Breast enhancement

Breast augmentation using silicone breast implants is an operation intended for women who want larger breasts. Careful selection of a suitable breast implant, correct choice of surgical procedure and use of optimal operative technique can lead to you achieving long-term and fully satisfactory results with the minimum of possible complications.

Who is a suitable candidate for breast enlargement?

Any woman who has a stabilised breast size and whose breast tissue has a clean bill of health is a suitable candidate for breast augmentation. This means that it is not appropriate to perform the procedure on young women with growing breasts or women who are breastfeeding, or those who have recently finished breastfeeding. If the patient is planning to get pregnant within the next two years, it would also be sensible to defer the operation. Other unsuitable candidates include women with appreciably drooping breasts. The results of simple breast enhancement are not usually aesthetically acceptable in such cases or are only satisfactory for a short period of time. In the case of these women, it is necessary to use combined breast enlargement techniques with simultaneous or two-stage breast lift. Unsuitable candidates also paradoxically include very slim women with the minimum of their own mammary glands, for whom the breast implant would only be covered by a small layer of soft tissue, the result of which would be a conspicuously visible outline of the implant under the skin with all of the negative aesthetic consequences that go with this. The breast augmentation should also not be performed on women who have an ongoing disease of the mammary glands or those who have a high risk of occurrence of such a disease.

How does consultation take place?

The overall state of health and any possible contraindications to the procedure are ascertained in terms of consultation. The patient’s ideas about the size and shape of the breasts after the operation are discussed in detail. Careful examination is followed by precise measuring with selection of the ideal shape and size of the breast implant. Decision is made as to which type of breast implant will be used (anatomical or round), where the implant will be inserted (under the muscle or under the gland) and agreement is reached as to which point of access the implant will be inserted via (groove under the breast, incision around the areola or in the armpit). The patient is always informed in detail of the advantages and disadvantages of individual surgical procedures and the possible complications, which may relate to breast augmentation. It is always necessary to inform the doctor of all medicines which the patient uses. This especially relates to medicines which affect coagulation.

Essential pre-operative examination

Apart from standard pre-operative examination, which is performed by a general practitioner approximately seven to ten days before the procedure, it is also necessary to undergo mammalogical examination, which consists in obtaining anamnesis, where any possible risk factors with regards to disease of the mammary glands is ascertained. This is followed by visual and tactile physical examination, ultrasound examination of the breasts and examination using a mammograph in indicated cases.

Hospitalisation

Breast enhancement is performed under general anaesthesia whilst the patient is hospitalised, the length of which does not normally exceed two days after the operation. Photo documentation is created before the operation and the operative plan is marked out on the patient’s body. Prevention of thromboembolic diseases by injection of preparations and equipping the patient with elastic tights goes without saying. The actual operation takes about one hour. After the procedure, the patient spends several hours in a recovery room and after stabilisation, is moved to a standard ward. The drains are removed on the first day after the operation if introduced during the procedure, and the patient receives an elastic bra. If there are no complications and the patient feels subjectively well, she may be released.

Post-operative care

Post-operative pain is not usually great and reacts well to regular analgesics. In general it applies that the larger the breast implant, the more intensive the pain usually is. Implantation under the muscle is also usually more painful than under the gland. The intensity swiftly subsides after the operation and after two to three days the patient feels rather pressure than pain. Too much physical activity that places a burden on the upper limbs is not recommended in the period immediately after the breast enlargement. It is not advisable to frequently lift the arms above shoulder level. For this reason, it is better to select clothing for hospitalisation which does not need to be pulled over the head. Showering is possible after two to three days. An elastic bra is worn for four to six weeks. Subsidence of swelling and forming of the breasts after the operation takes a few weeks or months. The condition of the breasts is already fully stabilised after three months in the majority of cases and after this, restrictions are no longer necessary. Care for the scars constitutes an important part of the post-operative regime. They are lubricated and massaged, and silicone patches may be applied to ensure quicker maturation. After breast enhancement, the patient should regularly visit her surgeon for check-ups, even if she is fully satisfied with the result of the operation and there are no complications whatsoever.

Complications

Complications are relatively rare in terms of breast augmentation and affect only a few percent of patients. Early post-operative complications include hematomas or accumulation of blood in the implant bed. Small amounts of blood are no problem – they are quickly and spontaneously absorbed and no surgical intervention is required. In the case of larger hematomas, the wound must be checked, the blood removed and the source of the bleeding treated if necessary. From the list of later complications, we must mention seromas – accumulation of bodily fluid in the implant bed. Similarly to hematomas, small amounts are quickly absorbed. In the event of a larger seroma, when spontaneous absorption cannot be expected over a short period of time, it is advisable to remove the seroma either by means of suction or surgically with a view to the risk of dislocation of the implant, or rotation of the (anatomical) implant. The long-term presence of a seroma also decreases the likelihood of correct healing of the breast implant into its bed and on the other hand, increases the risk of the creation of a capsular contracture. A capsular contracture is heightened scarring around the implant. It could cause the breasts to harden and become painful. In extreme cases, this could even lead to significant deformation of the breast implant or the whole breast. Correction is mostly only possible by means of surgery. Other possible complications could include changes in sensitivity of the breasts after the operation. In the vast majority of cases, these changes are temporary and fully subside over the course of a few weeks or months. We come across dislocation of the breast implant relatively rarely, when the implant could drop or move upwards. Correction is mostly only possibly by means of surgery. Bursting or rupturing of the implant is a rare complication. This could even exhibit itself several years after the operation, for example in swelling, pain of reddening of the breast. Ruptures are more frequent in the case of patients with a capsular contracture. Correction is only possibly by means of replacement of the implant. Nowadays, most breast implant manufacturers provide various types of warranties, so if the implant bursts, they provide a replacement breast implant free of charge. Complications in terms of healing could include the creation of hypertrophic scars (wider rigid scars that protrude above the level of the skin).