Breast implants

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Breast implants are plastic pillows that are used in the surgical enlargement or restoration of the breast. Breast augmentation with implants is currently one of the most common cosmetic interventions in Germany. Read everything about breast augmentation with implants, when it is used and what the risks are.

What are breast implants?

Breast implants are plastic pillows that are inserted into the breast tissue to enlarge the breast. All common breast implants currently consist of a silicone shell that is filled with either saline or silicone gel. The surface of the implants can either be smooth or roughened (textured).

So far, the textured surface has proven itself, since with its help painful adhesions of the connective tissue can be avoided. In addition, breast implants with a roughened surface do not slip as quickly. Some manufacturers also offer breast implants that are coated with various substances. This is to prevent adhesions, adhesions and infections.

Breast Implants: Fillings

A breast implant is traditionally filled with a firmer silicone gel. In contrast to the liquid silicone used previously, this reduces the risk of the filling leaking and the shape does not change. Silicone-filled breast implants also ensure a natural shape of the breast even when moving. Silicone has not been shown to be carcinogenic in studies and has no negative effects on pregnancy or breastfeeding.

Breast implants filled with saline solution are an alternative to silicone: They do not pose a health risk if leakage occurs, as the saline solution is harmless to the surrounding tissue. Further advantages of saline implants over silicone implants are their lower costs and easier introduction via a smaller incision.

Fillings with soybean oil or so-called hydrogel have given poor results, which is why they are currently no longer used.

Breast Implants: Shapes

The most commonly used breast implants are round in shape. This emphasizes the upper half of the breast and thus the cleavage. Anatomical breast implants, on the other hand, imitate the natural shape of the female breast due to their teardrop shape: They are rather narrow in the upper area and widen towards the bottom. This gives the breast a natural-looking approach. They are also particularly suitable for balancing asymmetrical breasts. Many women, however, want an emphasis on the décolleté, which is why round breast implants are usually used for cosmetic breast enlargements.

When to perform breast augmentation with breast implants

Breast implants are used in the following situations:

• Breast augmentation in women for cosmetic reasons
• Asymmetrical breasts
• Restoration of the breast after it has been amputated, for example in breast cancer
• Breast enlargement in transsexuals

So breast implants are used both to restore and enlarge the breast.

What do you do with breast augmentation with breast implants?

The surgery to place the breast implants usually takes between one and two hours. Before the operation, the doctor must first find out the implant shape and size that is individually suitable for the patient. In doing so, he or she is primarily guided by the patient's ideas and wishes. He also has to consider the width of the chest, the texture of the skin and the symmetry of the patient's body. The surgeon then draws the cutting lines on the patient's chest using a marker suitable for the skin.

As a rule, the anesthetist puts the patient under general anesthesia before her breast enlargement. So she can spend the procedure asleep without pain. Local anesthesia is rarely used, but possible. The patient is then placed on her back with her arms slightly bent.

In the operating room, the surgeon carefully cleans the patient's skin with disinfectant. This lowers the risk of wound infections. Then the doctor covers the patient with sterile cloths, leaving out the breast region. He also covers the nipple with a special film to prevent the spread of bacteria from the milk ducts of the breast into the surgical wound.

Breast Implants: Access Routes

The surgeon uses a sharp skin knife to make an incision four to five centimeters long directly below the chest (inframammary access). This incision allows precise placement of the breast implant and has proven to be the access route with the lowest rate of complications.

Alternatively, the doctor can also choose a cross-section in the armpit or the so-called areolar margin incision, in which he incises the skin on the lower edge of the areola over a length of four centimeters. Since the milk ducts that open into the nipple are lined with a germ-colonized biofilm, there is a particularly high risk of spreading bacteria into the wound with the areolar margin incision.

The insertion of the breast implants

Breast implants are preferably placed below the chest muscles, what the doctor then calls a subpectoral implant box. In this way, the pectoral muscle can cover the transition between soft tissue and breast implant and naturally shape it without stepping. After the skin incision has been made, the surgeon has a clear view of the pectoral muscle. The surgeon then cuts through the muscle fibers with an electric knife. He can now use his finger to feel behind the pectoral muscle and separate it from the underlying tissue, being careful to protect the underlying nerves. This creates a kind of pocket for the breast implants.

Alternatively, the surgeon can place the breast implants in the tissue on the pectoral muscle, which is known as a prepectoral implant box. It is particularly suitable for patients with sagging and excess breast skin, as the sagging skin is filled directly by the breast implant.

After breast augmentation with breast implants

After inserting the breast implants, the surgeon carefully closes the wound with sutures. He also puts a plaster bandage on her in the operating room. To prevent the breast implants from slipping, he wraps the patient's chest tightly with cotton wool and elastic bandages.

The patient is now taken to the recovery room to recover from the procedure. It can then be moved back to the normal ward. After breast augmentation with breast implants, the patient usually remains in the hospital for a day or two; if problems such as wound infections occur, the hospital stay is extended.

What are the risks of breast implants?

The insertion of breast implants is usually not a medically necessary procedure. In this case, it is all the more important to know the possible dangers. These include:

• Increase or decrease in the sensitivity of the breast skin and nipples
• Painful and shape-changing capsule formation around the breast implant (capsular contracture)
• Damage to the implant, possibly with emptying
• Asymmetrical breast shape or implant malposition
• Formation of skin folds
• Bleeding during and after surgery
• Formation of a bruise (hematoma)
• Necessity of blood transfusions with a corresponding risk of infection
• Injury to soft tissues and nerves
• Wound infection and wound healing disorder
• Incidents of anesthesia
• Allergic reaction to materials and drugs used
• Cosmetically unsatisfactory scarring

In the event of capsular contracture or damage to the breast implant, it may be necessary to remove or change the implants.

In order to keep the risk of breast implants as low as possible, it is important that the operation is carried out by an appropriate specialist: In Germany, these are the “specialist in plastic surgery” and the “specialist in plastic and aesthetic surgery”. The job title “cosmetic surgeon” is not a legally protected term and therefore does not say anything about the qualification of a doctor for breast augmentation!

What do I have to consider with breast implants?

In the first few days after the breast implants have been placed, it is very natural for your breast to be slightly swollen and sore. If necessary, your doctor will be happy to prescribe you a pain reliever medication.

For four weeks after having the breast implants, avoid sports or activities that require you to raise your arms above shoulder height.

From the second day after the operation, the doctor replaces the bandage applied after the operation with a support bra with a compression belt. You should wear the compression belt for six weeks and the support bra for three months.

Within the first four weeks after the operation, your doctor will again check with an ultrasound whether there is any blood or wound fluid in the wound area. If necessary, these accumulations have to be suctioned off or even removed by a renewed intervention.

As part of the follow-up care, you should have an annual breast examination with ultrasound control, palpation and mammography or magnetic resonance examination of the breast. Which follow-up examinations are specifically important for you depends on the general preventive examinations.

When do I have to change breast implants?

The breast implants must be removed or replaced in the following situations:

• Implant rupture or slipping of the implant
• Capsular contracture
• Soft tissue problems

Of course, it is always possible to change the breast implants if you are dissatisfied with the result and, for example, would like a different size or shape.

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