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The era of modern breast augmentation began in 1963 in the USA with the use of silicone implants. Ever since, the trend in breast implants knew only one direction: upwards. Today, it is one of the most important plastic surgeries worldwide. In 2010, 296,000 women, in the United States alone, had their breasts enlarged. The annual increase since 2000 is 39%. Surveys among women show that breast enlargement enjoys the highest satisfaction ratings.
The goal of the operation is not only to create larger breasts, but to improve their shape as well. Which implant to use, is determined both by the wishes of the patient and objective criteria such as body shape, chest shape, and skin texture and quality. New-generation implants offer a wide choice of alternatives. Instead of one size fits all, women can now choose among different shapes with the same overall volume. This allows for a (near) perfect match for every body shape.
Frequently asked questions about breast augmentation:
Who is a good candidate for breast enlargement?
Ideal candidates are women with small or medium-sized breasts, and women who lost volume after breast-feeding. Women with medium-sized or large breast, which have lost their firmness, belong into another group of patients. Here, the implants must often be combined with a lifting and tightening procedure.
What is the best age for this surgery?
The best time is up to medium age. As a rule, we wait until breast development has stopped before we consider an intervention. Exceptional cases apart, we do not accept underage patients. Minimum age for plastic surgery is 18 years of age.
Since when is breast augmentation surgery performed?
The first operation was reported in 1895; a lipoma, (fat tumour) removed elsewhere, was implanted. In the 1950s, people injected all sorts of substances into the breast, among them liquid silicone and bee wax. They all caused severe postoperative complications. Experiments with a sponge-like synthetic material, Ivalon, also ended in failure. The breakthrough was finally achieved in 1963 with silicone implants. Since then, development has not stopped, and so have discussions about the pros and cons of implant use. Today, silicone is the dominant material worldwide.
What are the main features of today’s implants?
Most implants are made of a silicone-based polymer. Since their first introduction 50 years ago, they have undergone a tremendous development. Today’s products are the 5th generation since 1993. Leaking and bursting implants or deformations are a thing of the past. Manufacturers grant a life-long warranty for the latest generation of products. The problem of capsular contracture has not been completely solved yet, but it has been reduced to a minimum. The 5th generation implants contain a cohesive gel that does not flow, the implant surface is textured to suppress slippage, and they retain their round or anatomical shape in the body. The importance of implants filled with physiological salt solutions, on the other hand, is constantly declining.
What are the alternatives to silicone implants?
Implants with physiological salt solutions are available, but they are constantly losing market share. Since the ban on silicone has been lifted, and because silicone technology has made great advances, the salt water-filled alternative is out of favour.
Do silicone implants cause cancer?
In 1993, the American Food and Drug Administration (FDA) suspended the use of silicone implants for 10 years. The reasons for this decision were uncertainty about the cancer risk, negative impact on mammographic scans, and suspicion that silicone might cause diseases of the joints. In the 10 years following the temporary ban, it could be proven beyond reasonable doubt that the fear was baseless. Subsequently, implants were permitted again in the USA in 2003. Studies on the relationship of silicone implants and cancer did not find any connection, on the contrary, what they found was, that women with implants have a 30% smaller cancer risk than women without. The reason for this surprising result may be that women with an elevated cancer risk prefer not to have implants.
Are fat injections an alternative?
In recent years, fat injections have become an accepted practice for breast augmentation. However, the results are less predictable, and the achievable enlargement is smaller. The procedure requires several repeat interventions. Usually, slim women request breast augmentation which means that not enough own body fat is available for the procedure. Fat injections are mainly used to balance asymmetries, but they may also be a good alternative in individual cases. To improve permanence (up to 80%) stem cell-enriched fat is injected. But this procedure comes at a price. Another disadvantage, besides cost considerations, is calcium deposits that may have an impact on the interpretability of future breast scans. When applied professionally, fat injections do reduce the risk of the intervention.
What other fillers could be used?
Breast augmentation with large amounts of hyaluronic acid (HA) is another tried method to obtain larger breasts. But they are very costly, and the effect is only temporary. There is also a high risk of complications. For these reasons, HA injections are not a widely used method.
What to do and what not to do before treatment?
Three weeks before an invasive / surgical treatment patient must stop smoking and taking aspirin. In the last week, patients must stop taking any anticoagulant (“blood-thinning”) medicine.
The following substances are also prohibited:
• pain killers such as Apranax, Voltaren and Vermidon (alternative brand names are Minoset and Novalgin)
• multivitamin tablets containing ginseng, ginkgo biloba and coenzyme Q,
• green tea, herbal products containing linseed, sour cherry stalks, tomato seeds
• all diet products.
Before breast surgery, a mammogram / ultrasound scan must be taken. It is important for postoperative examinations. A year later, another mammogram / ultrasound scan is taken.
Does the procedure require anaesthesia ?
The surgery is carried out in a clinic under general anaesthesia.
How long does the operation take?
About 1-1.5 hours.
Does the surgery leave any scars?
After every surgery there are scars. Breast augmentation is an intervention that leaves only very small traces. A 4-5 cm long incision is sufficient to place the implants which can be inserted via the breast crease, the areola or the arm pit. The navel is another possible, but rarely used, insertion point. Arm pit and navel are suitable insertion points only for implants that are later filled with physiological salt solution. An incision in the areola would leave almost no trace, it would, however, require a cut into the breast tissue; a higher incidence of capsular contracture is another disadvantage of this method. Too small areolas are also an obstacle for this method. For this reason, the most common approach is through the breast crease which hides the scar. Depending on skin type, in some cases, the scars may remain visible.
Are the implants placed under or over the muscle?
In slim women with a thin tissue layer under the skin, the implants are placed beneath the muscle. In this procedure, the upper part of the implant lies beneath the muscle, and the lower part under the breast tissue. This “dual plane” method is the most frequently used surgical procedure today. If the subcutaneous tissue is thick enough, the implants are placed under the breast tissue or into the muscular fascia, the thin tissue layer that envelops the muscle.
Is the procedure painful?
Placement of the implant on the muscle causes almost no pain; insertion beneath the muscle is more painful. To reduce the pain to a minimum, we use strong sedatives. They prevent severe pain in the immediate postoperative phase. The pain will set in only the next day; it is not excruciating and can easily be controlled with pain medication. The pain may linger for up to 3 days. After that, an unpleasant sensation of pressure may set in. Depending on the size of the implant and the skin tension, it can continue for up to three week.
What happens after the operation?
After 3 hours, patients can eat and get up. After 6 hours they can be discharged. A dressing is placed on the incision. After 2 days, patients can take a bath. On the 3rd day, they have to return to the clinic for a check-up; afterwards they can return to their normal life. In the first three week, all physical exercises, except walking, must be avoided. During this time, the patient must wear a sports bra at all times. After 3 weeks, physical exercises are permitted, except arm and chest movements. After 6 six weeks, you are free to exercise as you please.
In the first 3 weeks, the implants lie higher than normal, and the appearance is unnatural. After week three, they begin to move downward into their final position which they reach after 3 months. Further check-ups follow after 3 weeks, 3 and 6 months and one year after the operation. At that time, a control mammogram / ultrasound scan must be taken as well.
What side effects may occur after breast augmentation?
Bleedings, infections and difficult scar healing may occur in the early postoperative phase. But they are rare. The most frequent long-term problems are capsular contracture, asymmetries and aesthetic issues. Leaks and burst implants are a thing of the past, at least when you use branded products. Brands like Allergan and Mentor come with a lifelong warranty.
Capsular contracture occurs when the body perceives the implant as a foreign object and tries to get rid of it. The implant is covered in a hard tissue layer and pushed to the side. The results are a hardening of the breast and asymmetries. Such a reaction is observed in 1-5% of all cases and requires surgical removal and replacement of the implant. If the problem occurs again, the procedure may be repeated a third time. If that does not help either, the patient is advised not to use implants. Repeat capsular contracture is a rather rare phenomenon, in particular when new-generation implants are used. Insertion through the breast crease, sub-muscular placement and a grained surfaces further reduce the risk. Expert surgery and the use of moderately-sized implants on the other hand improve the chances of a highly satisfactory long-lasting breast augmentation.
Other complaints concern: visibility of the implants, rippling and depressions on the skin, dissatisfaction with the achieved size, and unnatural appearance. This can be prevented to a large extent with dimensionally stable new-generation implants and through sub-muscular placement. An experienced surgeon is certainly an asset. Patients should also be advised that over-sized implants increase the risk level.
Does breast augmentation surgery cause sensation changes?
The feeling in the nipples may be temporarily reduced or they may become over-sensitive. Normal sensation usually returns after a few months. Permanent numbness is rare. This complication is also dependent on implant size. Capsular contracture can also result in sensation loss, and it can cause pain.
Should I have my implants removed when I am pregnant?
Implants neither adversely affect pregnancies nor breast-feeding. However, breasts may begin to sag after childbirth and breast-feeding, and may require lifting.
Do implants adversely affect breast-feeding?
Scientific studies have found no adverse impact.
Should I have my implants removed when I am pregnant?
Implants neither adversely affect pregnancies nor breast-feeding. However, breasts may begin to sag after childbirth and breast-feeding, and may require lifting.
Do implants adversely affect breast-feeding?
Scientific studies have found no adverse impact.
Do sub-muscular implants weaken the strength in the arms?
Scientific studies have found no such influence on arm strength. Even sports persons can use implants without having to fear adverse effects on their performance.
Do breast implants impair the results of breast scans?
We advise our patients to continue regular breast scans after the operation. Implants do not affect the diagnostic quality of scans taken with modern devices. The same is true for ultrasound and MR scans. Inserted through the breast crease, the procedure leaves no trace in the breast tissue.
Do I have to change my implants after some time?
Older models had to be removed after 8-10 years. This is no longer necessary with dimensionally stable 5th generation products. For as long as they cause no complications, they need not be replaced. New implants include a replacement warranty by the manufacturer, should any problems occur.
