Breast augmentation

In addition to the subjective perception of a beautiful breast, there are generally valid parameters that define the female breast as well-formed: the "ideal" breast is full and firm, two-thirds of the volume is below the nipple, one-third above. Breasts should also be relatively symmetrical.

In our practice, we perform breast augmentation with silicone implants and / or autologous fat. Modern silicone gel implants are manufactured and offered in a variety of shapes and sizes. We can therefore respond individually to the wishes and expectations of a breast augmentation. The implant used is determined by your anatomical requirements. In order to find the right implant and achieve the best result for you, we as your plastic surgeons are equipped with a high degree of experience and a feel for aesthetics.

Breast augmentation is permanent (especially in patients with small amounts of their own own glandular tissue). Nevertheless, the natural aging process can lead to further changes in the shape of the breasts. It may then be necessary to change the implants or perform a skin lift in the future to once again achieve an attractive breast shape.

Basically, breasts are never mirror images. This is due to the varying amount of glandular tissue, the shape of the thorax and the ribs among other things. Breast augmentation surgery will not usually result in absolute symmetry in the breasts.

After the breast augmentation at our Clinic for Plastic and Aesthetic Surgery in Nymphenburg, Munich, our patients report an increased self-confidence and improved quality of life.

Modern breast implants consist of a silicone shell and a silicone gel filling. If the surface of the silicone gel implants is roughened, which is usually the case nowadays, then this is called a "textured" surface. This is important in anatomically shaped breast implants to prevent unwanted implant rotation. Furthermore, the textured surfaces of breast implants minimize the development of capsular contracture (see Possible complications and risks).

Silicone gel implants of the highest quality

In principle, we only use breast implants that we believe are the best quality products on the market. Currently, these are mainly products by the company Polytech Health and Aesthetics, which manufacture their implants in Germany.

In addition, we use implants from Motiva (Costa Rica), which have a special nanostructured shell and extremely high durability.

In addition to the normal textured implants, there are also special silicone gel implants which have a coating of micro-polyurethane foam shell, as a result of which the implants grow particularly solidly together with the surrounding tissue. Studies have shown that this reduces the rate of capsule fibrosis even further. However, when augmented with PU implants, the breasts may feel somewhat firmer over a longer period after surgery.

More comfort thanks to particularly lightweight silicone implants

At our Clinic, we also offer new lightweight breast B-Lite® implants. These are about 30% lighter than conventional silicone gel implants due to air-filled microspheres introduced into the silicone gel filling. As a result of this weight saving, wearing comfort is increased, especially with larger implants, and an overstretching of the breast tissue over time can be reduced. The silicone gel consists of cross-linked silicone polymers and is therefore cohesive. This means that the silicone filling is not liquid as with pervious implants. The key advantage of this is that the silicone can not penetrate into the body tissue in the case of a rupture of the sheath and be deposited, for example, in the axillary lymph nodes.

Round or anatomical implant shape?

In general it can be said that round implants produce a stronger projection in the upper pectoral pole and anatomical implants a more natural shape with more volume in the lower pectoral pole.

A general recommendation for you as a patient (round versus anatomical) can not be given here, as your wishes, your anatomical requirements and the multitude of technical possibilities are, in our opinion, very individual. After detailed consultation and assessment, we are able to suggest a selection of possible implants for you. During the operation, we first use trial implants to then make the final implant choice according to your vision. We always have a wide range of different implants to choose from during surgery, and we do not limit ourselves to a preselected implant. For despite all the experience you can have the situation whereby the preselected implant is not ideal. It is then crucial to have other implants available.

Access route and positioning

Silicone gel implants for breast augmentation are implanted using various approaches. The first option is the incision in the lower breast crease or around the areola. An access route through the armpit can also be chosen.

The implant can be placed under the large pectoral muscle (pectoralis major - subpectoral muscle), under the muscle fascia (subfascial) or on the muscle (epipectoral / subglandular).

Which positioning is suitable for you depends on your individual soft tissue. The leaner you are, the more likely it is for the implant to be at the top. In this case, positioning under the muscle would be more advantageous.

The placement on the muscle is the "natural" position, but can only be chosen for good soft tissue. By combining this with autologous fat transplanting, it is possible to improve the soft tissue envelope and conceal the implant margins. This is to be taken into consideration in particular when liposuction is to be carried out at the hips, for example, during the same session.

During your consultation at our Clinic for Plastic and Aesthetic Surgery in Nymphenburg, Munich you tell us your wishes and expectations for breast enlargement. After an in-depth analysis of your breasts with measurement and photo documentation, we can recommend the appropriate surgical method and implants to achieve the desired result.

It may be necessary to have a mammogram or ultrasound scan of your breasts prior to surgery to clarify or document any tissue changes. We can provide recommendations for this is necessary.

Use of aspirin two weeks prior to surgery should be avoided to minimize the risk of postoperative bleeding. The consumption of alcohol and nicotine should also be reduced to a minimum. If you get an infection in the days immediately prior to the operation, the operation should be postponed for the sake of safety. For the first few nights after the operation, you may not want to be alone at home or have someone around you who can assist you. For four to six weeks after surgery, do not expose yourself to any sport or other physical stress. When scheduling, work the necessary recovery phase after the procedure into your plans.

With effect from 01.04.2006, the publication of before-and-after images on websites is prohibited by law. However during your introductory consultation, we can of show you before-and-after pictures of breast enlargements.

As a rule, patients are hospitalized on the day of the operation at the renowned Dritter Orden Clinic. In the days before the operation, you will have an appointment with the anesthetist where you will be asked in detail about your medical history, such as pre-existing conditions, allergies and intolerances, and the anesthesia will be discussed with you. In most cases, a one night stay at the clinic is enough. Before the procedure, we will draw the markers that are important for the operation in on you while in a standing position to create the best conditions for a symmetrical result.

After administration of anesthesia, the operating area is sterilized and covered according to hygiene protocol. As a prophylactic measure, you will receive a single dose of broad-spectrum antibiotics. These measures have been proven to reduce postoperative infections. To minimize postoperative pain, a local anesthetic is administered to the surgical site.

After placement of trial implants and review of the result in position on the patient, we select the final implant model. It may be necessary to drain the wound fluid. Under highly sterile conditions, the final implant is then inserted and checked in a sitting position in mutual comparison for optimal positioning. The multilayer skin closure is then done in such a way that no stitches have to be removed. After applying the sterile bandage, the upper body is dressed with an elastic bandage. This will be removed the next day and a compression bra applied.

After being discharged you must present at the clinic on the 5th and 12th day after the operation, as well as 6 weeks and 6 months after the operation. An ultrasound is performed to establish whether the implant is still in the optimal position or whether for example, fluid has accumulated around it. This helps us to take necessary measures as soon as possible. The success of the operation is photographically documented.

Placement of implants under the muscle in particular can bring about pain in the form of a strong muscle pain. However, with cooling and painkillers such as ibuprofen, the pain should subside within a few days. Prolonged "tweaking or meteorosensitivity" are "normal" and no cause for alarm. At first, the size of the breasts may still be very unfamiliar. After some time, however, you get used to your new body feeling.

Initial swelling will also disappear within six weeks. Sport and upper body work should be avoided for six weeks. At first, the breasts can feel firm, but they should feel soft and natural within a few weeks.

In the hands of an experienced thoracic surgeon, the operation involves an extremely low rate of complications. As with any other surgery, there are general and specific complications due to the nature of the procedure.

First and foremost, we endeavor to achieve the desired surgical result with appealing aesthetics, as agreed preoperatively and in broad symmetry. The more asymmetrical the breasts were before surgery, the harder it is to achieve good symmetry. However, even perviously symmetrical breasts are not identical, and after breast augmentation this will still be the case.

In rare cases, even a few days after removal of the drainage, accumulation of blood (hematoma) or fluid (seroma) may occur. This liquid can be detected by ultrasound around the implant and punctured under controlled conditions. If the fluid is left there, the implant may twist. This does not have to be a problem with round implants, but this can lead to an unsatisfactory change in the shape of anatomical implants.

In very rare cases, it may be necessary to reopen the surgical site and remove the fluid (hematoma removal), otherwise there is a risk of capsular contracture. Around each foreign body, as well as a breast implant, the body will form a connective tissue capsule. In most cases, the capsule remains tender and soft. A capsular contracture is when the capsule thickens and becomes firm. This may require an implant replacement with partial or complete removal of the capsule.

Although it can be said today that patients can wear their breast implants for a lifetime, we know from experience that a change of silicone gel implants will be made at some point for a variety of reasons.