Breast implants

introduction

Breast implants are used as part of a breast augmentation (Breast augmentation), used for breast malformations or breast reconstructions.

Surgical implantation is usually carried out for purely aesthetic reasons.

A medically indicated use of breast implants is for disfiguring malformations of the female breast (such as a pathologically underdeveloped breast, clearly visible asymmetries, disorders of the breast) or for breast reconstructions after the loss of a breast, for example due to cancer.

Breast implants are medical devices according to the Medical Devices Act.
They are classified in the highest risk class for medical devices across Europe, as serious incidents and complications, for example due to burst breast implants, have repeatedly occurred in the past.

Breast implants basically consist of a silicone shell that can contain various filling materials.
Breast implants currently approved in Germany are filled with silicone, saline solution or, in rare cases, with hydrogel.
The selection and decision for a variant is based on the desired ideas, as each material has different properties and achieves a different result.

Since the implants are mostly used for aesthetic breast augmentation, such an intervention is a self-payment service.
Likewise, all additional costs for corrections, follow-up treatments or any complications (like a necessary implant change) in this case must be paid by the person concerned.

If there is a medical indication for the use of breast implants, the health insurances often cover the costs of the entire treatment or grant cost subsidies.

Form of breast implants

There are different implants that differ in size, shape, surface structure and material.

In addition, the strength of the breast implant can be selected and adapted to the individually different tissue strength.

Teardrop-shaped breast implants are asymmetrical and thus imitate the natural shape of the breast. For this reason they are also called anatomical (corresponding to the human physique) Called breast implants.
These anatomical breast implants are rather narrow at the top and wider at the bottom.
This mimics the natural shape of the female breast and creates a natural-looking breast silhouette.

Depending on the individual differences, anatomical breast implants can be varied in the three dimensions of height, width and projection thickness.
A disadvantage of these asymmetrically shaped breast implants is that in some cases there is an undesired change in shape of the operated breast.

This complication can be triggered by possible rotation of the breast implant in the breast.
This risk does not exist with the rotationally symmetrical breast implants with lens shape. The likelihood of implant rotation can be reduced with asymmetrical breast implants by using only textured (roughened) Implant sleeves are used.

Round breast implants result in a naturally falling shape with filling of the cleavage and are therefore the most frequently implanted shapes for breast augmentations.

Breast implants in teardrop shape

The anatomically shaped implants are in the shape of a drop. Because the volume center of gravity is in the lower breast area and the implant becomes narrower towards the top, these implants resemble the natural breast shape.

Depending on the manufacturer, a distinction is made between different subtypes of this type of implant. Opticon® refers to breast implants with an anatomical curvature and a transversely oval contact surface. Another subtype is Optimam®which, as the longest implant, is particularly suitable for tall, slim women.

The Optimam implant has a longitudinally oval contact surface with an anatomical curvature. There is also that Opticon®-Implant, which also has an anatomical curvature with a transversely oval contact surface. The Replicon®-Implant is the absolute basic shape of the anatomically shaped implant, which has a central arch in the lower half. This type of implant also has a round contact surface.

Breast implants in lens form

This implant shape has a central bulge and gives the breast more fullness both above, below and on the sides. The round or lenticular shape of these implants gives the breast a more rounded appearance in profile and décolleté.

This makes it look unnatural compared to the drop-shaped implants. For maintaining such a breast shape are particularly suitable Même®-Implants that have a round support surface in addition to a central arch.

Surface of breast implants

smooth

Breast implants with a smooth surface texture can move freely in the implant bed and can be optimally shaped with push-up bras. However, a disadvantage of this form of implant is that the implant bed expands over time, so that the risk of dislocation is increased.

The use of smooth surfaces only occurs with round implants.

textured

Breast implants with a textured surface are characterized by their ability to fix the implant in the intended location. This significantly reduces the risk of slipping or twisting.

Textured surfaces of breast implants also reduce the risk of capsular contracture. This complication, which often occurs with breast implants, is the body's immune reaction to the implant. A fibrous capsule forms around the implant and compresses it.

In addition to states of tension and severe pain, the chest is also deformed. In addition, a distinction is made between microtextured (slightly roughened) and macrotextured (heavily roughened) surfaces in terms of the size of the texturing.

Implant filling

Breast implants can be filled with various materials and fluids. However, most of the implants available these days are made with silicone gel (about 90 percent) or saline solution (about 10 percent in Germany, about 50 percent in the USA) filled.

Silicone fillings offer a better tactile feel compared to the saline fillings (better feel).

Breast implants can be filled with two different types of silicone. Either liquid silicone gel is used, which is not dimensionally stable, or dimensionally stable cohesive (coherent) Silicone gel.

Cohesive silicone gel can leak from the breast implant shell, but it cannot leak.
In the case of an implant rupture, this is a clear advantage over liquid silicone gel, which leaks out in such a case and because of its adhesive (adhesives) Properties are difficult to remove from the fabric.

In contrast to silicone gel, filling a breast implant with saline solution is less of a problem, since saline solution is completely absorbed by the body, i.e. it is absorbed and excreted.

However, a breast implant filled with saline solution can make it feel unnatural because the fluid in the shell moves back and forth "wobbles".Silicone gel, on the other hand, offers a feeling that is comparable to what one is used to from natural breast tissue.

Other fillings for breast implants such as soybean oil, hydrogel or polypropylene have also been used in the past.

However, these filling materials either showed significant weaknesses or could not establish themselves on the market.
Hydrogel fillings were developed in the hope of combining the advantages of silicone and saline implants while avoiding the disadvantages.

Hydrogel is less harmful to health than silicone gel, as the substance is water-based. It is also more dimensionally stable than saline and very similar to the consistency of silicone gel.
Health risks could not be excluded despite the good tolerability of hydrogel.

In addition to the typical breast implants that are only filled with one material, there are also double-lumen breast implants. These consist of a large inner chamber filled with silicone gel and a smaller outer chamber filled with saline solution.

Alternative fillers have also been experimented with in recent years. Soybean oil, for example, has not proven itself as a filling material for breast implants and is no longer used.
In contrast, hydrogel implants, which consist of more than 95 percent water, which becomes viscous when mixed with cellulose, could represent an interesting alternative to silicone fillings.

The hydrogel filling feels like your own tissue and can be completely broken down by the body in the event of an implant rupture. So far, however, breast implants with hydrogel filling have rarely been implanted in Germany.

Breast implant sleeve

Breast implants are made with different shells or surfaces.
So far, only the materials have been successful in the long term silicone and Polyurethane can be used as breast implant sleeves.

The commonly used silicone sleeves can be either smooth or rough (textured) Have shell surface.
The surface structure of the implant influences the way in which the breast implant reacts with the surrounding tissue.

Every breast implant is considered to be for the body foreign body and is therefore dated body's defense system recognized and fought.
Since the body cannot break down the material of the implant shell, the implant will be defended against by a connective tissue capsule enclosed.
This protective reaction is completely natural and happens with every implant implanted in the body (e.g. knee prosthesis, stent, pacemaker).

However, it can happen that the capsule is particularly strong around the breast implant. This can lead to a so-called Capsular contracture come, which means that the strong capsule contracts, causing hardening and pain.

The risk of such pronounced capsule formation around the implant is lower with textured than with smooth implant surfaces, since the surrounding tissue can anchor itself better to the rough surface.

Because of this, today it is standard textured implant shells used because they are superior to the smooth surfaces.
Smooth implant sleeves have the advantage that they feel more natural. However, due to the higher risk of complications, they are only used in exceptional cases today.

In addition to the silicone coating of breast implant covers, there is also a scientific discussion Polyurethane-coated implant sleeves.
These are currently only offered in Europe, not in the USA.

The early 2000s were short-term titanium coated implant sleeves approved in Germany, but no clear evidence of the harmlessness of titanium in breast implants has so far been provided.

Size and choice of breast implants

Before the surgical implantation of breast implants, there is a detailed consultation so that the right breast implant can be selected.

One can be very fine Size gradations meet, why should Side differences can be balanced very well with two differently sized breast implants.

There are Simulations on your own body With different patterns possible, but also pictures of women with a breast shape that was comparable before the operation can facilitate the choice of the right implant.

The size of the breast implant is often determined by certain characteristics of the existing one Breast tissue limited. Factors such as the elasticity of the skin or the amount of breast tissue play a role in the size selection.

The skin must be elastic enough to completely cover the entire implant. If the implants are too large, it can Tensions, Skin cracks or Stretch marks come.

If there is little breast tissue, a breast implant that is too large may be visible or palpable under the skin.
In some cases, consideration may be given to placing the breast implant under the Chest muscle to place so that it takes over the wrapping of the implant instead of the breast.

Should be the one you want Breast augmentation cannot be implemented at first due to the natural conditions, a two-stage process can be used.
In doing so, an initially used expander stretching the skin to the desired size. This expander will be removed again later and the correct breast implant can be inserted without tension.

It is generally recommended not to enlarge the breast by more than two bra sizes so that an optimally natural result can be achieved.

As a rule, a exact volume information of breast implants agreed.
During breast surgery, an assessment is made for shape and symmetry and can be easily adjusted. However, only the im Educational talk fixed type of breast implants used.

What do breast implants cost?

As a rule, no general statements can be made about the costs of breast implants, as these vary greatly depending on the manufacturer and size. The costs per implant can range from EUR 400 to EUR 800.

What does breast implant implantation cost?

The cost of implanting breast implants depends on the type of operation, the clinic and its location, and the costs set by the treating surgeon. Overall, the costs including the surgical intervention amount to approx. 4500-8000 euros.

Autologous fat as a breast implant

As an alternative to the implantation of exogenous substances such as silicone implants, Autologous fat be used for breast augmentation.

For this purpose, the autologous fat is first obtained from the suctioned fat tissue, via a special processing Stem cells enriched and implanted in the breast.

This method of breast enlargement is also called Cell-Assisted Lipotransfer (CAL) and is a controversial issue with regard to safety. The Autologous fat transplantation has the goal of making the treatment result more permanent and reducing the risk of Withering away (necrosis) of larger parts of the implanted cells should pass through the Stem cell enrichment be lowered.

surgery

Breast implants are usually in an in general anesthetic performed surgery.
An incision is made, the breast tissue is lifted and a Implant pocket formed in which the breast implant will later come to lie. The breast implant can come to rest either partially or completely under the pectoral muscle (submuscular implantation), which is especially true in very thin women with little Fat or glandular tissue is applied for a better grip.

Alternatively, the breast implant can also be placed under the Mammary gland above the pectoral muscle (subglandular implantation) can be used. With this method, the breast tissue itself remains largely untouched.
A more difficult and time-consuming method is the so-called subfascial implantation, where the breast implant is placed directly within the Muscle stocking and under the connective tissue layer covering the muscle (Fascia) is placed.

Various options are also conceivable for the necessary skin incision. Since the skin incision should be as little visible as possible after the operation, it can be in the newly formed Underbust crease (inframammary access), around or through the Areola (transareolar access) or in the armpit (transaxillary access).

When using breast implants filled with saline, the skin incision can also be made in the navel.

There are the usual risks from the operation and general anesthesia. The appearance of a Capsular contracture, in which a capsule of scar tissue is formed in response to the foreign body, is the most common complication after silicone implantation.

This capsule can too Hardening of the chest, to a deformation and in extreme cases to persistent pain to lead.

In addition, it can also under certain circumstances if the operation does not go well asymmetrical breasts come. In some cases, the breast implants slip, which is why a Reoperation may be necessary for aesthetic reasons.

Pain after the operation

The occurrence of pain after breast augmentation with implants up to two weeks after the operation is normal and usually goes away on its own after this time. The pain is different depending on the individual pain sensation.

They come about because the skin is stretched to a greater or lesser extent during the operation. In addition, when the implants are placed subpectorally, the chest muscle is also stretched.

The pain caused by stretching is even more intense when large implants are used. In addition, many movements of the body also cause the chest muscles to contract.

Since the implants are behind the muscles, these movements lead to pain in the form of pulling, which is comparable to sore muscles.

Breast implantation in front of the pectoral muscle

There are two ways to position breast implants in the female breast. The subglandular technique is often used on women with a lot of autologous tissue. Here, the breast implant is placed under the mammary gland or over the pectoral muscle (epipectoral) placed.

This technique is least suitable for slim women with relatively little autologous tissue, as the contours of the implant are both visible and palpable under the skin.

One advantage of the subglandular technique is that the chest muscle does not have to be stretched with an expander beforehand and the surgical procedure is overall less traumatic and gentler on the surrounding tissue.

In addition, the risk of rebleeding is significantly lower.

Breast implantation under the muscle

With this technique of implanting breast implants, these are placed under the pectoral muscle (subpectoral) placed. This method is very suitable for slim women with relatively little fat and autologous tissue.

The contours of the implant are therefore not visible from the outside. The restriction in the choice of the size of the implants proved to be a disadvantage. Since there is only limited space under the chest muscle, implants of any size cannot be used with this method.

One advantage over the subglandular method is that this technique produces a natural breast shape, as the implant has more freedom of movement in the lower area of ​​the breast.

Pain after years on the breast implants

Pain that occurs with breast implants after years can have various causes. On the one hand, they can be caused by an encapsulation of the implants or by other autoimmune diseases such as sarcoidosis or Sjogren's syndrome.

In the former, small knots form in the connective tissue and in the latter, the salivary and lacrimal glands are restricted in their function.

There is also the disease scleroderma, in which the skin ossifies in a life-threatening way. What they all have in common with these diseases is that, in addition to depression and fatigue, they also cause pain.

Influence of breast implants on the quality of a mammogram

Studies have shown that breast implants can make it difficult to diagnose breast cancer early. In particular, implants inserted subglandularly (under the mammary gland) cast a shadow on the gland during mammography.

In addition, breast implants can make the compression required for the breast examination much more difficult. This impaired early diagnosis of breast cancer can increase breast cancer mortality in such patients.

How often can you change breast implants?

If the desire for more naturalness arises or if patients want further changes in their breast shape, the breast implants must be removed. There are also medical reasons that make it necessary to change breast implants.

These include unfavorable implant positions in front of or above the pectoral muscle and what is known as capsular contracture (see below). Breast diseases and damage to the implant itself can also make it necessary to change or remove implants in the breast.

The frequency of changing the implants is not limited to a certain number, but the surgical intervention must be carried out by an experienced plastic-aesthetic surgeon.

What should be considered during the change operation?

Breast implants are changed under general anesthesia, using the existing scar in the underbust crease as access. This will prevent new scars from forming on new areas of the skin.

For medical reasons, it is often advisable to create a new implant site. A new implant pocket for the new breast implant is formed in front of or behind the chest muscle. A subsequent breast lift is particularly recommended in the case of age-related relaxation of connective tissue.

Depending on the extent, the procedure can take between 2-4 hours. After the procedure, the patient must wear a special bra for the first few weeks and avoid excessive physical strain. After about 1 to 2 weeks she can carry out light professional activities, after about 6 weeks she is allowed to do sports again.

For optimal scar-free healing of the access point, direct UV radiation should be avoided for half a year.

How are breast implants removed?

Breast implant removal can be performed under both general and local anesthesia. Usually the patient is hospitalized for 1 or 2 days and the procedure is performed under general anesthesia.

The implant is preferably removed via the original interface in the underbust crease so that no new scars are created. During the operation, care is taken to remove the implants completely and undamaged and to create as few new scars as possible.

The duration of this operation is 2 to 4 hours, whereby it is associated with significantly more effort than the initial breast augmentation or the implantation of breast implants.

The removal often leaves an excess of skin. In such a case, a breast lift is also performed as part of the implant removal. After the operation, the healing time is approximately two weeks.

How is the breast tightened after an implant removal?

The breast lift lasts on average between 2 and 4 hours and is performed under general anesthesia. In the context of an implant removal, a breast lift is carried out when the skin has lost its elasticity and elasticity or when there is excess skin.

The excess skin is then removed and the nipple moved up, usually moving it along with nerves and blood vessels. In this way, the nipple sensitivity and breastfeeding ability are preserved.

Read more detailed information on this topic under: Breast lift

What durability can be expected from a modern breast implant?

There are numerous sources reporting conflicting opinions about the durability of breast implants. A prominent rumor is that breast implants have a shelf life of 10 to 20 years and should be removed or replaced afterwards.

Basically, however, it is not necessary to replace or remove implants as long as there are no complications and the patient reports no complaints.

These complications include capsule rupture due to wear and tear or mechanical impact.The cracks could leak silicone gel, deform them, or cause infection. The type of gel obviously also plays a decisive role here.

High quality implants are filled with so-called cohesive gel, which is very tough. As a result, the risk of leakage is significantly lower and even if cracks occur, these gels retain their shape and are usually immediately enclosed by connective tissue.

So the older rumor about the limited lifespan of around ten years is due to the lack of stability of older breast implants. A purely precautionary change after this time is usually no longer necessary.

What to do if a breast implant has slipped

Whether implants slip after the operation or maintain their stable position often depends primarily on the quality of the operation. During the operation, an implant pocket is created for the breast implants before they are inserted.

This work requires the surgeon to be extremely precise. Because only in an optimally prepared pocket does the implant get the necessary hold and can grow together with the surrounding tissue. If this implant pocket is too large, the risk of displacement increases.

If it is noticed that the implant has twisted, no attempt should be made to push it back into its original position. In any case, an appointment for correction or removal should be made with the treating surgeon as soon as possible.

In the case of a postoperative removal or correction, the implant is either repositioned or replaced with a new one in the event of damage. Since the original incision can be used, no new scars are to be expected.

What are the symptoms of a breast implant defect?

In the case of a capsule rupture, in the case of saline breast implants, liquid escapes into the surrounding tissue. The implant shrinks and the breast loses its shape. This consequence is easy to determine by looking at the breast alone.

In addition, locally swollen lymph nodes can be palpable, especially in the armpit area, and patients complain of pain when arm movements. In addition, the occurrence of infections in the context of a defect in breast implants is not uncommon.

The typical symptoms of an infection are redness, swelling, and warmth of the skin around the chest. If the infection is treated early, these symptoms often resolve quickly.

However, the defective implant must either be replaced with a new one or completely removed. An increased feeling of tension in the breast and hardening, especially in the context of capsular contracture, are common symptoms of defective breast implants.

Capsular contracture

The capsular contracture (lat. capsular fibrosis) is one of the most common complications after breast augmentation with implants. Tissue hardening as a result of a natural immune reaction of the body against the implant.

Under physiological conditions, this reaction results in the formation of a very delicate and elastic capsule around the breast implant, so that no further complications are to be expected.

However, in capsular contracture, the immune reaction is so strong that a firm, thickened capsule forms around the breast implant and contracts it. The result is hardening and deformation of the implant.

These consequences manifest themselves in severe pain, tension and deformation of the chest. Capsular contracture can have many different causes, the validity of which has not yet been clearly proven.

This includes the nature of the surface of breast implants, which can be either smooth or textured. The smooth surface of older implants encourages fluid leakage as a result of an implant rupture, which significantly increases the risk of capsular contracture.

In contrast, roughened implant surfaces are less likely to form the fibrous capsule. The position of the implants also has a notable influence on the development of capsular contracture. The risk of disease is higher if the implant is positioned over the chest muscle.

It is therefore preferred from a medical point of view to place it under the chest muscle. Bruises in the wound cavity are a particular risk factor. Scar tissue can form very quickly from these, which is why drains are placed after breast surgery to avoid large bruises.

Breast cancer patients who have received radiation therapy have a very high risk of developing capsular contracture. For this reason, the surgeon to be treated uses the method of using his own tissue for breast reconstruction.

Breast implants after breast cancer

After breast cancer, the breasts can be reconstructed with breast implants made of either silicone gel or saline solution. First of all, the skin in the chest area must be stretched before the implant is inserted.

To do this, surgeons use an expander, a kind of balloon that is filled with saline solution over a period of time. At the end of this procedure, the expander is replaced by the implant.

However, this requires healthy skin. A disadvantage of breast reconstruction with silicone implants is that women perceive their breasts to be much firmer than before and it is quite uncomfortable for them.

Breastfeeding with breast implants

In principle, breast implants are not an obstacle to breastfeeding and they also have no influence on the baby's health. Since the implant is placed under the mammary gland or the muscle, there is no direct connection between it and the gland.

However, in the rarest of cases, sensitivity disorders or failures in the nipple can occur, which would significantly limit the ability to breastfeed.

You might also be interested in the following topic: Pain in the nipple

In particular, if the breast implants were inserted behind the milk ducts, it can be assumed that these and the larger nerves remained uninjured and that breastfeeding is not impaired in this case.

However, scars may form in the breast in response to the breast implants, which in some cases can cause pain and discomfort while breastfeeding.

The suspicion that silicone can pass into breast milk and lead to health problems in the child has not yet been confirmed. An increased level of harmful substances or silicone in breast milk has not yet been proven in silicone implants.

However, pregnancy can lead to changes in the tissue and the position of the implant can be changed.

In principle, it is possible to exchange breast implants after pregnancy. However, it is advisable to only have breast implants placed after family planning has been completed.

History of Breast Implants

Surgical breast augmentation with the help of breast implants has been carried out since the end of the 19th century.

At that time, a German-Austrian doctor tried a woman because of one Tumor a breast had been removed through the insertion of a benign fat tumor (Lipoma) the chest rebuild.

Since then, a wide variety of materials have been implanted in the female breast, such as sponges, rubber, glass balls.
Liquids such as cooking oil or paraffin were experimentally injected into the breast to increase the volume.

However, many of these interventions were involved severe complications connected, not infrequently was one Amputation of the breast inevitable.

In the 1960s, the first actual breast implants, which were made of silicone or implants filled with saline, became available.

Since the 1980s there have been repeated reports of complications from silicone implants, which is why the use of this material was banned in the early 1990s.

In 2000 there were problems with soybean oil implants, which were withdrawn from the market a short time later because of fear of poisoning consequences if the implant shell was damaged.

After extensive studies, silicone implants were returned to Europe in 2004 for the Breast augmentation authorized.

However, in 2010 there was another worldwide scandal about the company PIP, whose breast implants contained industrial silicone, which is verifiably a carcinogenic effect owned.