Breast augmentation

Many women are dissatisfied with the size of their breasts: They often feel they are too small, either after breastfeeding or losing a lot of weight, or they have never liked them. Such women may well suffer stress, resulting in psychological issues and sexual inhibition. Breast augmentation offers them a way to achieve a new sense of well-being.

However, the costs of breast augmentation are not covered by basic health insurance if it involves a purely cosmetic procedure. On the other hand, insurers will bear the cost of breast surgery if it is performed for health reasons, such as breast reconstruction following removal due to cancer or to correct a specific developmental disorder.

The cost of a breast augmentation varies depending on the complexity of the procedure. This is clarified in the preoperative consultation.

Types of breast augmentation

What are the surgical options?

A breast augmentation can be carried out using implants or the patient's own fat. If a patient opts for a procedure with her own fat, she must have enough spare fat on her body for an augmentation – for example, on the stomach, hips or inside of the thighs. This fat is injected using a fine needle that leaves minimal scarring. Breasts enlarged with fat taken from the body will look natural, and extracting this fat elsewhere on the body ensures that the patient's overall figure remains in proportion. However, if a woman's own fat is used, the breasts cannot be increased by more than one cup size.

A possible alternative here is implants. They are made of silicone or – nowadays much less commonly – filled with saline and are inserted in the breast via an incision. These implants are either round so they fill out the entire breast, or teardrop shape, where it then is more the lower part of the breast that increases in size. The volume of implants normally ranges between 80 and 600 millilitres, thus offering a wide variety of sizes for each breast augmentation procedure.

How are breast implants inserted?

The implants used at Hirslanden are governed by the provisions applicable to medical devices and satisfy stringent quality requirements. The shape and size of implants is decided individually during a personal consultation between the doctor and patient. This not only takes into account the wishes of the woman in question but also her physical attributes, such as the shape of her ribcage or the position of her ribs.

The implants are placed in the breast by means of an incision in the skin. This incision is generally made in the skinfold underneath the breast. At this location, the body heals well and scarring will be barely visible. This method also impacts less on the lymph tissue, which allows the patient to breastfeed later on. Alternatively, access is also possible via the areola or in the armpit.

Depending on the result desired by the patient, implants can be positioned either under, between or on the muscle of the breast. If the procedure involves opening the breast muscle, the healing process after surgery may be slightly slower.

Information and preparation

What does the preparation involve?

The doctor discusses every aspect of the intervention with the patient during a detailed preoperative consultation. This includes a description of the planned procedure and the subsequent follow-up treatment. The doctor also outlines possible complications during this consultation.

Two weeks before the operation, the patient should discontinue any blood-thinning medication – for example, certain painkillers – and abstain from alcohol and nicotine.

When do implants generally need to be replaced?

Modern implants do not wear out and normally last a lifetime. Nonetheless, they may need to be replaced on aesthetic grounds if the shape of the breasts changes due to subsequent pregnancy and breastfeeding. This may also come about through significant weight loss, surgery performed for health reasons or simply due to the natural ageing process.

Requirements and risks

What requirements must the patient fulfil?

There are no age restrictions on breast augmentation. Surgery is possible if the patient wishes it and her state of health permits it.

However, patients should not plan to fall pregnant or to lose a lot of weight in the near future as these factors may affect the shape of the breasts.

Surgical procedure

A breast augmentation normally takes around one and a half hours and involves a hospital stay lasting one or two days. First of all, the surgeon accesses the breast by means of an incision that is a few centimetres in length. This incision is generally made in the skinfold underneath the breast, and less frequently at the areola or in the armpit. The implant is then inserted through this opening. Depending on the surgical procedure used, it may also be necessary to open the breast muscle if the implant is to be placed underneath. The skin incision is closed with absorbable stitches, , and a support bandage is applied to the breasts to relieve any strain on them.

In individual cases, surgery can also be performed as an outpatient procedure or under local anaesthetic. The attending doctor will make a recommendation in this regard during the consultation with the patient. If no hospital stay is planned, the patient should not be left on her own, at least for the first night after the procedure.

Complications may also occur following breast augmentation, as is the case with any surgical intervention. This includes post-operative haemorrhaging, infections, blood clots and wound healing disorders. However, breast augmentation is a routine procedure at specialist hospitals and as such, carries little risk.

Aftercare and behaviour following breast augmentation

The support bandage is removed on the day after the operation and generally also the drainage tubes used to discharge the remaining wound secretion. A breast augmentation is considered to be complete when the body has formed supporting connective tissue around the implant and the incision site has healed well. These processes can take several weeks. Healing is monitored with repeated check-ups during this period, with individual appointments being agreed with the patient.

The length of time that a patient then takes off work depends on the procedure and varies between a few days and two weeks. The attending doctor makes a prognosis in this regard during the preoperative consultation.

How should patients behave following breast augmentation?

They should be very careful of their breasts in the first few weeks after surgery. Patients must wear a special sports bra 24 hours a day for a period of six weeks. Strenuous physical exertion such as lifting or carrying heavy loads as well visits to the sauna should be avoided. Exposing the breasts to direct sunlight will also hinder the healing process.

In the first few weeks after surgery, patients should only sleep lying on their back to relieve the strain on the breasts.

When can patients become pregnant following breast augmentation?

Despite the less intrusive surgical procedures available nowadays, breast augmentation always puts a strain on the breasts. For this reason, patients should wait at least three months before becoming pregnant (again). This allows the connective tissue around the implant to become stronger and the surgical wound to heal.

Breast augmentations do not impair a woman's ability to breastfeed later on. Surgery using the skinfold under the breast has the lowest risk of injuring the lymph tissue. Women who wish to have children afterwards should therefore inform their attending doctor of their intentions before the procedure.

Risks of breast implants

How does breast augmentation affect the risk of cancer?

Breast augmentation has no impact on the risk of getting breast cancer.

The recommended screening examinations for the early detection of breast cancer can be safely undertaken; implants do not affect the results of a mammography.

During the examination, the breast is heavily compressed, which may increase the risk of a tear in the outer casing of the implant. As modern silicone implants do not contain any fluids, it is not possible for the silicone gel to leak into surrounding tissue. In the case of saline implants, which are now not used as often, the fluid may escape but will then be readily broken down by the body.

What happens if implants have to be replaced?

The most common complication that may occur following implantation is capsular fibrosis. This is observed in four to eight per cent of all operations. Excessive connective tissue forms around the implant and hardens. This presents no health risk, but patients may suffer pain and a feeling of tightness in the breast. Connective tissue that has become stiff may also change the shape of the breast, as in pregnancy, breastfeeding, a reduction in weight or sagging of this tissue through ageing. In such cases, the implant can be replaced and modelled in line with the shape of the breast.