How does a breast implantation work

The preparation:
examination, planning, information and consent
Before implantation, a detailed examination is performed to determine which treatment is appropriate. Once the treatment option(s) has been found, a discussion is held with the patient to explain the type of treatment and the process. Before the actual treatment, the patient must give consent.

Sometimes pre-treatment may be performed.If palpation is suspicious and in any case in patients over 30 years of age, an X-ray examination is recommended beforehand.

With the help of expander implants, a breast can be built up within up to four months by increasing the volume week by week. This is particularly useful in cases of low breast volume or after breast cancer surgery.

Anesthesia
As usually, breast augmentation surgery takes one to two hours and takes place under general anesthesia.
Local anesthesia with the addition of sedatives is also possible in principle. The advantage: the inpatient stay is shorter.

The surgery
There are several ways of access to place a breast implant.
  1. The peri-areolar incision, or nipple incision, is one of the most commonly used incisions in breast augmentation surgery. The nipple incision allows sub-glandular, sub-pectoral, or sub-muscular placement of the implant. The implant can be both inserted and removed through the nipple incision in the event of complications.The incision is made where the darker skin of the areola meets the lighter skin of the breast. This allows the scar to blend in with the natural change in flesh pigment.
  2. The inframammary fold incision is another very common incision used for breast augmentation. Like the nipple incision, this incision allows for all three placement types and both insertion and removal of the implant. The incision is made in the crease under the breast, allowing for discreet scarring.
  3. The transaxillary incision goes via the armpit. It can be made with or without the help of an endoscope (a tube with a small surgical camera on the end) to insert the implant into the channel and place it. It´s for patients who want no breast scarring. It´s more difficult to perform, but leaves only a tiny scar hardly visible.
  4. The TUBA (trans-umbilical breast augmentation) incision, is less common. It´s made in the rim of the bellybutton. Then, using an endoscope, a tunnel is made below the skin all the way to the breast. Then the implant can be pushed through the tunnel in its place. Very rarely, this procedure leaves “V” tracks on the stomach.
    There are limitations with the TUBA incision: It requires inflatable implants. It only allows sub-pectoral or sub-muscular placement. In the event of complications, the path cannot be reused.

There are several sites where the implant can be placed.

Both subglandular and subpectoral implant positioning are acceptable for every type of implant, however, depending on the individual anatomy, lifestyle, preferences, and the particular implant chosen, one position may be preferred over the other. 

Advantages of subglandular placement include no interference with pectoralis muscle function, no “animation,” or movement of the breasts that occurs with arm movement if the implant is subpectoral, and no requirement for stretching of muscle for the implant to settle into its final position. Women who compete athletically or who are very active with their upper body may want to avoid surgical manipulation of their pectoralis and dynamic breasts that are inevitabilities of sub-muscular (dual-plane) implant placement.

Deeper implant placement helps more camouflage implant-related imperfections. So submuscular positioning is recommended for thin women with saline or cohesive silicone gel implants. Because the muscle better conceals implant characteristics, edges and rippling may be less visible. When a breast lift is simultaneously performed, submuscular implant placement improves blood supply to the overlying breast. The implant pocket under the pectoral muscle provides better opportunities for mammography.

Disadvantage of implantation under the pectoral muscle: the multiple incisions of the pectoral muscle, as this method this method, may limit arm mobility.

In any case, because of these and maybe some more individual variables, the surgeon must develop the breast implant pocket(s) extremely carefully and individually.
In some cases, more complex measures are performed, e.g. nipple relocation, breast lift.

After the procedure
  • No driving in the first 48 hours after surgery.
  • No alcohol for 48 hours.
  • You should take ten days off and plan about six weeks of general rest.
  • Taking your prescribed medication.
  • You can get a shower after 24 hours from the surgery.
  • Sleep in an upright reclined position for one week after the surgery
  • Remember always to use your post-op bra (for about 6-8 weeks)
  • Do not wear wired bras for a period of 6 weeks
  • Keep your hands and elbows to your side
  • Do not lift over 5 pounds objects
  • Do not perform heavy workouts for a period of at least 6 weeks
  • Avoid sun exposition for 3 weeks and use sunscreen.
  • Make sure you have the data of your implant: a certificate from your doctor or a confirmation of registration with the manufacturer or in a specialized or national registry. With the necessary data you can also register here or print and fill out a passport yourself here. You might need the data once if there is a problem.

As with any surgery, wound healing problems and secondary bleeding may occur.

7 – 10 days after surgery, the stitches can be removed – unless self-dissolving suture material was used.
Pain when moving the arms and tightness in the breasts may persist for a few days after the operation. Swelling can be expected for three to five weeks.

If a bacterial infection develops, a second procedure is necessary to remove the implants. New implants can be inserted after six months at the soonest.

After about three months, the final aesthetic result can be checked.

After completion
Implants require lifelong care. It is reasonable to have a control once a year, but the frequency should be decided individually by your surgeon.
A specific complication of breast augmentation is a hardening capsule formation (capsular fibrosis), which requires further surgery in about 20 percent and in about five percent of cases that occur, removal of the breast implant.

Breast augmentation with implants in any case entails further operations. At some point, the implant must be replaced because the material “fatigues”. Silicone gel implants are expected to last about ten to 15 years, saline implants somewhat less.
This is the description of typical proceedings. Medical treatments are individual and your doctor may recommend different ones.
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