Schnheitschirurgie

Breast augmentation

Synonyms

Mammaplasty, breast augmentation
lat. augmentum growth, increase
English: breast enlargement

introduction

Breast augmentation is in the jargon augmentation called and is a plastic-surgical operation that is usually performed for aesthetic reasons.
Breast augmentation is done either by the gynecologist or the plastic surgeon. Please note that “cosmetic surgeons” are not necessarily gynecologists or plastic surgeons, as the title “cosmetic surgeon” is not a specialist title.

definition

The Breast augmentation is used as part of the reconstructive surgery after mastectomy as a result of Breast cancer used as well as women who have their Breasts perceive as too small. The operation can be performed by plastic surgeons, general surgeons and gynecologists.

anatomy

In the chest are fat-, Bandage-, and Glandular tissue, such as Muscles, Vessels, nerves and milk ducts.
Depending on the anatomy of your own breast can be of different sizes Breast implants can be used. The breast cannot be enlarged at will, the size always depends on your anatomy and the elasticity of your skin.

Methods and materials

Implants

Implants to Breast augmentation fall under that Medical product law and were classified in the highest risk class. The surface of breast implants is usually made of siliconethat can be smooth and textured. The textured surface has the advantage of preventing the implant from slipping as well as the occurrence of capsular contractures (see below) less often than a smooth surface.

The shape of the implant can be evenly round or teardrop-shaped. The last-mentioned embodiment is intended to achieve a particularly natural result, but has the disadvantage of producing a disproportionate breast shape when the implant is rotated. To avoid this with breast augmentation, there are teardrop-shaped implants only with a textured surface.

The filling of the implant can be made silicone or Saline solution consist. Soybean oil couldn't convince.

Silicone implants were temporarily withdrawn from the market in the USA because they were caused by leakage Autoimmune- and Cancers were discussed, but this could not be confirmed.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 crack. Silicone implants also achieve the highest level of satisfaction in terms of natural feel and durability.

The advantage of implants with saline solution lies in the surgical method. Since the implant can only be filled here after it has been inserted into the breast, small incisions are sufficient. With an additional valve placed under the skin subsequent changes to the filling volume are possible. This is particularly suitable for women who are unsure about the size of the implant or who need a slow stretching of the remaining breast skin after a mastectomy before more volume can be introduced. The disadvantage of this breast augmentation of implants with saline solution lies in the lower stability of their positioning and possible "Sloshing noises“.

The operation itself is usually carried out under general anesthesia. First, an incision is made in the Underbust crease, Armpit or that Areola can be set. Then the implant is inserted, whereby it can be placed directly under it if there is sufficient fat and glandular tissue (subglandular). For thinner women, the implant should better be under the Chest muscle (submuscular) can be positioned.

Fat stem cells

The so-called C.ell-A.ssisted L.ipotransfer (CAL). At one Breast augmentation Stem cells that were previously obtained from suctioned fat tissue into the Breast tissue given and cause an increase in adipose tissue.

Postoperative procedure:
The patient is on sick leave for about 1 week. A should last for around 1-2 months special support bra to prevent the implant from slipping. The Chest muscles must be protected for about half a year.

surgery

Before breast augmentation surgery, it is important to have the breast examined by a doctor, preferably a gynecologist. A tumor must be ruled out before you can have an operation.
In addition, you should clarify your medication intake with your doctor before having a breast augmentation operation, as some medications may not be taken before an operation. These include, for example, aspirin and metformin. Smoking should also be stopped before an operation.
There are three different ways to place the implant for breast augmentation.
Once the "subglandular"Implantation, the" subfascial "implantation and the"submuscular“Implantation. "Sub" means "under", so the name refers to the structure under which the pillow is implanted. So subglandular is under the glandular tissue, subfascial is under the fascia (the fascia is a layer of connective tissue that surrounds the chest muscle) and submuscular means under the muscle.
The subfascial implantation is the rarest of all breast augmentation implants and is not offered by every doctor. If there is little glandular tissue, implantation under the muscle can be advantageous, as the implant is otherwise very visible. The disadvantage here is that the muscle has to be severed 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 anesthesia. In the case of implantations via the chest muscle, local anesthesia plus sedatives may be sufficient; this procedure is discussed with the responsible anesthetist (anesthetist).

The surgeon will make an incision either in the lower fold of the breast, in the armpit, or around the nipple.
Then space is created for the implant. The implant is then inserted and positioned through the skin incision. The wound is closed again and bandages are applied. The introduction of drains is usually necessary to remove the wound fluid. The drainage can be removed after a few days. After the operation, it takes about a week before you are fit and able to work again.
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 an operation is carried out through a “keyhole” with the help of a camera and surgical instruments.

This procedure is quite safe and has been around for almost 20 years, but not all centers offer it. It is advisable to use the experience of the doctor as a guide when deciding which type of surgery to use, as there are still no studies on which variant is better.

Find out more now: Scar care

Risks of the operation

Main risk with a Breast augmentation represents the so-called Capsular contracture represents. The chest a shell of scar tissue around the implant, which can lead to painful hardening and deformation of the breast. Risk factors for this are unsanitary surgical methods (bacteria!) as well as large and smooth implants. Capsular contracture occurs in around one in ten women with breast implants after a few years.

About every fifth woman who has been operated on has to undergo a re-operation because of massive capsular contracture, slipping or damage to the implant.

The appearance of Breast cancer among implant recipients is not increased and the Breast diagnostics not disabled for cancer screening.

Breast augmentation without surgery

Breast enlargement, which is called augmentation in technical terms, is mostly used by women who feel their breasts are too small. Since many women fear the complications and risks of breast surgery, there are now other options for 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 pillows can make the breasts appear larger and more voluminous when they are clothed. Some tops, bras and bikinis are already offered with integrated silicone cushions, but these can also be purchased individually.

Vacuum pumps
Another option for breast augmentation without surgery is the use of vacuum pumps. The tissue is stimulated by vacuum pumps and temporary breast growth is achieved. The suction on the chest creates a stretching effect and the blood circulation in the chest is also increased. With regular use over a longer period of time, permanent breast enlargement can also be achieved through the application of tension. However, the shape of the breast cannot be changed by the vacuum pumps and a breast lift is not possible. However, vibratory massage devices can be used to tighten the tissue.

Sex hormones
Since the female mammary gland tissue reacts to hormone consumption, this is also one of the possibilities to achieve breast enlargement without surgery. Breast size gains of up to two cups can be achieved by taking high doses of tablets or injecting ingredients similar to those found in the contraceptive pill (especially estrogens). The increase in size is mainly linked to the high dose of estrogen. However, this also means that the breast will shrink again after the hormones have been discontinued and, under certain circumstances, the breast tissue loss with the same skin mass may result in a changed shape of the breast. It should also be noted that the hormones do not only have an effect on breast growth and can therefore cause side effects such as mood swings or weight gain.
Read more on this topic at: What happens if you stop taking the pill?

Hyaluronic acid (e.g. Macrolane®)
Hyaluronic acid occurs in the human body and has been used for some time in cosmetic operations such as used for folding. The hyaluronic acid can also enlarge, tighten and shape the breast. When the hyaluronic acid procedure for breast enlargement was introduced, it was considered that side effects such as wound healing disorders and scarring should be avoided. However, since the formation of cysts and other side effects could be observed even with small amounts of Macrolane® and breast cancer screening (mammography) was also made diagnostically difficult, the preparation was withdrawn from the market in mid-2012. A disadvantage compared to breast surgery is that breast augmentation with hyaluronic acid does not produce a lasting result and the procedure only lasts for about three years.

Autologous fat transplant
Autologous fat transplantation, also known as autologous fat transplantation, is a method in which fat tissue is removed from one part of the body and then inserted into another area of the body. This assumes that the patient has excess fatty tissue in one part of the body (e.g. on the thighs or on the stomach), which can be used for the autologous fat transplant. During the procedure, fat cells are first suctioned off with a thick cannula under slight suction.After the fat cells have been cleaned, they are then reinserted under the skin on the breast with a special cannula. This procedure has been carried out for 25 years and is low-risk compared to breast augmentation surgery, even if you have to reckon with injuries or dents at the removal site with autologous fat transplantation. Autologous fat transplantation is particularly suitable for patients who do not want or can tolerate implants.

Assumption of costs

The health insurance companies only cover the costs of reconstructive breast surgery after cancer with mastectomy. The cost of a breast augmentation for purely aesthetic reasons is usually not reimbursed.

The cost of breast augmentation varies between 5,000 and 8,000 euros.

The large fluctuations can be explained by the fact that there are different types of surgery and different types of anesthesia. The duration of the operation, the difficulty of the operation, the nature of your breast and the use of the operating theater are also included in the costs.

The cost of the material is also different. Depending on whether a saline solution, liquid, gel-like or solid silicone is used, this can be a difference of several hundred euros.

The preliminary and follow-up examinations of the breast augmentation also cost. These are often extra services that are not always included in the price.
The cost of a breast augmentation is only covered by the health insurance company in special cases. As a rule, the patient has to bear the costs himself. If the breast augmentation takes place after cancer with a mastectomy (mastectomy) or there is a malformation of the breast, the operation will be covered by the health insurance.