What are breast implants?
Breast implants are plastic pads that are inserted into the breast tissue to enlarge or restore the breast. All current breast implants consist of a silicone shell filled with either saline or silicone gel. The surface of the implants can be either smooth or roughened (textured).
So far, the textured surface has proven to be the most effective, as it helps to avoid painful adhesions of the connective tissue. In addition, breast implants with a roughened surface do not slip as quickly.
Some manufacturers also offer breast implants coated with various substances. This is to prevent adhesions, adhesions and infections after insertion of the implants.
Breast implants: Fillings
Classically, a breast implant is filled with firmer silicone gel. Compared to liquid silicone used in the past, it has the advantage that the filling is less likely to leak and the shape of the implant does not change. Silicone-filled breast implants also ensure a natural shape of the breast even during movement.
Breast implants: Shapes
The most commonly used breast implants have a round shape. As a result, they emphasize the upper half of the breast and thus the décolleté – the wish of many women who have opted for cosmetic breast augmentation.
Anatomical breast implants, on the other hand, mimic the natural shape of the female breast with their teardrop shape: they are rather narrow in the upper area and widen towards the bottom. This gives the breast a natural-looking base. They are also particularly suitable for compensating for asymmetrical breasts.
When are breast implants used?
Breast implants are used in the following situations:
- breast augmentation in women for cosmetic reasons
- asymmetrical breasts
- reconstruction of the breast after its amputation, for example in case of breast cancer
- @ breast augmentation in case of transsexuality
So, breast implants are used both to restore the breast and to enlarge it.
Which specialist should perform the surgery?
Terms such as “cosmetic surgeon”, “specialist in aesthetic medicine”, “specialist in cosmetic surgery” or “aesthetic surgeon” are not legally protected terms and therefore say nothing about the qualifications of a doctor for breast augmentation (or other cosmetic surgery)!
What do you do during breast augmentation with breast implants?
When preparing for the surgery, the doctor must first find out the most suitable implant shape and size for the patient individually. In doing so, he is primarily guided by the patient’s ideas and wishes. He must also take into account the width of the chest, the condition of the skin and the patient’s body symmetry.
Immediately before the operation, the surgeon draws the incision lines on the patient’s breast using a marker suitable for the skin.
The actual procedure – surgical breast augmentation – is usually performed under general anesthesia. More rarely, only local anesthesia is used.
Breast implants: Access routes
In most cases, the surgeon uses a sharp knife to make a four- to five-centimeter incision just below the breast (inframammary approach). This incision allows precise placement of the breast implant and has been shown to be the access route with the lowest complication rate.
Alternatively, the physician may choose to make a transverse incision in the axilla or what is known as an areolar margin incision, in which he or she incises the skin at the lower edge of the areola over a length of four centimeters. However, since the milk ducts that open into the nipple are lined with a germ-populated biofilm, the areolar rim incision poses a particularly high risk of bacteria being carried into the wound.
The insertion of breast implants
Breast implants are preferably inserted below the pectoral muscles (subpectoral implant position). This allows the pectoral muscle to cover the transition between the soft tissue and the breast implant and to shape it naturally without the formation of steps:
Alternatively, the surgeon can place the breast implants over the breast muscles. This prepectoral implant position is particularly suitable for patients with flabby and excess breast skin, as this is filled directly by the breast implant.
After the breast augmentation
After inserting the breast implants, the surgeon carefully closes the wounds with sutures. He also dresses them with a plaster bandage while still in the operating room. To prevent the breast implants from slipping, he wraps the patient’s chest tightly with absorbent cotton and elastic bandages.
The patient is now taken to the recovery room to recover from the procedure. She is then transferred to the normal ward.
After breast augmentation with breast implants, a patient usually stays in the hospital for one to two days; if problems such as wound infections occur, the hospital stay is prolonged.
What are the risks of breast implants?
The placement of breast implants is usually not a medically necessary procedure, but a cosmetic one. This makes it all the more important to know the possible risks. These include:
- painful and shape-changing capsule formation around the breast implant (capsular fibrosis)
- damage to the implant, possibly with emptying of the filling into the tissue
- asymmetric breast shape or implant malposition
- formation of skin folds
- bleeding during and after the operation
- formation of a bruise (hematoma)
- necessity of blood transfusion with corresponding risk of infection
- Injury to soft tissues and nerves during surgery
- Wound infection and wound healing disorders
- Anesthesia incidents
- allergic reaction to materials and medications used
- cosmetically unsatisfactory scarring
In case of capsular fibrosis or damage to the breast implant, it may be necessary to remove the implant and insert another one if necessary.
Cancer due to breast implants?
A few women with roughened (textured) breast implants – especially those with macro-textured implants – develop a special form of cancer: breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). This is a rare form of non-Hodgkin’s lymphoma.
Also unclear to date is exactly how high the risk is that a woman with breast implants will develop such lymphoma (even taking into account the different types of textured breast implants). One reason for this is that BIA-ACLC appears to be rare overall:
For example, on 07 September 2021, the Federal Institute for Drugs and Medical Devices (BfArM) in Germany reported 30 confirmed BIA-ACLC cases and 27 suspected cases at that time. To put this in perspective, more than 67,600 breast augmentations with silicone implants were performed throughout Germany in 2020 (breast implants made of silicone are used much more frequently in Europe than those with saline).
To the best of our current knowledge, there have also been and continue to be few cases of BIA-ACLC in other countries. For example, the U.S. Food and Drug Administration (FDA) registered 733 case reports of BIA-ACLC worldwide as of January 05, 2020.
Detected early and treated properly, breast implant-associated lymphoma appears to have a good prognosis.
What do I need to be aware of with breast implants?
During the first few days after your breast implants are placed, it is natural for your breast to be slightly swollen and painful. If necessary, your doctor will prescribe an analgesic medication.
Avoid exercise or activities that require you to raise your arms above shoulder height for the first four weeks after your breast implants are placed.
The doctor will replace the wrap bandage applied after surgery with a support bra with a compression belt beginning the second day after surgery. You should wear the compression belt for six weeks, and the support bra usually for three months.
Within the first four weeks after the operation, your doctor will check again with an ultrasound whether blood or wound water has accumulated in the wound area. If necessary, these accumulations must be suctioned out or even removed in a new operation.
When is it necessary to change breast implants?
Removal or replacement of breast implants is necessary mainly in the following situations:
- Implant rupture or slipping of the implant
- @ Capsular fibrosis
- Soft tissue problems
Some women have their breast implants replaced because they are dissatisfied with the results and want a different size or shape, for example.
