Hybrid breast augmentation is the combination of conventional breast augmentation with an implant and an autologous fat transplant (lipofilling).
How is hybrid breast augmentation performed?
Before each operation, the patient is meticulously checked several times to ensure the greatest possible patient safety. The operation is not started until all the prerequisites have been fulfilled according to the checklist.
Before the operation, the breasts are marked in a standing position. If the operation is performed in twilight sleep, you will be given medication that will relieve your anxiety and reduce your sensitivity to pain. If you do not sleep deeply anyway, you may feel something happening on the surface of your body.
The breast implant with the surrounding capsule is removed through a small incision in the area of the lower breast fold. The pectoral muscle is then reattached to the sternum. The scar tissue is firmly closed towards the midline. The pocket into which the new implants are inserted is formed above the pectoral muscle. With the Keller Funnel Method, the new breast implants are inserted gently and precisely. The procedure is also known as the "no-touch" technique. It prevents the implant from coming into contact with the surgeon's skin or hands. Depending on the findings, drainage tubes are inserted into the wound, which can be removed again after a short period of time. The wound is closed with fine threads that dissolve themselves after about three weeks.
If necessary, an additional own fat treatment can be carried out for an optimal result. The advantages of own fat treatment are: an emphasis on the cleavage, a prevention of wrinkling of the implant and an improvement in skin quality. In the operating room you will be placed in a sitting position (while still asleep) before the end of the breast augmentation operation in order to check whether the shape of the breast meets the highest standards when sitting or lying down. Finally, a bandage and a special support bra are applied.
The outpatient procedure lasts about 180 minutes. Immediately after the operation you will be continuously monitored in a so-called recovery room. You can drink something after the complete awakening and, if you tolerate it well, eat something. Before you leave the practice, appointments for check-ups will be made and the behavioural measures will be discussed with you in detail. You will receive a comprehensive written report and a telephone number where you can reach the surgeon 24 hours a day in an emergency.
Before, after and even during the operation you can watch movies or your favourite series with virtual reality glasses. This is not only entertaining, the distraction also demonstrably leads to less sensitivity to pain.
How can you prepare for hybrid breast enlargement?
- All your questions about possible complications and alternative treatments should be answered before surgery.
- Keep nicotine and alcohol consumption to a minimum.
- The intake of hormone-containing medication (pill) should be temporarily stopped.
- Blood-thinning medication (e.g. ASA, Thomapyrin®) must be discontinued ten days before the operation after consultation with your doctor.
- Stop taking vitamin preparations (A, E) and dietary supplements (e.g. omega-3 fatty acids, St. John's wort preparations) four weeks before the operation.
- Surgery limits the ability to travel by air. Do not plan any professional or private air travel during the four weeks following the operation.
- Take out follow-up insurance before an aesthetic operation.
- On the day of the operation, shower with a disinfectant soap (e.g. HiBiScrub® Plus, Octenisan® Wash Lotion, Prontoderm® Shower Gel).
- Your well-being and the result of the operation will be checked regularly.
- Make sure that your upper body is raised by 30 degrees during the first five days, including when you sleep. This ensures better decongestation and wound healing.
- During the first six weeks you should sleep on your back. This reduces the risk of the implants slipping.
- From the third postoperative day, you can shower in the CenterPlast Saarbrücken before the wound check.
- Wear the previously fitted support bras continuously for six weeks.
- Massage the scar several times a day for a few minutes from the third postoperative week. Use an oily cream such as Bepanthen® Ointment or Linola® Fat. Pay attention to circular, longitudinal and transverse movements of the scar. These measures help to create an inconspicuous scar.
- Avoid bending over, lifting heavy loads, swimming, sauna, sexual intercourse and sporting activities for four weeks. If swelling still exists, a longer period of rest may be advisable.
- Smoking prevents the transplanted fat cells from healing and increases the risk of inflammation and thrombosis. Avoid smoking tobacco and e-cigarettes for six weeks after the operation.
Hybrid breast augmentation is the ideal procedure for patients who wish to have at least two cup sizes enlarged in one operation. Approximately 300 to 400 millilitres of fatty tissue are needed to obtain the fat cells. This amount of adipose tissue cells can usually also be obtained in slim women on the abdomen, on the outside or inside of the thighs, buttocks or knees.
In the course of the consultation, we will first of all respond to your wishes for change. Among other things, the surgeon will want to know which cup size you would like. It is also important for us to know how satisfied you are with your breast shape and décolleté.
In order to recognize possible risks in time and to be able to prevent them better, we will ask you questions about preventive examinations, pregnancy, family planning, previous illnesses and allergies, occupation, medication and general surgical risks.
It is important to tell us whether you smoke or take dietary supplements, as these can have a major impact on your surgery.
Next, your breast will be accurately measured. This also includes small differences in the sides of the breast. Further important characteristics for the planning like the skin elasticity, a possible spinal column curvature or chest deformations are examined.
All patients are photographed for precise planning of the operation. On the basis of this thorough examination and a discussion of your goals, you will be shown various alternatives and all the associated risks and limitations. During the interview you will receive all the information you need to decide which treatment is right for you. It is very important to discuss your expectations openly with your surgeon. Often a poorly informed patient or surgeon is the cause of an unsatisfactory outcome, even if there are no complications during the operation.
The surgeon will discuss all details of the procedure with you, including the type of anesthesia used, the facility where the surgery will take place, the follow-up insurance, the breast enlargement preparations and the post-operative procedures. You will be given a transparent and comprehensible explanation of how the costs of breast augmentation are made up.
If you are unsure or do not feel fully informed, do not hesitate to ask your doctor questions. At the end of the consultation, we will gladly offer you a second consultation. It is not uncommon for patients to have questions after the consultation. It is very important to us that all your questions have been answered before the operation.
- With the own tissue the contours of the cleavage can be harmoniously and naturally adapted. Thus, round and softer implants can also be used. Anatomical (drop-shaped) implants are slightly firmer than round implants so that they retain their shape. Hybrid breast augmentation has the advantage that you get a natural shape and firmness.
- Implants are ready-made products. There is therefore no ideal fit that is individually tailored to the patient. However, the contours can be individually corrected by using the patient's own fat tissue.
- Especially implants with roughened (textured) surfaces are associated with the development of a breast implant associated large cell anaplastic lymphoma (BIA-ALCL). Since hybrid breast augmentation does not require anatomical implants, the risk of developing BIA-ALCL is much lower.
- Through the use of autologous tissue, the implant is better covered and the risk of wrinkling (the so-called rippling phenomenon) is reduced. The implant therefore does not have to be placed under the muscle to avoid wrinkling. The placement of implants under the pectoral muscle is accompanied by a more painful and protracted recovery phase after the operation.
- If the breast implants are inserted under the pectoral muscle, implant displacement is more frequent. In hybrid breast augmentation, the implant can be placed above the pectoral muscle. The risk of implant displacement is therefore lower with hybrid breast augmentation.
- The autologous fat treatment achieves an additional enlargement so that a smaller implant can be used.
- By using softer and smaller implants in conjunction with autologous fat treatment, the breast retains its natural shape, both when lying and standing.
- The transplanted autologous fat tissue also contains numerous stem cells. The autologous fat treatment therefore leads to an improvement of the skin's elasticity.
- The décolleté and the depression located between the breasts can be emphasized with a hybrid breast enlargement.
- Round implants are cheaper with all manufacturers of breast implants.
Treatment is associated with both opportunities and risks. When breast implants are used, there is always a risk of capsule contracture (capsular fibrosis). Although today's implants are well tolerated, a certain immunological reaction will inevitably occur after several years or decades. During the healing process, side differences may occur in relation to breast size and shape, as well as the position and size of scars. In general, breast implants involve the risk of wrinkling, displacement, rupture or the development of anaplastic large cell lymphoma (ALCL). However, these risks are lower with the use of smooth smaller implants for hybrid breast augmentation than with classical breast augmentation with anatomical textured implants without autologous tissue. During liposuction or fat transplantation, contour irregularities may occur. However, the risks are lower than with classical liposuction, e.g. for the removal of fat deposits on the hips. The transplanted fat tissue can die if the supply of nutrients and oxygen to the breast is insufficient. The risk that the fat tissue cells do not heal is increased, as are the general surgical risks (inflammation, thrombosis) for smokers. Since implants attenuate X-rays, the assessment of mammary gland tissue may be limited by mammography. Alternatively, the breast can be examined with ultrasound or magnetic resonance imaging.
The following remuneration components must be considered for hybrid breast augmentation:
- Value added tax of 19%.
- Remuneration for Plastic Surgery
- Nursing services required within the framework of the treatment
- Medical anaesthesia services
- Costs of the implant
- Consumables required during the above-mentioned procedure, e.g. for filtering and cleaning the own grease
- Compression garment including a changeover supply
- Consequential cost insurance
- The operation-related dressing changes on the occasion of wound inspections
- The operation-related long-term control examinations
- Permanent availability of the surgeon in the 2 weeks after the operation
- Medication for the treatment of nausea or pain in the first 2 weeks after surgery.
- Postoperative low molecular weight heparin for the prevention of thromboembolic diseases
- Medical thrombosis prophylaxis stockings
Many patients compare different offers before an operation. For a direct comparison, all expenses including aftercare must be taken into account. The training, experience, skills and scientific competence of a physician are more difficult for a layman to compare than the costs. Ask about the qualifications of the doctor you trust. The terms "cosmetic surgeon", "aesthetic surgeon" or "cosmetic surgeon" are not protected. The situation is different with the professional title "Plastic and Aesthetic Surgeon", these physicians have all completed an appropriate six-year training course. This is similar with ear, nose and throat specialists and oral and maxillofacial surgeons, who can acquire the additional qualification "plastic surgery" after two years of further training and are thus qualified for operations in the area of the head. The medical activity also includes research, for example in the context of a medical doctorate or habilitation. The ability to incorporate scientific findings into rational treatment decisions is strengthened by independent scientific work. The professional experience in a leading position strengthens the sense of responsibility and the competence to solve complex and difficult challenges. The costs of treatment are relevant for decision-making, but trust in the doctor should ultimately be decisive.
Unfortunately, it is not possible to give an exact price without an examination because, among other things, the scope of treatment and possible pre-existing conditions and/or pre-treatments cannot be taken into account. We can therefore only tell you the exact costs after an examination as part of the consultation. We will also be happy to advise you on financing options without obligation.
According to § 1 paragraph 1 no. 2 of the Heilmittelwerbegesetz, the comparative illustration of the success of treatment by before/after photographs may not be published on the Internet. Nevertheless, before/after images may be used to inform patients. We will therefore be happy to show you before/after images as part of a personal consultation and, of course, in compliance with data protection regulations, in order to show you the possibilities and limitations of cosmetic surgery.
Brazil has been a pioneer in aesthetic surgery for decades and is considered the cradle of cosmetic surgery.
Brazilian plastic surgeons, for example, have played a major role in shaping the techniques of breast surgery:
Ivo Pitanguy, Liacyr Ribeiro, João Carlos Sampaio Góes
Dr. Santos Stahl has already operated many hundreds of breast augmentations independently during her specialist training in Brazil with first-class surgeons. Later, Dr. Santos Stahl acquired the German and European specialist qualifications. In addition, Dr. Santos Stahl has expanded her spectrum and knowledge with the most influential plastic surgeons in Dallas, Oakland and Salt Lake City - thanks to a scholarship from Germany's largest association of plastic surgeons (VDÄPC).
In 2015, Dr. Stahl became senior physician and permanent representative of the medical director at the University Hospital of Tübingen. From 2016 to 2018, he moved to Lüdenscheid as clinic director. Over the years, Dr. Stahl has continued to refine his microsurgical techniques so that today he enjoys a reputation among experts as a particularly gentle and precise surgeon. Various scholarships have led him to outstanding cosmetic surgeons in Brazil, New York, Atlantla and Salt Lake City.
Medical decisions and recommendations must be made on the basis of proven efficacy. The scientific competence of a physician is important for assessing the significance of a scientific proof. An additional qualification as an investigator and experience in conducting clinical trials is advantageous for this. These requirements apply to Dr. Santos Stahl and PD Dr. Stahl.
We systematically examine and compare the appearance, well-being and satisfaction of our patients after surgery. This includes not only uniform photo documentation, but also the survey of patient satisfaction with breast shape and size. At the same time, we also systematically examine the possible influence of the procedure on the patient's perceived self-confidence and attractiveness. We encourage our patients to rate us on Jameda and Google. Many patients are willing to share their experience with other patients to help them make the right decision. During the consultation we are happy to put you in touch with these patients.