Breast augmentation with implants
Breast augmentation with B-Lite implants
Breast augmentation with autologous fat
Hybrid Breast Augmentation
Breast reduction
Breast lift
Breast lift with implants
Implant change
En-bloc capsulectomy in BII and BIA-ALCL
Nipple correction
Breast malformations
BREAST AUGMENTATION
WITH IMPLANTS
Based on the experience that we have been able to gain in large breast surgery centers, we know and are familiar with the various reasons that lead women to decide to have their breasts operated on. These are just as diverse as the women who choose those procedures.
Patients often feel that their natural breasts are too small for their silhouette, or they want an implant after pregnancy or breastfeeding to fill the sagging breasts with volume again.
The most commonly used method worldwide, and one of the most requested surgeries overall, is breast augmentation with silicone implants. Statistics from the International World Association of Plastic Surgeons state that in 2018 more than 1.8 million women worldwide underwent this procedure.
The "ideal" breast is based on the balance of volume, natural shape and symmetry that is individually tailored to the body.
When planning a breast augmentation, the respective anatomical starting position, the width of the chest and the condition of the skin, mammary glands and connective tissue are decisive and are therefore analyzed in detail. The selection, shape and position of the implant are further aspects that must be determined individually and worked out together in order to achieve an optimal result.
Our advice on breast augmentation begins with us using a special simulation set in front of the mirror to show you exactly how the planned change in the breast will affect your own body.
Since breast implant surgery is a complex topic, we would like to answer the common questions about surgical breast augmentation at this point:
Implants
In recent years, there have been tremendous advances in the technological development of breast implants. Today, implants are embedded in a shell of up to ten layers, each with different surfaces. The filling material consists of cohesive silicone gel and, due to strong cross-linking, has a very stable leakage security. Silicone is a synthetic polymer and extremely well tolerated in the human body. In medical applications, access points, catheter systems, cases for pacemakers, artificial heart valves and parts of artificial joints are therefore predominantly made of silicone. Mainly because there are almost no allergies to this group of substances. During the past 45 years, many international studies have classified medical silicone as a very safe material.
The geometric shape of the implants makes the main difference.
An implant either corresponds to a semicircle (round shape) or has a teardrop shape that mimics the natural shape of the breast (anatomical implants). Each implant shape has advantages and disadvantages.
In Europe women tend to prefer anatomical implants, in the USA and South America round shapes are preferred. A round implant emphasizes the décolleté more and creates a full volume. An anatomical implant, on the other hand, more closely mimics the natural shape of the breast. In the case of small breasts in particular, anatomical implants create more natural results and the change may be more discreet. However, possible, albeit very rare, rotations of the implant are disadvantageous. These, in turn, do not pose a problem with the round implants.
Other parameters:
Implant surface, projection and position of the implant
Projection describes how much volume of the implant is pointing horizontally forward from the chest. That means: For the same volume there are different implant profiles depending on the height of the implant base:
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Low volume implants are wide and flat implants with low projection
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High profile breast implants are called moderate or high profile implants. They are correspondingly narrower at the base and offer higher projection. This gives the breasts more volume, which is ideal for women with narrow breasts
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Breast implants with an extra high profile (Extra High Profile) are almost spherical, they give significantly more volume and strongly emphasize the round appearance.
This geometric consideration is very important because the filling volume of an implant is often discussed in comparison, or patients come to the practice with a specific volume idea. But this approach is misleading because it ignores existing breast size and chest shape. A patient with a wider thorax automatically needs a wider implant for a beautiful breast, i.e. the contact surface of the implant on the thorax (the implant base) is larger. Accordingly, in this woman, a 350mL implant would have a significantly smaller projection than a 350mL implant with a smaller base. Because the selection of the implant depends on the existing breast tissue and is based on the existing bearing surface on the chest. Based on these parameters, the desired projection can be worked out and the final target volume of your desired implant can be determined together.
The surface of the implants can be either smooth or textured to varying degrees. Smooth implants move more because they are less attached to the surrounding tissue. They are softer and have a lower risk of wrinkling but a higher risk of capsular contracture when placed over the muscle. In order to reduce the risk of capsular contracture, manufacturers have started roughening the surfaces of their implants. This achieves tighter integration into the tissue and allows a more delicate capsule to form around the implant. With anatomical implants, this surface finish helps reduce the risk of implant rotation. However, visible wrinkling is increased with anatomical implants.
The topic of implant coating is currently the subject of lively discussion among experts and is also the subject of current research.
Finally, the surgical access route and the position of the implant in the breast differ
"Above or below the pectoral muscle?". Similar to the geometry of the implants, this question cannot always be answered in general, but must be decided individually.
The implant should be placed under the large pectoral muscle (pectoralis major muscle, so-called subpectoral position), particularly in slim women with natural, small breasts. This ensures good soft tissue coverage of the implant in the visible décolleté area, which at the same time becomes less visible and less noticeable. However, people who regularly do fitness, for example, occasionally observe a phenomenon of tension, which manifests itself as annoying hopping of the breasts and occurs during exercises that tighten the pectoral muscle (so-called "jumping breast").
For larger natural breasts, which have a higher amount of autologous tissue, the position above the muscle and below the mammary gland may be a better approach (so-called epipectoral position).
A sensible combination of both methods is the so-called "dual plane" augmentation, which has recently become increasingly popular in our professional practice. This method of application is complicated and requires many years of experience in breast surgery. In this case, the lower part of the mammary gland is separated from the pectoral muscle, but the implant is still placed under the muscle. This allows the mammary gland to slide better over the implant and the two separate layers of tissue allow your breast to be shaped in even more detail.
In order to insert the implant into the breast, an implant pocket is formed. Regardless of whether this is above or below the muscle, a surgical approach must be determined. The three most commonly used methods have their respective advantages and disadvantages, which are briefly described below:
With the most commonly used standard access via the lateral inframammary fold, a scar of approx. 4-5 cm is created under the breast. When the upper body is upright, it remains invisible and can only be seen when lying unclothed in a supine or lateral position. The advantage of this method is that the mammary gland usually remains intact. This is very important for maintaining the ability to breastfeed. Not least for this reason, this form of access is used most frequently.
Inserting an implant through a small incision in the areola area leaves a scar that is barely visible. However, in order to get the implant under the mammary gland, it is necessary to cut through the mammary gland. This leads to a reduction in sensation in the nipple and may affect the ability to breastfeed. Today, this type of access is only used in rare cases.
Finally, a silicone implant can also be inserted via the armpit, the scar is also very inconspicuous. However, if the implant has to be changed or removed, an additional incision in the submammary fold is unavoidable.
That was quite a lot of information at once. But that is exactly the claim of JJPS Berlin: Comprehensive information at eye level. As part of a personal conversation during our consultation, we will answer further questions and work with you to determine the perfect implant for you and the most suitable implant position.
Preparation
During our consultation, we take the time to work with you to determine the right implant, the location and the access route for you. In this context, we will also inform you in detail about the after-treatment and possible risks. About a week before your planned surgery date, there will be a detailed and final explanation and any necessary preliminary examinations will take place. On the day of the operation, we draw the relevant operation plan together again while standing. The procedure itself takes place under general anesthesia by our experienced anesthetist, whom you will of course also get to know. He is with you all the time and monitors you throughout the operation. Then he makes sure that you don't feel any pain. The operation itself takes about 60-90 minutes during which you sleep deeply.
We put on a compression bra while we are still in the operating room, so that after a few hours of regeneration in our patient room, you can go home if you are feeling well and fit. Of course, the surgeon will still be available to you by phone at any time. After that, you should rest completely physically for about a week, only then can light office work or similar work be resumed. However, the special compression bra should be worn around the clock for a period of six weeks. You should also refrain from sports for just as long. Showering using a special shower plaster is possible immediately after the operation.
All follow-up examinations are included with JJPS. We'll see you the day after the operation, again about 5 days after the operation, and 14 days after the operation for the removal of the sutures. We recommend arranging a check-up appointment after around six weeks and after around six months for a preliminary or final check of the operation result.
Before the procedure, your gynecologist should perform an ultrasound or a mammography of your breasts (depending on your age and risk profile) to be on the safe side. The pain of a breast augmentation can be moderated well with normal painkillers; However, especially if the implant is under the pectoral muscle, it can feel like severe muscle soreness for a few days.
Technique
As already described in the overview, the implant technology has developed very dynamically and has been significantly refined. We have mastered all relevant techniques and will find the "tailor made" solution for you that suits your wishes and ideas. It often makes sense to use a combination of different techniques to achieve optimal results (hybrid augmentation/augmentation mastopexy/asymmetry correction). We will discuss the details with you during our consultation hours.
Costs & Financing
A breast augmentation starts from 4,800 EUR including the implant costs. Financing is possible on request through one of our financing partners.
External follow-up insurance should be taken out for all aesthetic operations. It protects you in the event of rare complications and the associated follow-up costs.
Risks
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In the hands of board-certified specialists in plastic and aesthetic surgery with proven experience in breast surgery, breast augmentation with implants is a low-risk procedure that is performed thousands of times a day in clinics around the world. General risks such as infections, secondary bleeding, bruising, etc. are relatively rare and can usually be easily remedied with surgery.
However, there are some issues that need to be discussed between the doctor and the patient when it comes to implants: The most important eventuality is the issue of capsular fibrosis. The organism recognizes the implant and surrounds it with a fine connective tissue capsule. Sometimes this capsule can be configured thicker and harder, deforming the implant, hardening the breast or even causing pain. This often only happens after many years, but sometimes it can occur months after the operation and may then make it necessary to change the implant. It is important to understand that an implant will not last indefinitely, especially in younger women. Similar to a dental crown, no implant lasts a lifetime. An implant change, about every 10-20 years, must therefore be expected.
Another topic is the so-called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), an extremely rare type of lymphoma. So far, around 900 women worldwide have been registered to be affected. BIA-ALCL is currently being intensively researched. The first case series on this was published by Dr. Julian Kricheldorff from JJPS in the renowned Deutsches Ärzteblatt (main journal of the German Medical Society). He has dealt extensively with BIA-ALCL and also Breast Implant Illess (BII) and can give you - scientifically sound - comprehensive information on breast implants.
Aftercare
You can take off the compression bra six weeks after the surgery and no longer have to worry about the implant slipping. Now you can increase physical activities again, according to your own feelings. If you come to our practice after six weeks for a follow-up examination, we will discuss the long-term follow-up care of implants with you and explain the examination intervals to you. You will receive an implant passport directly after surgery that lists the most important details about your implant (manufacturer, model, batch number). Your normal breast cancer screening at the gynecologist (including mammography) is of course possible. It should definitely be done regularly. Scar care is a topic that we will discuss with you personally.
Alternatives
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Lipofilling, i.e. the transfer of one's own fat for breast augmentation, has been enjoying increasing popularity for some time. With this application, the use of an implant can sometimes be dispensed with.
Often women, for example after pregnancy, also have sufficient breast volume, only the skin coat is overstretched and sags due to pregnancy and breastfeeding. In such a case, the so-called auto-augmentation, i.e. a breast lift, combined with an endogenous flap of subcutaneous fatty tissue, can create a firm and voluminous breast without the use of an implant.
Useful information
In order to achieve an even more natural result, breast augmentation can be combined with a breast lift and/or autologous fat transplantation. Breast optimization can also often be combined with other operations and carried out in a single operation. Feel free to contact us on this topic if you want to learn more about it.
INFORMATION
OVERVIEW
Duration
Depending on technique and implant positioning 45-90 Minuten
Anesthesia
General anesthesia
Costs
depending on complexity starting from 4,800 euro or 82 euros / month
Technique
Depending on anatomical conditions and desire above or below the pectoral muscle, dual plane, combination with autologous fat (hybrid breast)
Post-treatment
6 weeks special compression bra, no exercise, no heavy lifting
Financing
The possibility of financing is available upon request through one of our financing partners. For all aesthetic operations, an external follow-up cost insurance should be concluded. It protects you in the event of rare complications and associated follow-up costs.
Pain level
Mild, well tolerated with regular pain killers
Presentability
About 14 days
Useful information
The type of implant, position, access route, etc. are individually variable. We will be happy to advise you in detail, a simulation is possible and useful.
Procedure
Depending on technique outpatient setting or one night stay
Risks
Capsular fibrosis, multiple implant changes, infection, hematoma
BREAST AUGMENTATION WITH B-LITE IMPLANTS
Plastic surgical breast augmentation with implants is one of the most commonly performed operations. When it comes to the frequently expressed desire to use implants with the largest possible surface area, weight comes into play. For a long time there were different perspectives and arguments: On the one hand, plastic surgeons treated women who wanted larger breasts, for which they were willing to accept large-volume implants. On the other hand, women came to the practice who wanted a breast reduction in order to reduce the weight load from the breast and to reduce pain in the musculoskeletal system.
After years of research and development and subsequent extensive approval studies, the industry succeeded in developing a new type of breast implant: The B-Lite implant series from the German company Polytech. It gives specialists the opportunity to provide women who want large breasts with implants that are over 30 percent lighter than conventional implant lines. The technology used for this is based on so-called microspheres. These are tiny cavities that are inside the gel. They form a constant connection with the silicone molecules, but without penetrating them. Thanks to the high cross-linking of the microspheres, the gel is very dimensionally stable and leak-proof.
At JJPS, the indication for B-Lite implants is primarily for women with weaker connective tissue who want a larger change in volume. Thanks to the significantly lower implant weight, the sagging of the breast can be significantly reduced.
In terms of risk profile, B-Lite implants are just as safe as traditional implants. However, due to the even more complex production process, they are currently around 50 percent more expensive than conventional premium implants.
We will check whether B-Lite implants are suitable for you and discuss it together in our consultation hours. There you can also view all implant types and get a feel for the different textures, weights, shapes and sizes of the implants.