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    Dr. S. Fenner
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    german
    english
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    Dr. med.
    S. Fenner
    Specialist
    in Plastic
    and Aesthetic
    Surgery
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    .

    Breast
     augmentation

    (Augmentation)

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    .

    There are essentially two methods for breast augmentation: the insertion of silicone gel implants and autologous fat transplantation.

  • 1. Silicone Gel Implants
  • 2. Autologous Fat Transplantation

    • 1. Silicone Gel Implants

    A well-established method for breast augmentation is the insertion of silicone gel implants. Only high-quality implants from certified companies that offer a warranty on the implants are used.

    A wide range of different implant shapes and sizes are available: essentially anatomically shaped (teardrop) and round implants in various widths, heights, and projections. There are micro-textured, rough, smooth, and PU-coated surfaces available. Additionally, there are B-Lite® implants that are about 30% lighter.

    The implants are placed under the major pectoral muscle (which covers about the upper half of the implant), completely under the muscle, or under the breast tissue (i.e., on the muscle), taking into account the breast shape and size and the risk of capsule fibrosis.

    The access routes and the resulting scar locations include the inframammary fold (under the breast), the armpit, and the areola border. Scars in these areas, when using precise suturing techniques, are generally inconspicuous, delicate, and pale. The length of the scar depends, among other things, on the size of the implant.
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    Scar path inframammary fold
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    Scar around half areola
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    Scar in armpit
    The recommendation for implant shape, position, and scar location depends on the patient’s body, breast shape, size, and personal preferences, and can only be made after a detailed consultation and thorough examination. Various anatomical parameters are measured, and based on these, the optimal implant shape and size are calculated. By inserting different trial implants into a special bra, the surgical result can be simulated, helping the patient choose the implant size. Expectations, success probability, potential complications, necessary preparatory examinations, and post-operative care are also discussed.

    The goal is an attractively shaped, naturally appearing, full breast in harmonious coordination with the overall appearance of the woman.

    Since breast augmentation with implants involves the long-term implantation of a foreign body, women must be clearly informed about risks such as capsule fibrosis and breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) during the consultation. The chosen surgical method should minimize these risks as much as possible.

    Since 2024, Germany has introduced a mandatory breast implant registry, which will provide more security and transparency regarding breast implants for both patients and surgeons.

    Frequently Asked Questions
    silicone implant

    FAQ on the topic
    silicone implant

    Which implant surface do you recommend?
    Options include micro-textured, rough, smooth, and PU-coated surfaces. The choice depends mainly on implant position, risk of capsule fibrosis, and the very rare BIA ALCL, and is an individual decision.
    Are round or teardrop implants better?
    This depends on the shape and size of the breast tissue, the implant size, and the patient's expectations.
    How long do breast implants last?
    Compared to older implants (which often lasted only about 10 years), the shell construction of breast implants has significantly improved, leading to much longer durability, potentially even lifelong. The key is the use of high-quality implants from certified companies that offer guarantees.
    How long does breast augmentation surgery take?
    The surgery is performed under general anesthesia and takes about 1.5 hours.
    How long is the hospital stay for breast augmentation?
    Patients typically stay for 1 night in the hospital.
    What risks are involved in breast augmentation surgery?
    A detailed risk assessment and explanation are provided before the surgery, including risks like bleeding, capsule fibrosis, infection, implant displacement, rotation, scarring, and BIA ALCL.
    What aftercare is required following surgery?
    A compression bra must be worn continuously for 6 weeks (except when showering). Occasionally, a "Stuttgart belt," which prevents implant displacement, may be necessary. The sutures are self-dissolving, so there’s no need for suture removal. Regular check-ups are scheduled for wound healing and scar maturation.
    How long will I be unable to work or exercise?
    Depending on physical activity, you should plan for anywhere from a few days to two weeks off. Excessive physical strain, particularly of the arms, should be avoided for 4 to 6 weeks.
    What is the cost of the surgery?
    The surgery costs start at €6,500 net and are not covered by health insurance.
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    2. Autologous Fat Transplantation

    By transplanting autologous (one's own) fat tissue into the fatty layer under the skin (and in the area of the breast muscles), breast enlargement is possible. The goal is an attractively shaped, naturally appearing, full breast in harmonious coordination with the woman's overall appearance.

    According to guidelines, fat tissue is not injected directly into the breast glandular tissue, as calcifications or cyst formation could interfere with breast cancer screening.

    Water-jet-assisted liposuction is generally used to harvest the fat tissue, ensuring a high percentage of viable fat cells and thus a high success rate for the transplanted fat. According to current literature, there is no significant correlation between the fat removal site and the rate of fat transplant integration. Therefore, the donor site can be selected primarily based on the desired post-operative body silhouette.

    A portion of the transplanted fat tissue or fluid will be reabsorbed in the first few weeks following surgery. Post-operative care plays a significant role in the success of the fat integration process and must be discussed and carefully planned. The final result is expected about three months after surgery.

    Since overcorrection can lead to complications like fat necrosis, a staged approach is favored for larger volumes, which will be planned in advance. A minimum interval of three months between surgeries should be respected.

    After a thorough breast examination, expectations and success probabilities of this method are evaluated during a detailed consultation, along with possible surgical risks, necessary preparatory tests, and post-operative care.

    Frequently Asked Questions
    Fat Graft Transplantation

    FAQ on the topic
    Fat Graft Transplantation

    What preliminary tests are required before a breast augmentation with fat?
    Ultrasound and/or mammography are recommended before surgery, depending on age, medical history, and family history of breast conditions. Additional tests may be necessary based on individual health factors.
    How long does the breast augmentation with fat take and what is the hospital stay?
    The surgery is done under general anesthesia, and its duration depends on the amount of fat and number of donor areas. The procedure can be done on an outpatient basis or with one overnight stay.
    What breast size do you recommend?
    The breast size should harmonize with the body’s overall appearance—namely, body constitution and size. A limitation may occur due to the available fat tissue.
    What aftercare is required following fat transplantation?
    Post-surgery, excessive movement of the shoulders and pressure on the breast area should be avoided for about 6 weeks. Follow-up checks for wound healing and scar maturation are necessary. The final result will be seen about three months after surgery.
    What risks are involved in fat-based breast augmentation?
    A detailed risk assessment and explanation are provided before surgery, covering risks like bleeding, infection, fat tissue absorption, calcification, cyst formation, and thrombosis.
    What is the cost of the procedure?
    The cost of the treatment depends on the extent of surgery, including the amount of fat to be transplanted, the number of donor areas, and whether the procedure is outpatient or inpatient. Costs vary significantly and are not covered by insurance.
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    Follow-up cost insurance

    When performed by an experienced and specialized plastic surgeon, aesthetic surgeries are relatively low-risk procedures. However, despite the greatest care, there is always a possibility of complications with any surgery. Therefore, a serious and comprehensive consultation should also include information about the potential economic consequences of such surgery, as well as the option of follow-up cost insurance.