Breast Augmentation - Information on Breast Surgery with Implants

Anyone considering breast augmentation should seek comprehensive counseling beforehand. Many women desire larger, fuller, and firmer breasts. The reasons for breast augmentation are very diverse. In most cases, however, the decision to undergo breast augmentation is made for aesthetic reasons.

The following are the most common reasons for breast augmentation:

• Uneven or asymmetrical breasts
• Naturally very small breasts, or
• Breasts that are subjectively perceived as too small and do not meet one’s own ideal of beauty

Changes in breast shape following pregnancy, significant weight loss, or the natural aging process can also lead to breast augmentation.

Another possible reason for breast augmentation can be a disfiguring breast deformity.

In 2022, approximately 76,600 breast augmentations were performed in Germany @ New Africa /AdobeStock

During the procedure, the surgeon makes an incision under the breast, around the nipple, or in the armpit. The surgeon then inserts a breast implant directly behind the breast tissue or between the pectoral muscle and the ribs.

The surgery takes about 1 to 2 hours and is performed under either local or general anesthesia.

The cost of such a breast augmentation is about 2,500 euros, plus 1,000 to 2,000 euros for the breast implants. Health insurance companies reimburse these services only if there is a “medical necessity.”

After breast augmentation with an implant, the breast shape is full and natural. It feels just like a firm, natural breast.

For women, this procedure generally leads to an increase in body confidence and self-esteem.

Although the results of breast augmentation are long-lasting, they do not last forever. The shape of the breasts may change again over the years due to aging. This may make a breast lift necessary at a later date.

In total, doctors in Germany insert around 25,000 breast implants each year. This makes breast augmentation the most common procedure in plastic and cosmetic surgery.

Breast augmentation should not be confused with breast reconstruction. Breast reconstruction is performed, for example, following an injury or a mastectomy (removal of the breast).

Before breast augmentation surgery, there are usually two detailed consultation appointments. During these appointments, the plastic and aesthetic surgeon takes precise measurements of the patient’s breasts. The surgeon also informs the patient about realistic goals for the surgery, different surgical techniques, and breast implants.

Breast augmentation may only be performed on healthy breasts. If there is an increased risk of breast cancer, the doctor may recommend a mammogram, breast ultrasound, or magnetic resonance imaging (MRI) before the surgery.

The silicone implants used for breast augmentation are typically double-walled silicone bags. They can contain different types of fillers.

Modern silicone gel implants consist of cohesive gels that virtually prevent leakage into the surrounding tissue. They can be filled with silicone gel, hydrogel, oil, or saline solution, among other substances. The double-walled silicone shell provides excellent protection against injury. The filling material used guarantees outstanding aesthetic and tactile results.

The quality of silicone-filled breast implants has improved dramatically in recent years. Today, cohesive gels are used as the filling material, which significantly reduces the likelihood of leakage into the surrounding tissue.

Breast augmentation with silicone implants is the most commonly chosen method. Silicone gel implants feel more natural than saline breast implants.

In addition to the filling, implants also differ in shape (round vs. teardrop) and surface texture (textured vs. smooth). The surgeon works with the patient to determine the breast implants that are best for her.

Silicone breast implant @ H_Ko /AdobeStock

Before breast augmentation, several preliminary examinations are necessary or recommended; these are performed at the clinic the day before the surgery.

These include, among other things, a mammogram and an ultrasound examination of the breasts. These tests allow the treating physician to detect any tissue changes prior to the breast augmentation.

Since pain relievers such as aspirin can delay blood clotting, you should avoid taking them for two weeks before the surgery. You should also avoid taking sleeping pills and drinking alcohol.

Breast augmentation is typically performed on an inpatient basis as part of a hospital stay lasting 1 to 3 days. The surgery takes about 60 to 90 minutes (or longer if a breast lift is also performed).

Depending on whether the implant is placed under the muscle or under the gland, a distinction is made between submuscular and subglandular implantation. If the surgeon places the implants on top of the chest muscles (submammary/subglandular implantation), the patient can freely choose the type of anesthesia: options include local anesthesia with additional twilight sedation or general anesthesia.

The reasons for breast augmentation are varied and highly individual @ H_Ko /AdobeStock

Breast augmentation in which the surgeon places the implants under the chest muscles (submuscular placement) is performed under general anesthesia.

Various access routes are available for inserting the implants, each with its own advantages and disadvantages.

The most common approach is through a small incision in the inframammary fold (inframammary approach).

When accessing the area through the armpit (transaxillary approach), the breast remains completely scar-free. However, this procedure is only suitable for smaller implants. It is believed to carry a higher risk of infection (due to bacteria in the armpit).

In addition, the surgeon can also insert the implants through the areola (periareolar approach)—while preserving the ability to breastfeed.

A breast lift can be performed at the same time as breast augmentation. This is suitable for correcting nipples that are too low or unevenly positioned, or for sagging breasts. In some cases, a separate procedure is necessary for the breast lift.

Patients who have naturally different-sized breasts receive breast implants to correct the asymmetry.

At the end of the surgery, the surgeon must close the incisions using fine sutures and skin adhesive or skin adhesive strips.

The surgical procedure for saline breast implants differs from that for breast augmentation with silicone gel implants.

With saline implants, only a small incision is necessary. Since the surgeon fills the implant shell only after it is inside the body,

After the surgery, the breasts may feel tight and sore, and mobility in the upper body may be limited.

In addition, breast augmentation can cause swelling and bruising of varying severity. However, these usually subside within the next few days to weeks.

One to two days after the surgery, the patient is usually feeling well again. She will be fully able to return to work after one week at the latest.

The scars from the incisions fade over time until they are barely noticeable. A final assessment of the breast augmentation results can usually only be made after 6 to 9 months.

The patient should wear a support bra for approximately four to six weeks after the surgery. In addition, she should take care of the operated breast during the first two months after surgery and avoid overexertion.

During this time, she should therefore avoid strenuous physical activities and sports (exercise, lifting heavy objects, etc.). Swelling may persist for several months.

Like any surgical procedure, breast augmentation carries certain risks. 

In rare cases, the following complications may occur:

• Postoperative bleeding
• Wound healing complications
• Swelling
• Bruising
• Infections or
• Temporary loss of sensation in the nipple

Other possible complications include capsular fibrosis and defects in the double-walled silicone shell of the breast implant.

Capsular contracture

With capsular contracture, a capsule of scar tissue forms around the breast implant during the healing process following breast augmentation.

In rare cases, this capsule can harden. This can lead to pain, breast deformity, and implant displacement.

In this case, another surgery is required to remove the scarred capsule or replace the implant.

Defects in the Silicone Shell

Material fatigue or severe accidents can lead to defects in the double-walled silicone shell of the breast implant.

As a result, filling material leaks into the surrounding tissue. If the implant is filled with saline solution, this is completely harmless, as the body can fully break down the saline within a short time.

However, other filling materials can cause tissue reactions that, after months or years, lead to the development of so-called siliconeomas.

Preventing Complications from Breast Augmentation

To avoid complications, the patient should inform the surgeon in advance if she suffers from allergies or other medical conditions. She should also mention if she is prone to noticeable bruising or prolonged bleeding following minor injuries.

In the latter case, the doctor should rule out blood clotting disorders before the surgery. You should also be sure to inform the surgeon of any planned weight loss or pregnancy.

1. What types of implants are available?
A distinction is made between round implants and anatomical (teardrop-shaped) implants; the plastic surgeon works with the patient to select the optimal shape and size during the consultation.

2. Is breast augmentation with autologous fat possible?
Yes—in breast augmentation with autologous fat, the patient’s own fat tissue is harvested and injected into the breast; however, the achievable increase in volume is less than with silicone implants.

3. Is it still possible to breastfeed after breast augmentation?
In most cases, yes—breastfeeding after breast augmentation is possible, provided that the mammary gland and its ducts were not damaged during the procedure.

4. What should be considered with an axillary approach?
With breast augmentation via the axilla, the breast remains scar-free; however, this approach is only suitable for smaller implants and is associated with a slightly increased risk of infection.