HERE YOU WILL FIND ALL IMPORTANT INFORMATION FOR BREAST OPERATIONS
Breast operations are surgical procedures, which change the size, shape or fullness of the breasts. The different kind of breast operations are:
- Breast augmentations, which increase the size and form of the breasts via fat transfer or with implants, which are placed either under or over the breast muscle.
- Breast reduction, which reduces the volume of the breast.
- Breast lifting can be used to correct changes in the shape of the breast so that they subsequently appear more harmonious and aesthetic.
By far the most common type of breast surgery is breast augmentation. With around 1.6 million annual operations worldwide, this is one of the most popular aesthetic procedures. 83% of women choose implants and only 17% choose breast augmentation via fat transfer.
The main reasons are often small or asymmetrical breasts, which do not meet personal aesthetical perceptions. Changes in breast size and shape after pregnancy or weight loss can also be corrected.
Besides aesthetical reasons, breast surgeries are also carried out for reconstructive purposes as mastectomy after breast cancer.
HERE YOU CAN FIND OUR REASONABLE
Breast implants offer well-shaped and full breasts. A permanent enlargement and reshaping of the breasts give the wearer more femininity and sex appeal and increases self-esteem.
The best known and preferred type of breast implants are silicone implants. These contain a core made of special silicone gel, which has a soft, yet dimensionally stable structure. In their consistency, they resemble a natural female breast. The gel is surrounded by a multi-layered shell made of polymerized silicone rubber, which can differ in its surface properties. Smooth or textured surfaces are possible. The advantage of textured implants is that they adhere better to the tissue.
Our partner clinics use branded implants from B-Lite, Mentor and Motiva, which have the world’s highest quality certificates. They are available in different shapes (round and anatomical) as well as in different sizes, therefore the breast can be perfectly shaped according to the ideas and wishes of the patient. Modern implants are extremely safe and, unlike previous generations of implants, last a lifetime.
Together with your surgeon your will find the ideal implants for you. Factors such as the current breast size and shape, the tissue volume and the anatomy are taken into consideration. A 3D simulator will support the choice of implants, by projecting the appearance of the different implants to your body. With such an extensive decision making, you will get results, which will provide you long lasting satisfaction.
Polytech – B-Lite
Polytech B-Lite silicone implants consist of a microsphere-reinforced silicone gel, which reduces the weight by 30%. This means they resist gravity for much longer, which in turn slows down the lowering of the breast significantly. Just like with other breast implants there are available different shapes and sizes as well as the surgical procedure.
Mentor MemoryGel Xtra
MemoryGel Xtra implants are particularly suitable for slim patients with a sporty body type who would like to have larger breasts.
The implants are characterized by a narrower base and a larger projection according to the base width. This means that more fullness is possible than with breast implants from other manufacturers.
Due to the narrower base, the edges are less noticeable, which makes the breast feel more natural. Due to the cohesive MemoryGel in the Xtra silicone cushions, the implants feel like soft, natural breast tissue. This is also confirmed by a blinded study in which 9 out of 10 people opted for Mentor implants, rather than from a different major brand. Another advantage is a stronger filling, which leads to increased strength and dimensional stability, thus wrinkling (rippling) occurs less frequently on the implant.
Motiva – Ergonomix / TrueFixation
Motiva Ergonomix implants with ProgressiveGel Ultima® are designed to follow a woman’s movements – holding a round shape while lying down and forming a natural-looking, sloped silhouette when standing. The implants feel very soft and lifelike and follow the natural contours and movements of the breast. As a result, Ergonomix implants are able to mimic how real breasts look, feel and move.
Motiva anatomical TrueFixation implants are rotation-resistant. Due to its special shell, these don’t have inflammatory complications associated with textured shells. The teardrop shape makes a natural appearance of the breast.
Motiva Q Inside® is the world’s first micro-transponder that provides an electronic serial number (ESN) with implant-information such as manufacturing date, implant type, volume, and more. This can be integrated into Motiva implants.
In order to give you an idea of your future breast size and to increase the satisfaction of the chosen implants, we recommend the so-called rice test before the consultation with your doctor. Fill two knee-length nylon stockings with rice and knot them. Then place them in an unpadded or sports bra and wear it in your daily life for 1-2 days. Alternate the amount of rice until you find the perfect size and achieve the desired appearance.
1 ounce (28 grams) of rice is equivalent to approximately 30cc. Therefore if you want to add one more cup size, you could use 150 grams of rice, which corresponds to a 150cc implant.
Whether you opt for round or anatomical implants, while deciding for the size of the implants, the anatomical shape of the body should be considered. To find the right implants, which correspond to the own wishes, a consultation with a doctor is very important.
Round implants give the breast an even volume. The breast looks fuller from the profile and provides more „sexy“ cleavage. First, the basic width of the implant is determined by the doctor depending on the anatomical conditions. Then the projection is chosen in which a fuller or more subtle result can be achieved, as desired.
Under certain circumstances, the implant might be visible in the undressed state. For small and medium-sized implants (150-250 grams), if these have been placed under the pectoral muscle, this aspect does not play a decisive role. Here the implants are creating a natural shape by the pressure of the pectoral muscle in the upper pole. However, many women deliberately want to achieve a more artificial effect.
Anatomical implants resemble the shape of a drop, as they have less volume in the upper part than in the lower part. As a result, the breast implant better follows the natural lines of the body and the breast looks more natural in general.
During production, the implants are very strongly pressed, to retain the special form. Therefore the shape cannot be changed anymore, which means that even a push-up bra can only produce a limited amount of décolleté, which for some people might be a disadvantage.
In addition to the shape of the implant, the projection of the implants plays another essential role in the choice of the implant. The projection represents the height or profile of the implant.
There are low-profile, moderate-profile, high-profile and extra-high-profile implants.
POSITIONING OF THE IMPLANT
There are different approaches to position the implant. A basic distinction is made between submuscular (under the chest muscle) and subglandular (over the chest muscle). A subfascial method, where the implant is placed beneath the thin layer of fascia on top of the muscle, is also possible. The choice of the method depends on the individual anatomical properties of the breasts and the patient’s wishes. This will be consulted with the surgeon.
ABOVE THE BREAST MUSCLE
Breast enlargements with positioning above the pectoral muscle provide the possibility of a significantly larger projection per implant volume, which corresponds to the wishes of some patients. A better result can also be achieved for women with weak connective tissue and enough own tissue, since the implant is easier to embed. This positioning is also recommended for particularly athletic women or bodybuilders who want to avoid implant deformations due to muscle contraction.
- short operation time
- easier positioning
- larger implants possible
- short healing phase
- less pain and tension than when placed under the muscle
- less suitable for very slim patients, since the implants can be easily visible / palpable with a small amount of tissue
- Depending on the size of the implant, an unnatural transition from the implant to the breast tissue can occur
- Bottoming-out risk (slipping of the implant)
UNDER THE BREAST MUSCLE
Breast enlargements with a positioning under the pectoral muscle offer a more natural feeling and appearance, since the contours of the implant are not visible from the outside. This method is particularly suitable for very slim patients with little own tissue. A kind of pocket is formed in the chest muscle, where the implant will be inserted. This creates a beautiful and natural breast shape.
In this method, the possible implant size is limited due to anatomical conditions. If particularly large implants are desired, smaller implants are first used to stretch the muscle, which will later be replaced by larger implants in the expanded pockets.
- More natural breast shape as the implants are not visible
- Breast feels softer and more natural because the implant is not palpable
- Stable hold by the muscle tissue
- Lower risk of lowering the implant
- Lower risk of capsular fibrosis (hardened, connective tissue-like capsule that forms around the implant and causes pain)
- Lower edge visibility
- More complex surgical technique
- Longer healing phase
- Temporary pain and feelings of tension can occur after the operation
- Strong muscle tension can affect the implant
Inframammary incision (breast fold)
In the inframammary incision, the implant is simply and securely pushed under or over the muscle via a 3-4 cm long opening in the breast fold under the breast. This is the most common method, as it is considered very safe and damage to the milk ducts is minimized. However, a scar remains in the breast fold, which can be visible in a lying position.
Axillary incision (armpit)
In the axial incision, an approx. 3 cm long incision is made in a natural fold of the armpit. The surgeon introduces an endoscopic special instrument with a built-in camera up to the chest. With this, the future implant pocket is first viewed and then prepared. The implant is then inserted through the axillary opening and placed at the planned location. This approach is minimally invasive and leaves scars that are barely visible. Breast sensitivity disorders occur less frequently with this access method.
Periareolar incision (around nipple)
In the periareolar incision, the implant is placed in a prepared pocket (usually on the pectoral muscle) through a crescent-shaped incision around the areola. This relatively difficult procedure is only suitable for small implants or empty pillows that are filled afterwards. The great advantage of this method is that the resulting scar remains almost invisible. Whether this type of access can be chosen depends on the nature and size of the areola. There is a risk of injury to the milk ducts, which can affect later breastfeeding.
Which cut is the best for breast augmentation with implants?
Periareolar access in the breast fold is particularly widespread and is now the standard for breast augmentation. The optimal choice of access differs individually and depends on the anatomical requirements as well as the wishes of the patient.
Which cut leaves the most inconspicuous scar?
A small incision on the edge of the areola is the most inconspicuous scar. However, this type of breast enlargement cannot be done for every woman because the areola needs a certain size.
Which access is the most gentle?
The safest and gentlest method is access through the underbust fold. Access via the areola carries the risk of damage to the milk ducts, which can affect later breastfeeding.
FAT TRANSFER BREAST AUGMENTATION
Breast augmentation with autologous fat was firstly used in 1990s and has developed in aesthetic and medical terms since then. With this method, the body’s own fat is removed and injected directly under the breast skin. This is mostly taken from parts of the body that have sufficient fat reserves, such as the belly, legs or hips. For this purpose, the fat cells are gently aspirated under general anesthesia and then collected in containers. The fat cells are then filled into small tips so that they can be evenly distributed in the tissue using thin cannulas. Due to the latest researches, stem cells can be admixed, which means that the solution introduced quickly forms new blood vessels and grows better into the tissue. This leads to a reliable and permanent increase in volume. This minimally invasive procedure is particularly suitable for modeling sagging or asymmetrical breasts as well as for enlarging small breasts. The final result is finally visible approx. 6-12 months after the procedure.
How long does a fat transfer breast augmentation last?
The breast volume gained through breast augmentation with autologous fat is permanent because once the fat cells have grown, they remain. However, experience has shown that around 20-30% of the injected fat cells are not accepted by the breast tissue.
How much more volume can be achieved?
If all the conditions are right and there are sufficient fat reserves, an increase by one cup size is realistic. e.g. from an A-cup to a B-cup.
How often is it possible to have a breast augmentation with fat transfer?
A Breast augmentation with fat transfer can be performed several times. A gradual enlargement is possible.
Is a breast augmentation with fat transfer less risky than with implants?
Breast augmentation with fat transfer is considered to be less risky than augmentation with implants, since the risk of capsular fibrosis is completely eliminated. Though the risk of capsular fibrosis when using implants is very low nowadays, as the quality of the implants has increased and the surgical procedures are becoming more and more gentle.
The operation is carried out under general anesthesia and takes about 60 minutes.
The implants are inserted over a small incision (3-4cm) in the breast fold, the armpit or the areola. At these points, the scar appears more naturally and remains completely hidden. Over time, the scar fades away.
After the operation, the patient gets a medical compression bra, which keeps the implants in place and protects them. This bra must be worn at home for the first few days.
Pain killers are administered to relieve pain after anesthesia has subsided.
Breast augmentation is a relatively short surgical procedure, but the patient should stay in the clinic for at least one night. This gives a chance of continuous medical care, especially in the first healing phase. Before the discharge, there is a follow-up examination to check the wound. If a surgical drain was used to drain the blood and fluid out of the body it will also be removed.
- How long you might be unable to work differs from woman to woman and also depends on the profession. Some women feel fit enough to go to work after only 3-4 days. Nevertheless, it is recommended to take a vacation for at least 1-2 weeks. A longer break of at least 3 weeks makes sense for physically demanding jobs. This should be consulted with the doctor. Sufficient recovery is helpful for a smooth healing process.
- Self-dissolving stitches will disappear on their own after 10-14 days. It is therefore not necessary to pull them.
- The healing process of breast augmentation with autologous fat is significantly faster than with implants.
- The incisions for implant placement leave small scars that fade over time.
- Swelling, tension and bruising usually resolve within 2 weeks. However, in some cases this can take up to 6 weeks.
- The final result is visible after 6 to 12 months.
- Pain may occur in the first week after surgery. Discuss with your doctor which pain killers are suitable for you. Most of the time ibuprofen should be enough. Anticoagulant drugs such as aspirin must not be used! Cooling the affected areas can relieve the pain. After 6-7 days, the pain should have subsided to such an extent that neither pain killers nor cooling are necessary.
- If something is unclear, you have pain or notice something unusual, the doctor should be contacted immediately.
POSSIBILITY OF RISKS
Breast augmentation is the most common surgical procedure therefore became a routine procedure. In recent years, the surgical methods have developed significantly, which means that the operation can now be seen as relatively low-risk. Due to optimized production techniques and better materials, the quality of the implants has improved, which means that bursting, tearing or leakage of the implants can now almost be ruled out. In contrast to older generation implants, modern branded implants are expected to last a lifetime.
Complications are rare nowadays, due to advanced medicine, but can also occur just like with any other surgical procedure.
These include allergic reactions or complications with the anesthetic during the operation. During the healing phase, bleeding, wound healing disorders, infections or impaired feeling on the nipple can occur. In order to minimize the risks, the instructions for aftercare should be followed as carefully as possible. If something is unclear, you have pain or you notice something unsettling, the doctor should be contacted immediately.
A specific risk of breast augmentation with implants is capsular fibrosis. During the natural healing process, a soft capsule of connective tissue usually forms around the implant. In extremely rare cases, a foreign body reaction can occur, in which the connective tissue contracts and thus forms a hardened or thickened capsule. In the worst case, this can lead to pain, a displacement of the implant or a deformation of the breast. The hardening can be felt. In 5% of cases of capsular fibrosis, a new intervention is necessary.
When choosing anatomical implants, it should be kept in mind that women with soft tissue or who are very athletic may run a slight risk of later implant rotation. Round implants, on the other hand, are repeatedly pressed into the same shape.
1. Do you get a medical certificate for the operation?
Since it is usually a purely aesthetic and therefore not a medically necessary procedure, no medical certificate can be issued. Therefore, leave should be taken for this operation. If it is a medically necessary operation (e.g. mastectomy after breast cancer), you will receive a medical certificate.
2. Will the health insurance cover the costs?
In the case of a purely aesthetic breast operation, the costs are not borne by the health insurance.
If it is a reconstructive operation after a mastectomy, the costs are often covered or subsidized. In the case of congenital deformations, missing mammary glands, extreme asymmetries and the associated enormous psychological stress (should be certified by a psychologist), it is also possible to assume the costs.
In these cases, please contact your health insurance company for more information about a cost / partial cost transfer.
3. Can a permanent surgical result be expected?
Breast augmentation is permanent, but the appearance can change over time. Both gravity and natural changes in breasts can affect the visual appearance.
4. Is there an increased risk of breast cancer?
Modern X-ray techniques nowadays enable the most precise results for breast cancer screening even for women with implants.
So far, no connection between breast implants and breast cancer has been noted. Reports about an increased risk of breast cancer when using textured or polyurethane foam (PU) -coated implants could not be confirmed in any scientifically based studies.
5. Breast surgery and pregnancy
Women who are planning to become pregnant should carefully consider the timing of their breast augmentation. Pregnancy leads to changes in breast volume and shape, which in turn could have a negative impact on the surgical outcome. Breast surgery should be awaited for at least 6 months after delivery.
6. Can breastfeeding or fertility be affected?
Breast augmentation has no impact on fertility. The ability to breastfeed is also not affected.
With the rarely chosen periareolar method, in which the implant is inserted through the nipple, there is little risk of damage to the milk ducts. In the worst case, this could impair the ability to breastfeed.
7. Is the nipple affected by breast augmentation?
In the course of breast enlargement, the nipples are usually moved upwards with regard to the change in shape and volume. The cuts around the nipple are minimal, so that the remaining scars remain small and unobtrusive. With good scar care, these heal quickly. Possible sensory disorders usually subside after some time. The ability to breastfeed is retained.
8. At what age can breast augmentation be performed?
The basic requirement for breast augmentation is a fully developed breast. A minimum age of 18 should also be reached.
9. Do the implants have to be replaced at some point?
While implant replacement from past generations was recommended after 10 years, modern branded implants no longer need to be replaced. As long as there is no personal request for a change in the implant size and no complications, there is no reason to replace the implants.
10. How Safe Are Breast Implants?
Modern branded implants are filled with a densely cross-linked silicone gel. Whereas breast implants from previous generations were only filled with a liquid and not dimensionally stable gel.
11. Do permanent scars remain?
Breast augmentation causes permanent scars, but they heal well with good care after the operation and fade over time. So these are hardly visible. Furthermore, the incisions are chosen so that the scars remain as hidden as possible. The most inconspicuous scar arises when accessed via the areola. With the armpit access method, the scar is covered by the arm. When accessing through the underbust fold, the scar remains largely hidden by the shadow of the underbust fold. The scar may only be visible in a lying position.
12. Is general anesthesia necessary? When is local anesthesia possible?
Breast augmentation with implants under general anesthesia usually takes place and is associated with an overnight stay in the clinic. Breast enlargements with autologous fat can be performed under local anesthetic
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Clinical Advisor DMCC
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