results look natural?
Yes, there has been a great deal of progress. Today, we see far fewer large volumes being fitted, too pronounced cleavages with a “staircase” effect, XXL breast augmentations, round breast implants in the shape of a ball, breasts too wide apart or multiple folds as before. Current results tend towards the natural given the progress linked to surgery and implants. Provided of course that the project is realistic and achievable. It would be impossible, for example, to achieve a natural result in someone who is very thin with almost no mammary glands and who wants a large breast volume. For example, going from an A to a D cup at 45 kg. This sort of breast morphology would not occur in nature. A breast augmentation to a C cup would be more reasonable and give a much better result.
What should you do before a breast augmentation?
Consult your cosmetic surgeon who will explain everything you need to know (technique, follow-up, life of implants, complications, etc.). An estimate will be given to you and the size of the implants defined. You will need to see the anesthesiologist a few days before the operation and have a blood test and mammogram, or even a breast ultrasound, if there is a risk of cancer. A post-operative compression bra is to be purchased and it is highly recommended to quit smoking before the operation. Being a smoker increases the risk of complications from a breast augmentation.
How is the operation carried out?
It takes place in a specialized establishment, clinic or hospital. The operation takes place under general anesthesia and lasts about an hour. It’s possible to leave the same evening or the next morning.
What are the postoperative effects?
It is necessary to plan to experience relatively bad pain for 3 to 4 days despite the prescription of analgesics. Unfortunately, completely pain-free breast augmentation does not yet exist. There are practically no threads to be removed today and drains are hardly used any more by the new generation of cosmetic surgeons. Care of the scars is very simple to carry out. A specific cream has to be applied for a few weeks and a special bra worn for about a month. Sport is to be avoided for one to three months depending on the activities. It will take between three to six months for the shape to be final and 12 to 18 months for the scar to be final. A week or even a month after the breast augmentation operation is too soon to see the results.
Where do you locate the scar?
Usually under the breast in the sub mammary groove. The scar is short, generally about 4 cm. Sometimes at the level of the areola and even more rarely at the level of the armpit (which is carried out more for various medical reasons).
How are the breast implants placed?
In dual plane, which means that the upper part of the implant is under the muscle and the lower part is under the mammary gland. It is the breast augmentation technique that gives the most natural results. Sometimes also behind or in front of the muscle, although the latter placement has become rare today.
What are the implants made from?
Hydrogel, polyurethane and saline solution are very rarely used. Most often we use new generation round implants pre-filled with cohesive silicone gel. These are unbreakable and flexible, covered with a microtextured envelope which allows them to adapt in a personalized way to the desired shape. All sizes are available and it is entirely possible to use a different size on each side to correct a possible (and frequent) breast asymmetry.
Will the implants have to be changed at some point?
Yes and I have to be very clear about this, there are no guaranteed breast implants in the year 2018. We are talking about a lifespan of ten years on average even if, according to the latest studies, it could be a little less. The results are stable but, to a certain extent, the redesigned breast will undergo the effects of gravity, aging, possible pregnancy, and weight changes the same as any natural breast would. Many changes are made for aesthetic reasons due to an imperfect result or natural deterioration related to the passage of time.
Are there any complications?
Yes, we are talking about surgery and all surgery carries certain associated risks with it even if, in practice, complications are rare. It is important however to differentiate between imperfections of the results from real complications.
Among the imperfections of the results obtained, it’s possible to experience a residual asymmetry, too much firmness, reduced mobility, an artificial appearance, feeling the implants, the worsening of a ptosis, and areolar dystopia.
Among the rare complications are the following: anaplastic large cell lymphoma (exceptional, but it has been described), complications related to anesthesia, hematoma, infection, lymphatic effusion, scarring abnormalities, shell reactions, folds, sensitivity problems, rupture, and displacement.
The French Ministry of Health has created an excellent information sheet which should be read before a breast augmentation procedure.
And let’s not forget the infamous urban legend: you can of course fly on a plane with breast implants!
How much does a breast augmentation cost?
On average, in Paris, the price varies from 5000 to 6000 euros.
Is there an alternative breast augmentation method?
Yes, a patient’s own fat can be injected to achieve a breast augmentation, but only if there is enough because you lose a lot during this procedure which is called breast lipofilling or lipomodelling. Breast augmentation without surgery does not yet exist, however.
Before and after example of a breast augmentation
Breast implants in cohesive silicone gel, sub-mammary route, dual plane technique, moderate profile, 300 ml for a transition from an A to a C cup.