Breast augmentation (mammoplasty)

Definition of breast augmentation

The Breast augmentation, medically known as Breast augmentation also known as augmentation mastopexy (when performed in conjunction with a breast lift), is a plastic surgery procedure designed to increase the volume of the female breast and, where necessary, to correct its shape. The primary aim is the insertion of breast implants; less commonly, autologous tissue (lipofilling) is used to achieve the desired breast size and projection.

Implant-based augmentation primarily involves the use of modern silicone gel implants in various shapes (round, anatomical) and sizes, which are selected according to the clinical indication and the desired result. In addition to simply increasing volume, this procedure can also correct breast asymmetry and optimise the overall breast contour to create a more harmonious silhouette.

Indications for breast augmentation

The indications for breast augmentation are varied and include:

• Micromastia/hypoplasia: Congenital underdevelopment of the breast.
• Postpartum or post-lactation volume loss: A reduction in breast size following pregnancy and breastfeeding.
• Loss of volume following significant weight loss.
• Breast asymmetry: Compensating for differences in size or shape.
• Desire for aesthetic improvement: A subjective feeling that one’s breasts are too small.
• Reconstructive purposes: For example, following a mastectomy (although other procedures are often the primary focus in such cases).

Careful assessment of indications and patient selection by the specialist are essential.

Breast augmentation procedures: choice of implant and surgical techniques

Breast augmentation requires a personalised approach to planning, taking into account the choice of implant and the surgical technique.

Choice of implant

Modern breast implants consist mainly of a silicone shell filled with cohesive silicone gel. Key distinguishing features are:

• Form: Round implants (which emphasise the upper part of the breast) or anatomical (teardrop-shaped) implants (which mimic the natural shape of the breast).
• Size/Volume: Determined by the base width, height and projection (low, moderate, high, extra-high profile).
• Surface: Smooth, textured (micro- or macro-textured) or coated with polyurethane foam. The surface texture influences, amongst other things, the risk of capsular fibrosis.
• Gel cohesiveness: Determines the strength of the implant.

The choice is made taking into account the patient’s anatomy, tissue characteristics and preferences.

Surgical techniques

The operation is usually carried out under general anaesthetic and lasts 1–2 hours.

• Surgical approach (access routes):
  • Intramammary: In the inframammary fold (the most common access point, providing a good view).
  • Periareolar: At the edge of the areola (inconspicuous scar, but a higher risk of sensory disturbances or contamination).
  • Axillary: In the armpit (no scar on the breast; technically more challenging).
  • Less common: transumbilical (TUBA).
• Implant placement (positioning):
  • Subglandular/epimuscular: Above the pectoralis major muscle, directly beneath the mammary gland.
  • Submuscular/subpectoral: Fully or partially beneath the pectoralis major muscle (dual-plane technique). Offers better soft-tissue coverage and, where appropriate, a more natural-looking result in slender patients, but may involve a longer recovery time or animation deformities.
• Surgical procedure: Once the incision has been made, an implant pocket is prepared, the implant is inserted and the wound is closed in layers. Drains are used less frequently.

Aftercare and the healing process following breast augmentation

The post-operative period requires patience and adherence to medical advice:

Support bra/compression bra: It must be worn consistently for around 4–6 weeks.

Taking care of your body: Avoid heavy lifting and strenuous activities for several weeks. Physical exercise can usually be resumed gradually after 4–6 weeks.

Wound and scar care: Regular check-ups, and removal of stitches if necessary. Specific scar care once the wound has fully healed. Sun protection for the scars.

Swelling and bruising: They usually subside within a few weeks. The final result is often only visible after 3–6 months.

Long-term monitoring: Regular breast self-examination and, where appropriate, imaging tests (ultrasound, MRI) are recommended.

Risks and complications of breast augmentation

Although breast augmentation is a standardised procedure, there are general and specific risks:

General surgical risks: Post-operative bleeding, haematoma, seroma, wound infection, impaired wound healing, thrombosis, embolism, anaesthetic risks.

Specific complications:

• Capsular fibrosis: The formation of a pathologically hardened connective tissue capsule around the implant, which can lead to pain, deformity and hardening of the breast (the most common long-term complication, Baker classification I–IV).
• Implant rupture/leakage: Mechanical damage to the implant shell.
• Implant dislocation/rotation: Slippage or rotation of the implant.
• Sensory disturbances: Changes in or a reduction in sensitivity of the nipples or skin (often temporary).
• Asymmetry: Differences in the shape, size or position of the breasts or nipples.
• Rippling/palpability: Visibility or palpability of implant folds or edges, particularly in slender patients with little soft-tissue coverage.
• Symmastia: The breasts meet in the centre.
• Bottoming out: The implant dropping below the inframammary fold.
• BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma): A very rare form of non-Hodgkin’s lymphoma, associated primarily with certain textured implants.
• Mondor’s disease: Thrombophlebitis of the superficial veins of the chest wall.

Thorough pre-operative counselling and the choice of an experienced surgeon are crucial for minimising risks.

Costs and who covers the costs of breast augmentation

The Costs The costs for breast augmentation vary (approx. 5,000–8,500 euros in Germany) and depend on the type of implant, the surgical technique and the clinic. A Coverage of costs Health insurance does not cover the procedure if it is performed purely for cosmetic reasons. The costs of any follow-up treatment required as a result of complications are also usually borne by the patient, which is why it is advisable to take out Consequential Costs Insurance should be considered. Exceptions regarding the coverage of costs apply only in very rare cases where there are strict medical grounds (e.g. following a mastectomy).