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Breast augmentation with implants

The appearance of the female breast, its size and shape are a central part of female identity. The breast changes with weight gain and loss, pregnancy, breastfeeding, menopause and with age. The reasons for breast augmentation with implants are individually very different.

What is breast augmentation with implants?

Commonly expressed desires include a more feminine silhouette, a natural balance to the rest of the body, a better love life, wearing clothes without worry, and a more attractive appearance. Breast augmentation is one of the most common aesthetic procedures in the world. It is estimated that over 1.5 million breast augmentations were performed in 2017. Scientific studies show that breast augmentation is usually associated with high patient satisfaction and a significant improvement in quality of life.

Breast augmentation by means of implants is one of the classic medical procedures in plastic and aesthetic surgery, which makes it possible to achieve the desired size. Often after pregnancies or severe weight loss, women want to regain the lost volume of their breasts and their previous cup size. In case a correction of the breast shape is desired at the same time, a breast augmentation can also be combined with a breast lift.

On this page you will find detailed information on surgical methods for breast augmentation with implants and receive help in deciding on the right implant for your needs. In addition, common questions are answered and you will receive a lot more information and details that you should know if you want a safe breast augmentation with a natural look. For the creation of an individual treatment plan you have of course the possibility to contact us for a first consultation.

Things to know about breast implants

Implants are selected based on their shape, whether anatomical (teardrop-shaped) or round, and also based on their size, outer wall and the filling material. CE and FDA certifications attest to compliance with European and American quality standards. In order to select the right implant, your change requests and your individual anatomical conditions of the body should be taken into account.

What should women who decide to have breast augmentation look for?

Breast implants are usually inserted through a few centimeters access (skin incision) in the area of the planned underbust fold. Alternative approaches are the armpit or on the edge of the areola. They can be placed under or over the large muscle (pectoral muscle) or under the mammary glands.

Facts about breast augmentation with implant

OP duration1h
AnaesthesiaGeneral anaesthesia / Twilight sleep / Fast recovery surgery
Hospital stay Outpatient
Costs to the price calculator
Aftercare 6 weeks
Thread traction Self dissolving threads
Socially acceptableafter 5 days
Supplements or alternativesHybrid breast augmentation / breast augmentation with autologous fat

What reference points are used in the examination of the breast?

1.clavicle middle
2. Thrush pit (Jugulum)
3. Cleavage
4. Upper inner chest quadrant
5. Gutter between the breasts
6. Nipple
7. Breastbase
8. Underbust crease
9. Elbow

Changes in breast shape and bust size can be emotionally distressing after puberty or later in life. Certain features and proportions are generally associated with beauty, harmony, youthfulness and health. In order to get a comprehensive picture, various reference points are measured during the investigation. These individually different characteristics are taken into account when creating a treatment plan.

Choosing the right breast implant

When choosing the right implant, decisions must be made regarding shape (round or teardrop), projection (implant thickness), surface (outer wall), filling material (inner material), strength level, manufacturer and size. We will be happy to advise you on how to achieve the optical result of a natural breast in the desired size. Take a look here at which implants can be used for breast augmentation.

A Ergonomic implant under the pectoral muscle
B Ergonomic implant over the pectoral muscle
C Round implant over the pectoral muscle

1.subcutaneous fat tissue
2. Greater pectoral muscle
3. Third rib
4. Cleavage
5. Intercostal nerves
6. Lesser pectoral muscle
7. Round implant
8. Mammary gland
9. Intercostal muscle
10. outer pleura

The position and shape of a breast implant affect the contour of the breast. Teardrop-shaped (anatomical) implants have more volume in the lower half of the breast (breast pole). These implants offer the advantage of a natural transition in the décolleté. Unlike round implants, teardrop-shaped breast implants have a rough surface to maintain your alignment (more volume at the bottom than the top). The rough surface is suspected to cause blood cancer in rare cases. To make the implant less visible or palpable in the décolleté, it can be inserted under the large pectoral muscle. The large pectoral muscle is large enough to cover the entire implant in only a quarter of women (Madsen et al., 2015, Ann Plast Surg). In most cases, the origin of the large pectoral muscle extends to the 6th rib. The origin of the small pectoral muscle extends from the third to the fifth rib.

Breast implant facts
Different forms of the implant Anatomical breast implants or implants in the form of drops: natural shape, possible risk of twisting the implant. Anatomical breast implants therefore have a rough surface. Round breast implants: full décolleté. Round implants can accordingly have a smooth surface.
Implant thickness Medium projection: most natural results. High projection: tends to be a full shape.
Outer wall of the implant Silicone shell with a smooth surface: tends to be smaller access, increased risk of capsular contracture. Silicone cover with a rough surface: adheres better to the tissue (prerequisite for using anatomical implants), increased risk of ALCL.
Filling material of the implant Silicone: usually dimensionally stable material, lower risk of wrinkling. Physiological saline solution: poorly dimensionally stable, increased risk of wrinkling.
Degree of strength of the implant Low strength: more natural shape, less projection. High strength: unnatural shape, especially when lying down, high projection.
1. nagor® / shape: round; implant thickness: high profile; outer wall: micro-structured; volume: 240 ml
2. Eurosilicone® / Shape: round; Implant thickness: high profile; Outer wall: smooth; Volume: 350 ml
3. Eurosilicone® / Shape: teardrop-shaped; Implant thickness: moderate projection; Outer wall: micro-structured; Volume: 235 ml
4. motiva Ergonomix® / shape: ergonomic; implant thickness: corsé; outer wall: micro-structured; volume: 380 ml
5. motiva Ergonomix® / shape: ergonomic; implant thickness: demi; outer wall: micro-structured; volume: 300 ml
6. motiva round® / shape: round; implant thickness: demi; outer wall: micro-structured; volume: 300 ml

Los Deline © liquid implant

The tissue filler Los Deline© was developed in 2005 and initially marketed under the name Aquafilling© (Biomedica, Prague, Czech Republic). The colorless, transparent gel consists of 98% saline and 2% of a multiple bond of acrylamide and N,N′-methylenebisacrylamide. There may be minimal differences in the bond structures between the structure of Los Deline© and other polymethyl methacrylate (PMMA) tissue fillers. However, the overall composition of these tissue fillers appears to be very similar [1]. With other PMMA tissue fillers (for example Aquamid®) complications such as inflammation, pain and nodule formation were seen in over 18 percent of cases [2]. The complications of Aquafilling© occur afterwards, in the time frame of 5 months to 12 years after the injection (average 3 years).

The complications occasionally have to be treated by surgery. The reasons for surgery are hardening in more than 80 percent, pain in more than 50 percent and inflammation in 7 to 8 percent (Cheng N, et al. 2002, Aesthet Plast Surg). The enlargement of a breast by injecting a liquid implant is seductive. All too often, these treatments are offered by doctors who, unlike plastic surgeons, are not proficient in alternative breast augmentation techniques.

Non-invasive procedures are neither harmless nor without risk. Tissue fillers for breast augmentation were therefore banned by the U.S. Food and Drug Administration in 2015 [3]. Since the term cosmetic surgeon is not protected, there are also providers of highly dubious methods of breast augmentation, such as a 24-hour push-up augmentation with a saline filling.

We therefore recommend that you not only question the quality of the implant, but also research the qualifications of the doctor in whom you place your trust. Always rely on high-quality implants of the latest generation. The combination of modern implants and experienced specialists in aesthetic surgery are the basic prerequisites for success. Inform yourself comprehensively.

Ways (accesses) via which implants can be inserted

Skin incisionAdvantagesDisadvantages
Underbust crease
  • Good overview
  • Placement of the implant under the pectoral muscle is possible.
  • Use of an anatomical implant possible.
  • Implant exchange possible via the same access
  • Breastfeeding ability not affected.
  • Scar visible when lying down or, in the case of small breasts, when standing up.
areola border
  • Inconspicuous scar
  • Not possible with small nipples or large implants.
  • Breastfeeding may be impaired.
  • Possibly reduced sensation of the nipple.
  • Further scar in case of implant change in the underbust fold.
Armpit
  • No scar on the breast itself.
  • Advisable if there is a tendency to scarring.
  • Advantageous for small to moderate enlargement of small breasts.
  • Breastfeeding ability not affected.
  • Precise placement of the implant is difficult.
  • Increased risk of asymmetrical underbust folds.
  • Keyhole technique with limited overview.
  • Risk of damage to cutaneous nerves of the arm and lymphatic vessels
  • Interferes with the examination of sentinel lymph nodes for the detection and treatment of breast cancer.
  • Further scar in case of implant change in the underbust fold.
  • Expensive equipment required.
Bellybutton
  • No scar on the breast itself.
  • Breastfeeding ability not affected.
  • Only water-filled implants possible.
  • Keyhole technique with limited overview.
  • Further scar in case of implant change in the underbust fold.

How is breast augmentation performed with implants?

Step 1: Preparation

Before the start, a before picture (photo with specific settings) is recorded so that the result can be optimally compared.

Step 2: The surgery

The medical intervention is not only carried out under local anesthesia, but also under general anesthesia as part of an outpatient procedure in the practice, in a special operating room.

Step 3: After the procedure

The wound after the operation is mostly sewn with self-dissolving skin threads. Depending on the findings, drainage tubes can be inserted into the wound as part of the breast augmentation operation in the operating room, which can be removed again after a short period of time. The duration of the operation including general anaesthesia is about 60 minutes. You will receive an implant passport / implant ID card in accordance with the legal requirements. In this way, the origin of the implants can be traced back to the manufacturer at any time.

How can you prepare for breast augmentation with implants?

The following instructions should be followed after breast augmentation with implants. General recommendations for breast surgery can be found on the Breast Surgery FAQ page.

  • For the first 6 weeks, sleep only on your back to avoid any risk of the implants slipping out of place.
  • All your questions about possible complications and alternative medical treatments should be answered in advance by the plastic surgery expert.
  • Avoid fast, sweeping and powerful shoulder movements. These could cause the breast implant to slip or twist. Chest muscle training should be paused for six weeks.

Silicone Implants & Breast Implant Illness

For many years, it has been intensively discussed that silicone implants cause numerous complaints. Many of these complaints are summarized under the term “Breast Implant Illness” (BII). Causal relationships are investigated in medicine according to the Bradford Hill criteria. A causal relationship, such as brain tumor disease and cell phone use, must be factually and substantiated using these nine criteria. The explanation of terms, an illustrative example and the reference to Breast Implant Illness help to better understand the complex relationships.

Explanation of terms Example Breast Implant Illness
1. strength of association1 The more frequently a disease is observed after an event, the more likely a causal relationship is. All students in a class get excellent graduation grades in math. They probably had a good teacher. Scientific studies come to different conclusions. The overall quality of studies is still insufficient.
2. degree of conformity2 If the conclusions of different studies, in different countries, at different times are the same, a causal relationship is likely. Climate researchers around the world agree – CO2 emissions are responsible for climate change. The conclusions of the studies are contradictory, with the voices that deny a connection currently predominating.
3 Specificity3 If there are no other risk factors, a link is likely. If a new watch with a new battery stops after one day when handled properly, it is probably a manufacturing defect. The described complaints are very different and occur in a variety of diseases. The causes and triggers of autoimmune disease are still insufficiently understood.
4 Temporal context4 The accumulation of a disease at a certain time after a damaging influence makes a causal relationship likely. If abdominal pain occurs before or weeks after a restaurant visit, food poisoning is unlikely. The length of time it takes to develop symptoms varies in scientific reports from one to 15 years.
5. biological gradient If there is a link, a harmful influence over a long time, should be associated with a higher probability of disease. The more cigarettes someone smokes, the more the risk of lung cancer increases. Different morbidity rates for unilateral or bilateral breast implants, saline implants, pacemakers or small joint prostheses could not be found.
6. plausibility The presence of a biological explanation supports a causal explanation. UV rays can damage the human genome and therefore also cause skin cancer. Definition: The presence of a biological explanation supports a causal explanation. Example: UV rays can damage the human genome and therefore cause skin cancer. Breast Implant Illness: Foreign bodies are recognized in the organism by the defense cells and trigger an immune response.
7. coherence Consistent observations from laboratory experiments and observations in patients are more likely to support a causal relationship. The harmful effects of particulate matter can be observed consistently in animal experiments and in traffic-intensive areas. Test results on humans and tests in the laboratory are very different.
8. experiment5 Elimination of the risk factor should reduce the incidence of the disease. When a smoker stops smoking, the likelihood of getting lung cancer decreases. A temporary improvement of the complaints was observed in 38 patients after implant removal.
9. analogy6 Similar risk factors should lead to similar diseases. As smoking leads to lung cancer, it is likely to have an influence in the development of bladder cancer. Silicone implants in other body sites are not suspected to cause disease.

Sources: 1JanowskyEC, et al. 2000. N Engl J Med 342(11):781-790. Balk EM, et al. 2016. Ann Intern Med 164:164-175. Colaris MJL, et al. Immunol Res. 2017 Feb;65(1):120-128.

2Perkins LL, et al. 1995. Ann Plast Surg 35:561-570. Hochberg MC, et al. 1996. Curr Top Microbiol Immunol 210:411-417. Wong O. 1996. Regul Toxicol Pharmacol 23:74-85. Whorton D, Wong O (1997) et al. West J Med 167:159-165. Janowsky EC, et al. 2000. N Engl J Med 342:781-790. Rubio-Rivas M, et al. Clin Rheumatol. 2017 Mar;36(3):569-582.

3Colaris MJL, et al. Immunol Res. 2017 Feb;65(1):120-128.

4Pavlov-Dolijanovic S et al. 2017. Rheumatol Int 37(8):1405-1411

5Rohrich RJ et al (2000) et al. Plast Reconstr Surg 105(7):2529-2537

6With the exception of ALCL, there is no known disease caused by silicone.

Breast augmentation simulation

3D simulations and VR glasses have become very popular in recent years. The problem with current algorithms is that they feign accuracy that is not realistic, especially when combining different methods. The variety and complexity of breast augmentation are not captured by most programs.

We develop an individual treatment plan for each patient, which may include different techniques such as autologous fat treatment, a tightening of the skin mantle or the correction of fat deposits in front of the armpits. Since current simulation programs are not able to show such changes, we explain the expected changes on before and after pictures during the consultation. In addition, we offer the possibility of using silicone bra inserts to get a feel for the size change before surgery.

Before and after pictures of a breast augmentation with implants

With cosmetic surgery, many patients expect to be able to view before and after pictures (after pictures / before and after photos). When it comes to the topic of breast augmentation with implantation, women naturally insist in particular on placing themselves in the hands of an extraordinarily trustworthy expert in the field of plastic-aesthetic surgery in order to receive a detailed and competent individual consultation. You want to make sure you’ll be completely satisfied with the results by looking at after photos and getting an idea beforehand. In this context, they also expect to be shown before-and-after pictures (before-and-after photos) of any surgeries that may have been performed. You can view such photos for a before and after comparison when you make an appointment for a personal consultation. Of course, this is done in compliance with data protection regulations. In addition, a trial bra will be put on at the appointment so that you can visualize the target size.

For further information, please consult the page on the subject of before and after pictures.

Testimonials about breast augmentation with implants

If you would like to read other patients’ experiences about their breast augmentation surgery with implants at Centerplast, you can check out our testimonials page.

Recommendations for patients with textured breast implants

Every woman should palpate her breasts regularly. After the age of 30, the breasts and armpits should be palpated annually by a gynecologist. After that, after the age of 50, an annual mammogram is recommended. Ultrasound or MRI examinations may be necessary if the mammography examination is not conclusive enough. Immediate examination by a plastic surgeon is required if you notice a change in the size, feel or shape of your breasts.

Frequently asked questions

What are the costs for breast augmentation with an implant?

The costs for a breast augmentation with implants are determined during the personal consultation. Should you wish to get an idea of the price range in advance, please visit our cost page.

Frequently asked questions about breast implant associated anaplastic large cell lymphoma (BIA-ALCL)

Frequently asked questions about “Breast Implant Illness” (BII)

The author

Unsere Fachärzte für Plastische Chirurgie Saarbrücken
Dr. med. Stéphane Stahl

“We provide you with extensive expert knowledge so that we can work with you to select the best possible treatment path.”

Dr. med. Stéphane steel is the former director of the Clinic for Plastic, Reconstructive and Aesthetic Surgery / Hand Surgery at the Lüdenscheid Clinic. Dr. Stahl studied medicine at the Universities of Freiburg and Berlin. In 2011 he passed the European and 2012 the German specialist examination for plastic and aesthetic surgery. Further specialist qualifications and additional qualifications followed (including quality management, medical didactics, physical therapy, emergency medicine, laser protection officers, hand surgery) as well as prizes and awards. In 2015 he completed his habilitation in plastic and aesthetic surgery in Tübingen. He is an experienced microsurgeon, a sought-after expert and a regular speaker at specialist congresses. After a multi-stage selection process, Stéphane Stahl became a member of the American Society for Aesthetic Plastic Surgery (ASAPS), one of the world’s largest and most influential specialist societies for aesthetic surgery. His authorship includes numerous articles in respected peer review journals and standard surgical textbooks.

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