AIM OF BREAST AUGMENTATION (BREAST AUGMENTATION)
The aim of breast augmentation is a naturally shaped and enlarged breast that aesthetically suits your silhouette and physique and gives you an attractive cleavage. The operation is based on the use of state-of-the-art breast implants. The selection of suitable and optimally shaped implants is a key success factor for an optimal result.
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SILICONE BREAST IMPLANTS
Developments in recent decades have resulted in a generation of silicone breast implants that are characterised by very good compatibility, secure dimensional stability, natural shape, unlimited durability and good anchoring in the tissue thanks to roughened surfaces. We use products from the largest German manufacturer POLYTECH® (Made in Germany) to offer you the greatest safety, but we also use implants from other highly respected manufacturers if they promise a better result for our patients.
THE SHAPE OF THE IMPLANTS - ANATOMICAL OR ROUND
Basically, the implants differ in their cross-sectional shape: either an implant has the shape of a half circle (round implants) or a teardrop shape (anatomical implants), i.e. it is modelled on the normal "young breast shape" of a woman. While round implants tend to emphasise the cleavage, anatomically shaped implants give the breast a more natural form. Nevertheless, the use of a round implant can be advantageous for certain initial shapes. It should always be borne in mind that the patient's own breast tissue sags over time and can migrate downwards over the implant. This changes the shape of the enlarged breast over the years. We can only decide together whether an anatomically shaped or round implant is the better choice for you when we analyse your breasts and try out different implants.
THE SIZE OF THE IMPLANT
People often only talk about the volume or filling quantity of the implant because they assume that this alone determines the breast size and shape. This is wrong for two reasons: Firstly, every woman has a different amount of breast tissue, so that a 320ml implant, for example, can result in completely different sizes and shapes. Secondly, every woman has a different breast shape. However, the contact surface of the implant on the rib cage (the so-called base) is defined by the shape and size of the rib cage. If a woman has a very large contact surface, for example, 320ml implants will naturally appear much smaller than with a smaller contact surface. The decisive factors for breast augmentation are the patient's own breast tissue and the measured contact surface of the implant on the rib cage. Only then does the desired cup size come into play and the volume of the implant can be determined.
POSITION OF THE IMPLANT: ABOVE OR BELOW THE MUSCLE?
Breast implants are placed either between the pectoral muscle (pectoralis major) and the mammary gland (epipectoral position), or below the muscle (subpectoral position). Both implant positions have advantages and disadvantages: placement under the pectoral muscle leads to good coverage of the implant by the patient's own tissue, making the implant less visible and, above all, less palpable. This position is particularly suitable for small breasts and is favoured by most women.
The position between the pectoral muscle and the mammary gland (epipectoral position) is more commonly used for larger breasts, as the implant is covered by more of the patient's own tissue. In most cases, a position under the muscle is chosen.
THE SPECIAL TECHNIQUE FOR BREAST AUGMENTATION: "BIPLANE DISSECTION"
During my time as a senior consultant at Munich University Hospital, we performed many augmentations using a special technique in which the breast shape can be additionally modelled with the implant already in place. This unique technique, also known as "biplane dissection breast augmentation", enables optimal results to be achieved. In this breast augmentation, the mammary gland is lifted away from the muscle, but the implant is still placed underneath the muscle. This creates two separate layers, enabling better shaping of the breast.
THE APPROACH: UNDERBUST CREASE, NIPPLE OR ARMPIT
The breast implant is placed in a cavity prepared by the plastic surgeon, regardless of whether it is above or below the muscle. The surgical access (incision) can be made in three ways - through the underbust fold, through the nipple or through the armpit. Here too, all techniques have advantages and disadvantages:
- If the incision is made through the armpit, a scar will only appear in the armpit itself, which may be visible when wearing summer dresses, waving, etc. If the implant needs to be changed or removed later, this approach is not ideal because an additional incision under the breast is then required.
- An approach via the nipple results in virtually no visible scars. However, the mammary gland must be severed. This generally has no long-term disadvantages, but a reduction in sensation in the nipple may be more common with this technique. Many women also have concerns as to whether breastfeeding is possible at a later date without problems if the mammary gland has previously been cut. Scientific studies show that breastfeeding is almost never impaired, but many patients still prefer access via the underbust crease.
- The standard approach via the underbust crease results in a 4-5 cm long scar on the side of the crease under the breast. Although this is recognisable when undressed in the supine position, it is invisible in everyday life. The mammary gland remains intact and the implant cavity can be created under visualisation.
Ultimately, the choice of technique is an individual decision that should be discussed in detail.
BREAST IMPLANTS WITH SALINE FILLING
Although they are widely used in the USA, saline implants have never been widely used in breast augmentation surgery in Europe. They consist of a stable silicone shell that is inserted empty into the previously created implant cavity and then filled with saline solution through a fine tube. Unfortunately, these implants lose their filling over the years and this is absorbed by the body. Many patients are also bothered by the less dimensionally stable filling (it is water) and the associated feeling. This is why silicone implants have become established in Europe.
