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Breast augmentation with implants is the most frequently performed plastic surgery procedure in the world. More than 50% of the patients are 19-34 years old, one third is 51-64 years old.
In this procedure, which we also call breast or mammary augmentation in technical jargon, we place implants made of silicone in a pre-prepared pocket above or below the pectoral muscle in order to achieve an enlargement of the breast.
Breasts can be enlarged not only with implants but also with autologous fat or, in the so-called hybrid technique, with implants and autologous fat.
Most patients, especially of the younger generations first research online and are already very well informed in a consultation. However, my personal experience shows that many patients are surprised by the number of relevant decisions they have to discuss and make together with me during the consultation. After all, the obvious decision of implant size is only one element on the way to planning a breast augmentation.
So what all needs to be discussed in detail with the surgeon?
First of all, let’s talk about the type of implant
Breast implants not only come in different sizes, they differ in many ways, including shape, filling material, surface texture and dimensions.
Basically, there are two different types of implants: Implants filled with saline and implants filled with silicone. Both are surrounded by a silicone shell, so they differ only in the filling material.
I almost exclusively use silicone implants because they are closest to the natural shape and consistency of the breast. Our implants have been tested in large-scale studies and come from recognized and tested manufacturers.
When talking about the type of implant, not only the filling material is relevant, but also the shell. Shells can be smooth, microtextured or coarsely textured. The silicone implants we use have an outer, microtextured, smooth shell of silicone and are filled with a cohesive gel on the inside. You have to think of a cohesive gel as having the consistency of a gummy bear. This filling silicone is very different from previously used silicone. Due to the cohesiveness of the gel, the implants cannot leak even if the shell is damaged.
The next question is which implant shape is the ideal solution?
There are basically two main shapes of implants: round and teardrop.
Round implants result in a more voluptuous cleavage, while teardrop-shaped implants look more natural.
A novelty are implants that are round when lying down and teardrop-shaped when standing up, thus behaving like a completely natural breast. For me, these are the ideal implants for breast augmentation.
And now for the much discussed implant size. This is probably the first and most common topic I receive questions about during a breast augmentation consultation. Contrary to what many patients think, it does not depend exclusively on the patient’s wishes. The size of the implant is determined to a large extent by the patient’s physical requirements. The implant must fit the patient’s physique and size. A natural result in harmony with the rest of your body is a top priority. Through different measurements, I define the ideal implant size in conjunction with the patient’s wishes.
Once the implant shape and size have been jointly defined, it is necessary to decide in which position the implant should be placed.
Implant position. Implants can be placed above the muscle, below the muscle, or only partially below the muscle. The decisive factor is the patient’s anatomy and in particular how good her skin and tissue mantle is in the breast and décolleté area and how active she is in sports.
If the tissue quality in the upper pole of the breast is good, the implant can be placed directly below the gland and above the muscle.
If a patient is very slender and has little soft tissue, placement under the muscle gives additional soft tissue coverage over the implant and prevents an unnatural appearance.
The last thing to determine is then the incision placement.
There are three possible incision guides to place the implant. This decision is important because where the incision is made is where the scar will end up.
The most common approach in our width grades and also my favorite approach is in the area of the underbust crease. In this way, the implant pocket can be prepared very clearly and the implant placed. This scar is located in the natural underbust fold and is therefore hardly visible afterwards.
Another option is access through the lower part of the areola or through an incision in the armpit area.
Each of these approaches carries different risks and has different advantages and disadvantages, which I discuss in detail with the patient.
As you can see, there are many decisions to make when planning a breast augmentation. I take time for this with you during the consultation.