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Experts in Breast Augmentation

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Expert Opinion: Breast Augmentation

MD Holger Osthus MD Holger Osthus

With more than 20 years of experience in plastic surgery, I offer a wide range of cosmetic surgery for your well-being - from wrinkle treatment to lip enhancement to cosmetic surgery such as eyelid tightening, liposuction and breast augmentation - for a younger, fresher and more natural look.

In a personal consultation, I show you how we can achieve a natural improvement of your appearance together with gentle therapy procedures of cosmetic cosmetic surgery or plastic surgery.

German plastic and aesthetic clinics offer the full spectrum of services for women including breast augmenation.

The reasons for mammary gland increase can be different. Some women want to restore firmness and volume of boobs after breast feeding. Others want to correct asymmetry of mammary glands. Women with small boobs wish to acquire a normal size and décolleté line Prior to breast augmentation operation, a doctor and a patient discuss many questions during an individual consultation. First, the desired size of boobs and the size of implants are defined. All implants used in our clinic have gel filling. Note that German plastic surgery clinics use high-quality prostheses of reliable producers. Besides, a woman is given the Implant Data Form lifetime warranty after the surgery.

The next question concerns implant position. During breast augmentation in Germany, it can be placed either under a mammary gland, or under muscles. The variant depends on the desired result and initial breast size and form.

The final size of breats depends on implant volume. Besides, prosthesis differ by their form: drop-shaped and round ones. Drop-shaped implants make breast look more natural and get bigger on their lower part, and round implants have push-up effect which attracts other women more.

Together with implantation, breast augmentation with patient’s own fat can be made. This type of surgery is called lipofilling. Prior to the operation, fat is removed from certain body areas and is transferred to mammary glands. The same way, breast augmentation can be added with face lipofilling for rejuvenation.

Breast augmentation in Germany can be combined with lifting, which can be discussed on an individual consultation. If mammary glands are sagging, mastopexy is performed to reach maximal effect.

  • Procedure is performed under general anesthesia;
  • Duration of surgery in Germany 1-2,5 hours;
  • Patient can go home the next day after the operation;
  • Drainage tube removal in 3-4 days;
  • Stitches are removed in 7-10 days after breast augmentation;
  • Patient can get back to work within 6 weeks;
  • Control bra should be worn during recovery period.
Breast augmentation

Breast augmentation is done under general anesthesia. A woman lies on her back. Three types of surgical access can be used:

  • Submammary access. The cut is made under mammary gland, and scar stays closed by breast. This is the most widespread type of cut since it allows accessing breast easily, and the surgeon can control implant position freely.
  • Periareolary access. Breast augmentation with this method is pretty complicated because it allows using small implants only. However, experienced surgeons can perform operations so that implants are placed correctly and breast stays symmetric.
  • Subaxillary access. Cut is made in axillary crease. As a rule, endoscopic instruments are used for such operations. However, it’s hard to define the right implant position via axillary crease, German doctors can easily perform this procedure. The main advantage of this approach is absence of scars on breasts.

When getting access to the inside of breast, a surgeon installs implants in a certain place. It’s important to have the space for implant to correspond with implant sizes. In this case, breast augmentation will be symmetric and high-quality. After implant installation, every layer of soft tissues is stitched with certain sutures. Drainage is fixed, and cosmetic sutures are made.

Augmentation mammoplasty realizes a patient’s desire to enlarge the breast through the use of unique endoprostheses ‒ silicone implants. There are three mandatory conditions, without which no surgeon will operate on you:

  1. The patient must be over 18 years old.
  2. No allergy to silicone or other implant fillers.
  3. The absence of medical contraindications.

If none of the above points applies to you, then feel free to make an appointment with a plastic surgeon.

Preparation

The first stage of preparation for augmentation mammoplasty is the examination of your bust, the assessment of the condition of the skin, the shape and size of the chest. The next stage is a clinical and instrumental examination of your body. It must be remembered that any, even the simplest at first glance, surgical intervention is a huge physical and psychological stress for the patient. Therefore, lying down on the operating table, you must be absolutely confident in your health.

Most often, women are prescribed the following types of tests:

  • Complete blood count ‒ to rule out anemia or the presence of latent inflammation.
  • Biochemical blood test (total protein, bilirubin, urea, transaminases) ‒ low protein can cause poor wound healing, bilirubin and transaminases help evaluate liver function (this organ is responsible for the breakdown of medications administered during anesthesia), urea is an indicator of kidney function (these organs remove most of the decay products of medical drugs).
  • Coagulogram ‒ this analysis helps to evaluate the work of the blood coagulation system and the risk of bleeding during or after surgery.
  • Complete urinalysis ‒ it will show the doctor if there is a problem with the urinary system.
  • Chest X-ray or chest radiograph.
  • Blood grouping and determination of Rh factor (in case of massive bleeding).
  • Blood test for HIV, viral hepatitis and RV.
  • Breast ultrasound ‒ in this way the surgeon will assess the degree of glandular tissue development, confirm or rule out the presence of tumour mass.
  • If necessary, an examination by a family doctor (therapist), a gynecologist, or a mammologist.

If the woman has no health problems, the patient and the doctor proceed to the next stage ‒ the choice of implants. So that augmentation mammoplasty will turn you into a full-bosomed beauty, listen to the specialist’s opinion.

The last stage of the preparation is the choice of anesthesia, types of surgical access, the peculiarities of the postoperative period and the choice of compression underwear. Besides, 14 days before the operation, the woman should stop taking hormonal contraceptive drugs and anticoagulants. Quitting smoking or reducing the number of cigarettes smoked will reduce the risk of complications.

Types of Implants and Their Features

Silicone is considered to be the best endoprosthesis for breast augmentation. They are hypoallergenic, can be of various shapes and sizes, as natural as possible in appearance and by touch. Also, implants differ in the type of fillers:

  • With cohesive silicone gel, which can be of different density (soft ‒ “jelly consistency”, dense ‒ “marmalade consistency”). This gel does not have fluidity, which excludes the possibility of its leakage in case of minimum damage to the endoprosthesis.
  • With physiological solution ‒ implants with such a “filler” are cheaper, but they have a small shelf life and can form sulci and/ or tubercles on the breast. The advantage of this type of endoprosthesis is their complete biocompatibility.

The cost of implants depends on their shape, volume, filler and manufacturer. The maximum complete consultation on endoprostheses must be provided by your attending surgeon.

More information about the types of endoprostheses, their pros and cons, see the article “Breast implants”.

Performing Augmentation Mammoplasty

The duration of breast augmentation surgery can be up to 3 hours or more. The intervention is performed under general anesthesia using mechanical ventilation. In some cases, mammoplasty is combined with mastopexy (breast lift).

The first thing the specialist and the patient should do is to choose the place of the surgical approach ‒ the area where the incision will be made, and later an inconspicuous and thin scar will remain there. Mammoplasty for breast augmentation can be performed through 3 different approaches:

  • Submammary ‒ the scalpel cuts through the skin under the gland. The safest way to make an incision, but it has a drawback ‒ if the breast is small, the scar may be noticeable.
  • Periareolar ‒ along the lower edge of the nipple areola. The advantage of this incision is the absence of a visible scar, but damage to the glandular tissue during the implant installation process can cause problems during lactation and the occurrence of inflammatory complications.
  • Axillary ‒ the incision is made in the axilla. This method requires a highly skillful surgeon, as it is fraught with damage to the nerves and large vessels, but the absence of scars and damage to the glands makes it quite popular among young patients.
  • During single-stage abdominoplasty and augmentation mammoplasty, access is provided through an incision in the lower abdomen. This incision is called transabdominal.

The essence of augmentation mammoplasty is quite simple ‒ a pocket is formed in the space behind the mammary gland where the chosen endoprosthesis is inserted. Depending on the patient’s wishes, the type of implant and the state of the breast, implants can be inserted in different ways:

  • Under the breast tissue ‒ subglandularly.
  • Subfascially ‒ the surgeon separates the fascia from the myofibrils of the pectoralis major muscle and inserts the endoprosthesis into the resulting pocket.
  • Submuscularly ‒ the implant is fixed under the pectoralis major muscle.
  • Some part of the implant is under the gland, and the rest of it is under the muscle.

The next stage is the installation of drainage and wound closure. The final stage is the application of a bandage or dressing compression underwear, which is done in the operating room.

Rehabilitation Features

Pain after the surgery is not intense. If it causes discomfort, non-narcotic analgesics are prescribed to the patient. By the end of the second day, with the normal postoperative period, the drains are removed and the woman is discharged from the hospital.

Suturing material is absorbed within 10-12 days, and if non-absorbable sutures were used, they are removed a week after the surgery. The compulsory condition of the rehabilitation period is the round-the-clock wearing of compression underwear, which prevents the development of edema, hemorrhages and supports the gland in a physiological position. Compression underwear should be used for at least 4-6 weeks.

In the same period, the woman is forbidden to raise her arms above her shoulders, to go to the gym, bath, sauna, lift things heavier than 2 kg. Breast insolation is also prohibited. The effectiveness of augmentation mammoplasty can be assessed no earlier than 12 weeks after the surgery. Finally, the implant “takes its place” only 8-12 months after the surgery.

Contraindications and Complications

Contraindications for augmentation mammoplasty are the following:

  • Acute infectious diseases.
  • Chronic pathology in the acute stage.
  • New growths in the mammary gland, and malignant processes in other organs.
  • Pathology of blood coagulation system.
  • Fibrous cyst that progresses.
  • Ulcers and other inflammatory processes in the skin in the area of ​​the operation.
  • Lack of tissue coverage.
  • Allergy to implant components.

In the postoperative period in rare cases, certain complications can occur. They may be associated with:

  • inaccuracies during augmentation mammoplasty surgery: hemorrhages, too large edema, asymmetry of implants, seroma;
  • anesthesia: nausea, vomiting, dizziness, hoarseness, cough;
  • the implant: asymmetry of the glands, leakage of the contents of the endoprosthesis, development of capsular contracture.

Aesthetic surgery on the breast is performed with the help of the method of implant insertion through various traditional approaches, mainly through an incision in the fold under the mammary gland (submammary access) or an incision around the areola (periareolar access). But the most aesthetic and gentle method is endoscopic breast augmentation through the axillary region.

The approach to the mammary gland from the axillary region (the axilla) is the most aesthetic one, since the scar which forms afterwards is completely hidden in the natural folds of the skin of the axillary cavity, unlike approaches from other areas. However, most plastic surgeons avoided performing the operation in this way.

This is because the incision in the axillary region is located at a considerable distance from the place of the intended location of the implant, which is inserted mainly under the pectoralis major muscle. The formation of a bed for it, accompanied by the muscle dissection is a rather traumatic manipulation. It represents a certain danger due to the high risk of damage to the large vessels and nerve branches and affects the final result of the surgery.

Most of the difficulties were overcome when the endoscopic equipment appeared and endoscopic breast plastic surgery through the axillary access was introduced. The endoscope is a fiber optic light guide, at the end of which there is a powerful light bulb for illumination and a miniature video camera. The enlarged image of the operative area is transferred to the screen.

The operation with the help of special tools is performed completely under constant visual control, which makes it possible to manipulate even in remote and hard-to-reach areas. In addition, the endoscopic creation of the “pocket” for inserting the implant reduces contact with the tissues of the mammary gland, avoiding damage to the milk ducts, large vessels and small nerve branches, and stopping even minor bleeding from small vessels by coagulating them.

Thus, the advantages of endoscopic breast augmentation are as follows:

  • The operation is performed through a small incision in the axillary region, due to which the postoperative scar, barely noticeable in the armpit, becomes almost invisible in 4-6 months.
  • Breast tissue is not injured during the surgery. It is very important for young girls, especially those who have not given birth, since breastfeeding is still possible. In addition, the risk of loss of skin sensitivity is minimal.
  • Postoperative pain is insignificant.
  • It is possible to position the fold under the mammary gland at the required level. Thanks to this, it is possible to give the breast an aesthetically beautiful shape.
  • Due to the visual control over the manipulation with special tools, the traumatic effect is significantly reduced, as well as the risk of complications and the postoperative period.

Indications and Limitations in the Use of Endoscopy

Endoscopic breast augmentation is indicated in the following cases:

  • The small size of the mammary glands with an ill-defined submammary (under the glands) fold or a small diameter of the areola, which makes it undesirable or even impossible to use other techniques.
  • Loss of shape and reduction in breast size as a result of injuries, previous operations for any reason or after breastfeeding.
  • Underdeveloped (juvenile) breast.

Unfortunately, breast implant surgery performed with the assistance of the endoscope through the axillary access is not always possible. It is limited in cases of:

  • Asymmetry in the location of the mammary glands, which cannot be corrected with endoscopic plastic surgery.
  • Significant difference in the level of submammary folds.
  • The presence of ptosis (sagging) or a tendency to mammary ptosis.
  • Excessive low elasticity of tissues and relaxed skin covering the glands.
  • Unilateral or bilateral symptoms of the tubular breast ‒ a condition where the mammary glands are located on the pectoral muscles not in the form of hemispheres, but have the shape of tubes.

The remaining contraindications to the endoscopic method are the same as to mammoplasty with the use of other techniques.

Endoscopic breast augmentation in the absence of contraindications is the most optimal, modern and promising method for breast plasty.

Some patients doubt whether they should increase boob size. They don’t know whether presence of silicone material will create the feeling of foreign object or whether the material it’s made of will be rejected by body. Other women are afraid that further complications are possible (for instance, cover fibrosis), so the time for implantation will be postponed several times in a row.

In this case, breast augmentation with patient’s own fat (autogenous material) is a great alternative variant. If a person has excess adipose tissues on legs, hips, buttons or belly, surgical invasion will be combined with liposuction. Later on, fat is cleaned, prepared and injected in certain breast areas.

If a patient needs additional information about breast augmentation with liposuction, she should consult with a doctor and inform about her demands and needs. In some cases, several transplantations of her own fat are required to reach the desired results.

The same applies to two other operations: about liposuction and breast augmentation with filteres autogenic fat. When breast is increased with patient’s own fat by adipose tissue transplantation, breast can be increased by one size or one cup.

Only your doctor can consult you and decide whether such form will comply with patient’s demands. We readily combine this method with many others, even facial rejuvenation to correct its form. To perform this operation, fat obtained during liposuction is processed and used for facial tissue.

Together with breast augmentation, our surgeons can perform breast lifting.

Breast augmentation surgery with liposuction takes 2-3 hours depending on patient’s state and the combinations of surgical invasions. It’s performed under general anesthesia. During the first bonding, a control bra is put on that should be worn during 4 weeks.

After breast augmentation surgery with liposuction, the surface of wound is regularly controlled. During 4 weeks after the operation, a patient should obtain from physical loads and sports. Control bra should be worn around the clock during this period. A patient can shower at the same day after the operation, while bathing is allowed only after full recovery. After the surgery, small scars up to 5 mm can stay.

Period of hospitalization in Germany takes 24 hours. During this period, bandaging and drainage control are performed. To decrease pain, anesthetics are injected intravenously. After breast augmentation, a patient should not perform physical exercises during 6 weeks. Control bra is worn within this period, as well. Some women are also recommended to wear a compressive belt.

Showering is allowed within a few days after breast augmentation, but bathing and swimming are prohibited till final wound recovery. During at least 6 months, a patient should avoid being exposed to direct sun rays.

First results after breast augmentation are noticeable when swelling disappears within 6-7 weeks after the surgery. Final effect is achieved within half a year when patient’s body adapts to the implant, and all recovery processes are finished.

German plastic surgery clinics offer special ointments for faster recovery process of postsurgical wounds – they’re recommended individually. Leave your requests and call, if you need more information. We will discuss individual operation variants and perform efficient breast augmentation for you.

1. Breastfeeding problems due to breast implants

The desire for breast augmentation often arises in women aged 20-30 years. Many still have a desire to have children at this time and are afraid that they can no longer breastfeed with implants. These fears are largely unfounded, as the mammary gland remains unaffected in a submammary approach via the cervical fold. The prerequisite for this, of course, is a clean operation performed by an experienced specialist. In comparison, access via the nipple is a high risk of breast injury. Therefore, we advise against this technique, especially if there is still a desire for children.

2. Breast implants look artificial and fake

Boulevard media often show the artificial-looking female neckline, fueling the myth that implants always look artificial. Silicone implant manufacturers offer a wide variety of shapes and sizes for implants. How naturally or artificially the breast works in the end, the patient decides herself. There are actually many women who deliberately opt for an artificial-looking variant. The choice of the size of the implant is therefore absolutely crucial! Here it is very important that your doctor takes a lot of time for the consultation and discusses the different forms with you. 3D images are strongly discouraged as they are very nice but mostly unrealistic. The best way to illustrate the "end result" is with a sports bra and inserted implants of the desired size. Then you can pull a tight white T-shirt over it and know how it will be "behind".

3. Saline injection is a temporary alternative to breast augmentation

Initially, saline injection was used to define the desired implant size. Now it has evolved into a treatment for temporary breast augmentation. A trend that has spilled from the USA to Germany. Injection of saline is unsuitable for defining the desired implant size and temporary breast augmentation. First, the breast swells by the injection of saline uncontrolled and yet the body begins after 24 hours to break down the saline solution. Second, tissue is extremely stretched, collagen and elastin fibers may be unnecessarily strained, and there is a risk of infection from intraglandular injection. So you set the tautness of your breast tissue for a short-term volume build-up on the game.

4. Aggravated cancer screening through implants

It sounds plausible that tumors are harder to find in a breast with implants. Some studies also confirm that the interpretation of conventional mammography is limited. The ultrasound examination, as well as the MRI examination offer here a meaningful alternative, which in combination provide even better results. On the other hand, studies have also shown that easier palpation in enlarged breasts is possible when the implant is used as an abutment. Tumor size at first diagnosis was also under investigation with augmented breasts on average smaller than in the non-augmented breast.

5. Breast implants can burst and leak

In saline-filled implants and silicone implants of the older generations, over the years, leakage and loss of substance have occurred, which has a visually very unpleasant effect. The new generation of silicone-filled breast implants is extremely safe as it consists of a highly cohesive (cross-linked) gel in a highly resistant sheath and yet feels completely natural. Therefore, the new breast implants can not leak anymore and certainly will not burst. It is important to make sure that your specialist in plastic surgery uses one of the brand implants. We recommend the brands Eurosilicon, Mentor and Allergan.

6. Breast enlargement causes severe pain

Depending on the initial findings as well as the size and position of the implants, the pain experienced by patients is very different. Individual pain perception also plays a major role. Generally, the first days can be stressful. Your body heals and you can feel a little weaker. Pain may occur and the movement is slightly restricted. With plenty of rest and a good pain therapy, you can make the first few days as pleasant as possible. We strongly advise against breast augmentation under time pressure. In the first two weeks it is also important that you refrain from heavy carrying or lifting as well as intense sports.

7. Implants must be changed after 10 years at the latest

A change of implants is only necessary if complications occur. The most common complication is capsular fibrosis, where the body around the implant forms a "tissue capsule" that can harden and cause pain. As soon as the capsular contracture disturbs the patient and restricts her, an implant change is made. Some patients leave the implants in the body despite capsular contracture because they do not find them disturbing. There is no danger of capsular contracture causing illness or other physical damage.

8. Breast implants can be "felt"

Some women with enlarged breasts report that they can feel their implants as they touch them. That's unlikely. But with very large implants, it can happen that you can feel them. Especially with very large and shaping implants increases the likelihood that the implant, especially under the help of both hands, can be felt. A rather small volume can significantly reduce the likelihood that an implant can be felt. New generation implants have already been developed and have a softer implant surface, which makes the implant even better integrated. Since in Europe mainly gel-filled implants are used, the unnatural feel of saline-filled implants is becoming less important.

9. Lower sensitivity after breast augmentation

The impairment of sensitivity depends on the surgical technique. Access through the breast crease under the breast is very rarely associated with decreased sensitivity just above the portal. In the case of the access through the nipple this can show later a reduced sensitivity. The period of time during which the decreased sensitivity is dependent on many factors. Therefore, we prefer to speak of "several months". As with many unwanted side effects of breast augmentation, there is also a relationship with the implant size chosen. The greater the size of the implant, the more tissue stress, and the lower the sensitivity.

10. Inappropriate prices for breast augmentation in Germany

The cost of course play a big role, but you should not choose your plastic surgery specialist for the cheapest offer. A well-founded education of the doctor, his competence and experience as well as the quality of the used implants decide on the price offered by the specialist. Always make sure that the quality of the doctor (education, awards, experience) and the quality of the implants (branded implants only) are correct.

Author: MD Holger Osthus on Facebook, Google+, Instagram, Xing, Jameda.

2018-09-27 We will help you to choose the TOP specialist for Breast augmentation GermanMedicalGroup + 49 (7221) 39-65-785 Flugstrasse 8a 76532 Baden-Baden Germany We will help you to choose the TOP specialist for Breast augmentation We will help you to choose the TOP specialist for Breast augmentation We will help you to choose the TOP specialist for Breast augmentation
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