Breast Augmentation • Surgery, costs and possible complications

More and more women are getting breast augmentation. Mostly there are cosmetic reasons behind the desire for such an intervention. Which implants are available, how high the costs are for breast augmentation and which complications can arise.

The reasons for breast enlargement (breast augmentation) can be different. Every woman should clarify in advance why she would like to have the operation performed. Breast augmentation can be performed from the age of 18, as the breast is then usually fully developed in women.

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Reasons for breast enlargement

Breast augmentation is primarily carried out for subjective aesthetic reasons. The own breast is perceived as too small or does not correspond to the current ideal of beauty. Some women also see the potential in breast augmentation to increase their self-esteem and their own sense of beauty.

There are also other cosmetic reasons for breast enlargement:

  • Micromastia: Underdeveloped breasts that are too small for their height and weight

  • Asymmetry: the breasts are of different sizes

  • Shrunken breasts or changed breast shape after pregnancy and breastfeeding

  • Breast malformations such as tubular breasts or sagging breasts

  • Reconstruction: When one or both breasts have been amputated after breast cancer or other diseases

  • Chest relaxation: Often occurs after significant weight loss or with age

Often a breast augmentation is carried out together with a breast lift in an operation. Medical reasons for breast augmentation are breasts of different sizes, which has orthopedic consequences, or the reconstruction after an amputation.

Medical objections to breast augmentation

Breast augmentation should be viewed critically in women who have a high familial breast cancer risk. Because every breast implant can impair or complicate the imaging control by mammography in preventive care. The same applies to breast cancer patients who are undergoing breast-conserving therapy, as the risk of encapsulation of the implant increases significantly after irradiation of the breast. Women who want to have children should keep in mind that later pregnancy can affect the results of breast augmentation.

Other medical reasons that speak against breast augmentation:

  • Autoimmune diseases
  • Infections
  • impaired wound healing and blood clotting
  • insufficient blood flow to the breast tissue

In the consultation, it must be ruled out that the woman has mental illnesses or that the decision is made involuntarily. In some cases, the partner wants a breast augmentation performed. If this is the case, the operation is usually not carried out.

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Breast enlargement implants

Breast implants come in different sizes and are usually round or teardrop-shaped. As medical devices, implants are subject to the Medical Devices Act and must meet strict quality and safety requirements. This also includes the CE mark, which shows that the breast implant has been tested in accordance with European requirements.

Breast implant fillings:

  • Silikongel: Modern implants are viscous cohesive gel implants that contain long-chain, highly cross-linked silicone molecules and are particularly leak-proof and form-proof. Compared to other filling materials, silicone implants feel more natural. As long as there are no complaints, they do not need to be replaced. Nevertheless, the condition of the pillows should always be checked after ten to 15 years.
  • Saline solution: It is a harmless filling material for breast implants because the body simply metabolizes it if something does leak out. Over time, however, implants with saline solution lose their volume, and the fluid can then make itself felt with a gurgling sound. The implants feel less natural than those with silicone gel.

  • Hydrogel: These breast implants consist of over 95 percent water, which has been made viscous by cellulose. While they feel like normal breast tissue, they haven’t caught on with breast augmentation. Because there have always been cases where some filling material has leaked into the tissue despite the shell being intact. Fluid from the tissue can also penetrate the hydrogel implant.

For most breast implants, the shell is made of silicone, it can be smooth or textured. Although smooth implants are softer and feel more natural, capsular contracture can occur more often here. With this complication, the body reacts to the implant as a foreign body and forms scar tissue – a hard, sometimes painful capsule is created, and deformations of the breast are possible. For this reason, women are often recommended to have an implant with a roughened surface for breast augmentation.

Breast augmentation surgery

The procedure usually takes no longer than one to two hours and takes place under general or local anesthesia. This is followed by follow-up care in the clinic for a few days in order to rule out complications or to be able to treat them in good time.

The breast implant can be placed either under or on top of the pectoral muscle. If the implant lies under the pectoral muscle, it is protected and cannot slip. In addition, the mammary gland is not injured and breast cancer can be easily detected on a mammogram. However, this method involves cutting into the chest muscle, which can impair mobility, especially of the arms.

If, on the other hand, the breast implant is placed on the pectoral muscle, the natural shape and movement of the breasts is retained. This is particularly noticeable in sports. However, the implants are more noticeable here in women with little natural breast tissue; an implant under the pectoral muscle is more suitable for them.

Which cutting technique: T-cut or Lejour

Various incision techniques are possible for breast augmentation: A distinction is made between the surgical access through the armpit (axillary), the breast crease below the breast and around the areola. The surgeon cuts the skin and fatty tissue, creates a pocket and places the breast implant there. The cuts are then sewn – the sutures are pulled after 10 to 14 days or dissolve by themselves.

Capsular contracture and other complications

Complications can occur as a result of breast augmentation or later through the implants:

  • Bleeding and secondary bleeding

  • Infections

  • Breast implants slipping

  • Wound healing disorders

  • Tissue necrosis (dying tissue)

  • Excessive scarring

  • Defective implants

In around ten percent of all cases, more or less pronounced disorders of skin sensitivity occur after breast surgery. Sensory disorders can affect the nipple and breast skin. Absolute numbness of the nipple, on the other hand, is very rare.

Rippling is the creases or waves in the silicone pillow after breast augmentation, which can be seen. It only occurs in implants over the chest muscle, mostly in very slim women with little fat tissue. Rippling cannot be prevented, and wrinkles cannot be smoothed out again with massages.

The most common complication of breast augmentation is capsular contracture: the breast implant is recognized as a foreign body and the body reacts to it. It forms a capsule of connective tissue around the implant that can thicken and harden, often causing pain.

How is the optimal implant size determined?

As a rule of thumb, 200 to 300 milliliters mean one bra cup size more. The most common pillows are therefore 250 milliliters, but sizes of 80-800 milliliters are possible. The most common mistake in breast augmentation is an implant that is too small or too large. With increasing implant size, negative aspects such as implant visibility, soft tissue overstretching and sagging breasts also increase.

Which size is suitable depends on the height and stature of the woman, the shape of the rib cage and the breast tissue. The texture of the skin and the mammary glands also play a role.

Breast augmentation cost

Only if there are medical reasons do health insurances usually cover the costs of a breast augmentation. This applies, for example, after an amputation or removal of a tumor so that the breast is then restored. If in doubt, you should ask your health insurance company.

For a medically unnecessary breast augmentation, the costs will not be covered by the health insurance. So you have to pay for the surgery yourself. As a guideline, you can expect 5,000-6,000 euros, since the breast augmentation itself costs at least 3,500 euros. The costs depend on the duration of the procedure and the effort, plus there are costs for the material used and the aftercare in the clinic. After a detailed consultation and examination, an individual cost plan for breast augmentation can be drawn up.

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Source: Lifeline | Das Gesundheitsportal by www.lifeline.de.

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