Synonyms
Mammaplasty, breast augmentation lat. augmentum growth, increase English: breast enlargement
Introduction
Breast augmentation is a plastic surgery operation that is usually performed for aesthetic reasons. Breast augmentation is performed either by the gynaecologist or the plastic surgeon. Please note that “cosmetic surgeons” are not necessarily gynaecologists or plastic surgeons, as the title “cosmetic surgeon” is not a specialist title.
Definition
Breast augmentation is used both in reconstructive surgery after mastectomies due to breast cancer and for women who find their breasts too small. The operation can be performed by plastic surgeons, general surgeons and gynaecologists. The breast contains fatty, connective and glandular tissue, as well as muscles, vessels, nerves and milk ducts. Depending on the anatomy of your own breast, breast implants of different sizes can be inserted. The breast cannot be enlarged at will, the size always depends on your anatomy and the elasticity of your skin.
Methods and materials
Implants for breast augmentation fall under the Medical Devices Act and have been classified in the highest risk category. The surface of breast implants usually consists of silicone, which can be smooth and textured. The textured surface has the advantage that both the slippage of the implant and the occurrence of capsular fibrosis (see below) is less frequent than a smooth surface.
The shape of the implant can be evenly round or drop-shaped. The latter is intended to achieve a particularly natural result, but has the disadvantage of creating a disproportionate breast shape when the implant is rotated. To avoid this during breast augmentation, drop-shaped implants are only available with a textured surface.
The filling of the implant can consist of silicone or saline solution. Soybean oil could not convince. Silicone implants were temporarily taken off the market in the USA, as they were discussed as causes of autoimmune and cancer diseases due to leaking, but this could not be confirmed.
In addition, the stability of the implants has increased so that the silicone filling does not leak even in the event of a tear. Silicone implants also achieve the highest satisfaction in terms of natural feeling and durability. The advantage of implants with saline solution lies in the surgical method.
Since the implant can only be filled after it has been inserted into the breast, small incisions are sufficient. With an additional valve placed under the skin, subsequent changes in the filling volume are possible. This is particularly suitable for women who are unsure about the size of the implant or who, after a mastectomy, first need a slow stretching of the remaining breast skin before more volume can be inserted.
The disadvantage of this breast augmentation of implants with saline solution is the lower stability of their positioning and possible “sloshing” noises. The operation itself is usually performed under general anesthesia. First of all, a skin incision is made, which can be placed in the underbust crease, armpit or areola.
Then the implant is inserted, whereby it can be placed directly underneath it if there is sufficient fatty and glandular tissue (subglandular). In thinner women, the implant should be better positioned under the breast muscle (submuscular). The so-called Cell-Assisted Lipotransfer (CAL) has existed for several years.
In breast augmentation, stem cells, which were previously obtained from suctioned fatty tissue, are inserted into the breast tissue and cause an increase in fatty tissue. Postoperative procedure: The patient is taken ill for about 1 week. A special support bra should be worn for about 1-2 months to prevent the implant from slipping.
The breast muscles must be protected for about half a year. Before a breast enlargement operation, it is important to have the breast examined by a doctor, preferably a gynaecologist. A tumour disease must be ruled out before you undergo surgery.
You should also check with your doctor before breast augmentation surgery, as some medications should not be taken before surgery. These include aspirin and metformin. Smoking should also be stopped before surgery.
There are three different ways to place the implant during breast augmentation surgery. One is the “subglandular” implantation, the “subfascial” implantation and the “submuscular” implantation. Here, “sub” means “under”, so the name refers to the structure under which the pillow is implanted.
Subglandular means under the glandular tissue, subfascial means under the fascia (the fascia is a connective tissue layer surrounding the pectoral muscle) and submuscular means under the muscle. Subfascial implantation is the rarest of all breast augmentation implantations and is not offered by every doctor. If there is little glandular tissue, implantation under the muscle can be advantageous, because otherwise the implant is very visible.
The disadvantage is that the muscle must be cut in some places, otherwise the implant will move with the muscle movements. Depending on the anatomical shape and condition of your breast, the surgeon will decide with you which method is best for you. The operation is usually performed under general anaesthesia.
In the case of implantation via the pectoral muscle, a local anaesthetic plus sedative may also be sufficient. This procedure will be discussed with the anaesthetist in charge (anaesthetist). The surgeon makes an incision either in the lower breast fold, in the armpit or around the nipple.
Then space is made for the implant. The implant is then inserted and positioned through the skin incision. The wound is closed again and dressings are applied.
In most cases, the introduction of drains is necessary to drain the wound fluid. The drains can be removed after a few days. After the operation it takes about a week until you are fit again and able to work.
In some clinics in Germany, breast augmentation is also performed with the help of endoscopic surgery. This means that only a small incision is made and a camera and surgical instruments are used to operate through a “keyhole”. This procedure is quite safe and has existed for almost 20 years, but not all centres offer it.
It is advisable to use the doctor’s experience when deciding on a surgical option, as there have not yet been any studies on which option is better. The main risk with breast enlargement is the so-called capsule fibrosis. Here the breast forms a scar tissue envelope around the implant, which can lead to painful hardening and deformation of the breast.
Risk factors for this are unhygienic operation methods (bacteria!) and large and smooth implants. In about every tenth woman with breast implants, capsular fibrosis occurs after a few years.
About one in five women who have undergone surgery have to undergo a post-operation due to massive capsular fibrosis, slippage or damage to the implant. The incidence of breast cancer among women with implants is not increased and breast diagnostics for cancer prevention is not hindered. Breast augmentation, which is called augmentation in technical terminology, is mostly used by women who find their breasts too small.
Since many women fear the complications and risks of breast surgery, there are now other ways to achieve breast augmentation without surgery. Optical corrections This method is not a long-term enlargement of the breasts. However, push-up bras, silicone inserts or sewn-in gel pads can make the breasts look larger and more voluminous when clothed.
Some tops, bras and bikinis are already offered with integrated silicone pads, but these can also be purchased separately. Vacuum pumps Another option for breast enlargement without surgery is the use of vacuum pumps. Vacuum pumps stimulate the tissue and achieve temporary breast growth.
The suction on the breast has a stretching effect and the blood circulation in the breast is also increased. When used regularly over a longer period of time, the tension can also result in a permanent enlargement of the breast. However, the shape of the breast cannot be changed by the vacuum pumps and a breast lift is also not possible.
However, vibration-capable massage devices can be used to tighten the tissue. Sex hormones Since the female breast gland tissue reacts to the intake of hormones, this is also one of the possibilities of achieving breast augmentation without surgery. By taking high doses of tablets or injections of ingredients similar to the contraceptive pill (especially estrogens), breast size increases of up to two cups can be achieved.
The increase in size is mainly linked to the high dose of oestrogen. However, this also means that the breast will shrink again after the hormones have been discontinued, and under certain circumstances the loss of breast tissue can lead to a change in the shape of the breast for the same skin mass. It should also be noted that the hormones do not have an exclusive effect on breast growth and can therefore cause side effects such as mood swings or weight gain.
Hyaluronic acid (e.g. Macrolane®) Hyaluronic acid is found in the human body and has been used for some time in cosmetic surgery, e.g. for injecting wrinkles. Hyaluronic acid can also be used to enlarge, tighten and shape the breast.
When the hyaluronic acid procedure for breast augmentation was introduced, it was considered that side effects such as wound healing disorders and scarring should be avoided. However, since cysts and other side effects could be observed even with small amounts of Macrolane® and breast cancer screening (mammography) was also made diagnostically very difficult, the preparation was withdrawn from the market again in mid-2012. A disadvantage compared to breast surgery is that breast augmentation with hyaluronic acid does not produce a permanent result and the procedure only lasts for about three years.
Autologous fat transplantation Autologous fat transplantation, also known as autologous fat transplantation, is a method in which fatty tissue is removed from one part of the body and then transplanted to another part of the body. This requires that the patient has excess fatty tissue at one body site (e.g. on the thighs or abdomen), which can be used for autologous fat transplantation. During the procedure, fat cells are first suctioned out under low suction with a thick cannula.
After cleaning the fat cells, they are then reinserted under the skin on the breast using a special cannula. This procedure has been carried out for 25 years and is low-risk compared to breast augmentation surgery, even though one must expect injuries or dents at the removal site in the case of autologous fat transplantation. Own fat transplantation is particularly suitable for patients who do not want or tolerate implants.
The insurance companies only cover the costs of reconstructive breast surgery after cancer with mastectomy. The costs of breast augmentation for purely aesthetic reasons are generally not reimbursed. The costs of a breast enlargement vary between 5000 and 8000 Euros.
The large fluctuations can be explained by the fact that there are different operation variants, as well as different anaesthetic variants. The duration of the operation, the difficulty of the operation, the nature of your breast and the use of the operation are also included in the costs. The costs for the material are also different.
Depending on whether a saline solution, liquid, gel-like or solid silicone is used, this can make a difference of several hundred euros. Also the costs of the pre- and post-operative examinations of the breast augmentation. These are often extra services that are not always included in the price.
The costs for a breast enlargement are only covered by the health insurance in special cases. As a rule, the patient has to bear the costs himself. If the breast enlargement takes place after a cancerous disease with breast amputation (mastectomy) or if there is a malformation of the breast, the operation is covered by the health insurance. You can find an overview of all gynaecology topics under Gynaecology A-Z
- Breast Cancer
- Mastitis
- Breast augmentation with own fat
- Breast augmentation risks
- Breast augmentation implants
- Breast reduction
- Lipofilling with own fat
- Male breast
- Reduce labia minora
