Breast augmentation
Breast augmentation is the technical term for breast enlargement – a surgical procedure ranging from the choice of implant through to its placement and the incision technique.
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Important note
This article is for information purposes only and is not a substitute for a medical diagnosis or advice. If you are unsure, or if you require a personalised treatment plan, it is essential that you consult a qualified specialist.
Whilst the desire for breast augmentation is an emotional decision, the process involved is a highly technical surgical procedure. The medical term for this procedure is breast augmentation. For patients who wish to make an informed decision, understanding the surgical details – from the choice of implant and its precise placement to the incision technique – is of crucial importance.
This specialist article serves as your detailed technical guide. It builds on our general guide to breast augmentation and explains the specific surgical techniques, technical terms and the complex decisions you will need to make together with your surgeon to achieve a safe and aesthetically perfect result.
What is breast augmentation?
The Breast augmentation (also known as breast augmentation) is the medical term for the surgical enlargement of the female breast.
The aim of the procedure is to increase breast volume and improve their shape by inserting breast implants.
Choosing a breast implant: shape, size and surface texture
The most important decision concerns the implant itself. Modern cohesive silicone gel implants are available in countless varieties.
- Shape: Round vs. Anatomical
- Round implants: They ensure an even fullness, particularly in the upper chest area (décolleté). They are not affected by rotation and are the most commonly used shape worldwide.
- Anatomical (teardrop-shaped) implants: They mimic the natural shape of the breast. They are ideal for very slender women or in cases of tubular breast deformity, but carry a rare risk of visible rotation.
- Size and projection: The size is given in cubic centimetres (cc) or millilitres (ml). Equally important is the projection (profile), which determines how much the breast protrudes forwards (e.g. moderate, high profile, extra high profile).
- Surface: The implant shell may be smooth or textured. Microtextured surfaces are thought to slightly reduce the risk of capsular contracture and rotation.
Implant placement: subglandular, submuscular and the dual-plane technique
The positioning of the implant is crucial for a natural appearance and long-term safety.
- Subglandular (above the pectoral muscle): The implant is positioned directly behind the breast gland. This technique is used less frequently nowadays, as the edges of the implant can often become visible (rippling).
- Submuscular (completely beneath the pectoral muscle): The implant is placed entirely beneath the pectoralis major muscle. Many studies have shown that this position carries a lower risk of capsular contracture than a purely subglandular position.
- Dual-plane technique (partly beneath the muscle): This is a modern, very commonly used technique. The upper part of the implant is positioned beneath the muscle, creating a natural transition at the décolletage. The lower, fuller part lies freely behind the breast tissue, allowing the breast to move and sag naturally.
The incision: inframammary, periareolar or axillary
The approach used determines the subsequent scar. Each method has its own specific advantages and disadvantages.
- Inframammary incision (in the inframammary fold): The gold standard. The incision, which is approximately 4–5 cm long, is concealed within the natural breast crease. It provides the surgeon with the best possible view and the highest level of precision, minimises damage to the glandular tissue and is considered an approach that carries a low risk of impairing the ability to breastfeed.
- Periareolar incision (around the areola): The incision is made at the edge of the pigmented skin of the areola. The scar may be very inconspicuous, but carries a higher risk of sensitivity issues and breastfeeding problems, as glandular tissue has to be cut through.
- Axillary incision (in the armpit): It does not leave a scar on the breast itself. The approach is technically more challenging, as the surgical site is less clearly visible; without the necessary experience, this can make precise positioning more difficult.
Specific risks associated with breast augmentation: capsular contracture and ALCL
Understanding capsular fibrosis (Baker scale)
One of the most common specific long-term complications is capsular fibrosis. This is a condition in which the body’s own connective tissue sheath around the implant hardens. Doctors classify it into four grades according to Baker:
- Baker I: Normal, soft capsule. No action required.
- Baker II: A slight hardening; the breast is palpable but not misshapen.
- Baker III: Significant hardening; the breast is visibly misshapen and may be painful. Surgery is often recommended.
- Baker IV: Severe stiffness, marked deformity and severe pain. Surgical correction is usually required.
Another very rare but serious risk is that of Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a form of lymph node cancer that can develop within the capsule surrounding the implant. It is mandatory for doctors to provide comprehensive information about this risk.
Financial protection in the event of complications
The treatment of severe capsular fibrosis (Baker III/IV) or other complications requires a further, often complex, operation. The costs of this are not usually covered by health insurance providers. A policy taken out prior to the procedure Consequential Costs Insurance It can therefore provide important financial protection, safeguarding you against high costs in the event of an emergency.
Frequently Asked Questions (FAQ) on breast augmentation
With the dual-plane technique, the surgeon detaches the pectoral muscle at its lower edge and positions the implant behind it in such a way that it is covered by the muscle at the top but can expand naturally at the bottom. This combines the advantages of the submuscular and subglandular positions.
Rippling refers to the visible or palpable formation of waves in an implant beneath the skin. It occurs mainly in very slim women with little natural breast tissue, when the implant is placed above the muscle.
The inframammary incision is regarded in many specialist sources as a particularly safe and precise approach, with a comparatively low risk of sensitivity issues or breastfeeding problems.
The size is determined by a combination of your preferences and your anatomy (breast width, skin thickness, chest shape). Modern clinics use 3D simulations or trial implants (sizers) to visualise the result.
The old rule of thumb regarding routine implant replacement after 10 years is now considered outdated. Modern implants are often supplied with long-term or lifetime product guarantees; replacement is generally only necessary in the event of medical complications (e.g. implant fracture, capsular fibrosis) or if the patient wishes to change them.
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