Breast Augmentation (augmentation mammoplasty)

With a breast augmentation the size and the form of the breast can be modulated. An enlargement of the breasts is done with an implant. Usually the ability of breast feeding a baby is not affected.

Basic preconditions:
	You are over 18 years old, in good physical and psychological condition and have a realistic idea.
	You are not pregnant and not nursing your baby.

Preparations:
	About 4 weeks before the surgery, you should reduce smoking. Moreover alcohol should be avoided.
	On the day of the surgery you should not have your menstruation.
	About 2 weeks before the surgery you should not take anticoagulants (Aspirin, acetylsalicylic acid containing drugs).
	Not later than 3 weeks before the surgery the birth control pill must be discontinued.

Surgery preparations and examinations:
	For the surgery you need a blood count and an ECG. Your GP can provide both. Please bring the findings with you (it should not be older than two weeks).
	If you are older than 40 you need a complete blood count.
	If you are older than 40 a mammography is additionally required.

Length of the surgery:

Usually the surgery will take 1-2 hours depending on how the implants are inserted and which incision is used. The surgery will be carried out during a stationary stay in hospital of about two days.

Course of action:

Before the surgery you will be informed during a detailed counselling talk on how the surgery is done, possible complications, risks, and alternatives. Maybe you want to write done your questions on the surgery. The surgery will be conducted under general anaesthesia. Before the anaesthesia you will be advised by an anaesthetist about the risks, complications and possible alternatives to a narcosis. The anaesthetist will be present during the surgery. A general anaesthesia means stress for the body. During narcoses risks or complications can occur, depending on previous diseases and your general state of health.

Three different breast implant incisions are possible:

1st under the breast (inframammary incision): The surgeon makes an about 4cm long incision under the breast, close the inframammary fold. The implant is then placed in front of or behind the muscle. This technique has the advantage of an easy preparation and it gives the surgeon optimal visibility of the breast while working. Usually it provides a good rest of bleeding. One disadvantage may be that the scar can possibly be seen when you lie down. 2nd in the armpit (transaxillary incision): The incision is about 6cm long and the scar will not be visible when standing in front. Here as well the implant can be placed in front or behind the muscle. The advantage with this technique is that the scar will almost be invisible when standing in front. Disadvantages are that the incision does not accommodate good visibility during the surgery and that the scar may be visible when the armpits are shaved. 3rd around the nipple (periareolar incision): The surgeon makes an incision around the areola. The implant can be placed in front of or behind the muscle. Advantages are that the scar is hardly visible and that the areola can be adjusted during the surgery. Moreover the incision is accommodates a good visibility for the surgeon. Disadvantages are that the incision is very narrow, that glandular tissue may be cut, and the risk of a milk ducts (mammary ducts) infection.

In all three cases the surgeon creates a "pocket" for the breast implant. During the counselling talk it will be decided whether this "pocket" is in front or under the breast muscle. The advantages of the implant in front of the muscle are lower pain after the surgery and an easier preparation. However there is a risk that the implant may become visible after several years at the upper edge but this happens only very rarely. Moreover there is the risk of a capsula fibrosis.

The advantages of the implant being under the muscle are a lower risk of a capsula fibrosis, the mammary gland cannot be harmed and the implants are less visible.

Disadvantages are that it may be more painful after the surgery and that the recovery takes longer. Until the wounds are completely healed you may have some difficulties raising your arms. The breast augmentation is carried out during a stationary stay of one day in hospital.

Perception and possible complications:

Usually the pain in worse in the first 48 hours but they can be alleviated by pain killers that you will get in hospital. Normally pain become less and less every day. Like after every surgery secondary haemorrhages cannot be excluded. Therefore you should avoid taking acetylsalicylic acid (Aspirin) and other acetylsalicylic acid containing drugs two weeks before the surgery. Despite aseptic measures inflammations can occur. Preventively you get antibiotics.

After a surgery there can occur blood clots in the main veins (thrombosis), these can be carried further and thus block a blood vessel (embolism). As prevention it can be considered to take anticoagulant drugs (i. e. injections of heparin), however these cause an increased bleeding tendency and in very rare cases grave dysfunctions of blood coagulation.

Even when the wound healing is normal, scars can initially become red or harden. After a while they will fade, they become inconspicuous. An implant can change its length or form due to a capsular tear. In this case a correction surgery can be necessary. Due to external forces it is possible that the implant is ripped. You will be informed on further risks and possible side-effects in a comprehensive handout.

After the surgery:

Please make sure that an accompanying person is with you and there is a person that can help you in the first days at home as you will need a lot of rest. Usually you can travel home one day after the surgery after a thorough follow-up examination. However you should not drive yourself. If during the surgery you get drainages, these will be normally removed the next day.

Like after every other surgery, after breast augmentation complications like haematoma, secondary bleeding, a shift of the implants, or a capsula fibrosis can occur. Breast implants can also cause a deterioration of feelings in the breast and around the nipple; this effect however normally disappears after several weeks. A feeling of tautness is normal and subsides usually after a short period of time.

You will have to wear the supporting bra 6-8 weeks day and night, so that your breast is supported and the implants cannot shift. After the wound is completely closed, you can again take showers or baths. You should avoid sports, sauna, and solarium for 6-8 weeks. After 1-2 weeks you will be able to work again. In order to support the process of healing you can activate the blood flow by taking cold showers. You can apply scar ointment (i. e. Dermatix), salves, or baby lotion after the wound is completely closed in order to look after the scare.

Please don't forget to go to the follow-up examinations regularly: after 4 weeks, after 6 months, after 12 months, and once every year after the surgery. It can be carried out by your hospital or your gynaecologist.


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