Breast augmentation

Before a breast augmentation: What constitutes the “ideal” breast?

The answers are as varied as a woman’s reasons for having her breasts augmented. Aesthetically, the “ideal” breasts are symmetrical, but in terms of small or large, firm or soft, slightly relaxed or “pushed up”, opinions and preferences vary considerably.

Women with very little glandular breast tissue and a very flat chest that looks rather “boyish” often desire (a) more feminine shape/breasts and a little more cleavage. Some women have beautiful breasts but would like them to be larger. Many patients come to us for a consultation after pregnancy, wanting their “old”, naturally firm breasts back. Yet others decide on a breast augmentation – be it with implants or their body’s own fat – or a breast correction because of their age or for aesthetic reasons. What constitutes the most beautiful breasts for a person is not a matter of age – however, you should be over 18 and should have stopped growing. Then we can discuss individually what is most suitable for you.

Breast augmentation: Why should I go to a plastic surgeon?

Almost any surgeon and specialist who familiarises himself with the relevant literature is able to insert a silicon pad above or under the pectoral muscle – provided the breasts are symmetrical and in perfect shape. Years of experience have taught me that this ideal scenario is rarely the case. Usually, my patients come to me because their breasts are no longer in perfect shape after a pregnancy, because their breasts are slightly asymmetric or have taken on a tubular shape. In such cases, different surgical techniques and elements of breast surgery must be combined, for which a 6-year training as a specialist for aesthetic and plastic surgery and many years of professional experience are required.

Detailed knowledge of the precise muscle insertions, the course of the blood vessels and nerves as well as the different kinds of tissue are imperative for a smooth healing process. In my capacity as a doctor of medicine and experienced specialist for plastic surgery I can inform you comprehensively about the different techniques for breast surgery and the risks associated with breast augmentation as well as the various options and make appropriate recommendations. A breast augmentation is a surgical intervention and should not be taken lightly. Therefore, you should always choose a plastic surgeon for such a procedure.

Comprehensive on-site analysis and consultation in Berlin

During your initial consultation in our practice near Kurfürstendamm we will comprehensively discuss all options available, which surgical methods and which kind of breast implant can achieve the best possible result desired by you. For that purpose, we use the Biodynamics System of Allergan. You insert sample protheses in a sports bra and check in the mirror which size you may be acceptable to you.  Before-and-after pictures will help you decide on the size. In addition, we offer a 3D simulation which allows you to see on a computer what you might look like after surgery. This is demonstrated in the following video.

We measure your chest, decide where to make the incision and discuss the surgery with you step by step. This consultation lasts around one hour.  For us, it is important to answer all your questions. And most of all, that you are content with your decision. This consultation is not binding and free of charge. You can ask any questions you might have about breast augmentation and get detailed information without having to conclude a treatment contract. Depending on your wishes, we will also discuss alternatives to a breast augmentation with you, e.g. breast lifting.

Video: Sequence of a breast augmentation by Dr. med. Bodo in Berlin:

Which implants are used for a breast augmentation?

A breast augmentation changes your body – and the changes vary depending on the patient. It is therefore important to recognise clearly which measures are most suitable for you. For most breast augmentations, we use high quality silicone gel brand implants with a manufacturer’s warranty. In our experience, this is the “gold standard”. This implant feels the most natural, is very well tolerated and there are no known allergies. The new models consist of a cohesive silicone gel. If there are no complications, these implants can last a lifetime. A change of implants every 10 years, which used to be customary, is then no longer required.

We use breast implants produced by Polytech, Allergan, Sebbin and Motiva, all of whom meet the highest quality standards. However, upon request we can insert (almost) any other products.
The particularly light B-Lite Implants represent a new alternative. Due to a special treatment of the silicone gel, their weight has been reduced by about 1/3. That means that silicone implants of 300g (10.5 oz) weigh only around 200g (7.05 oz).  This is a particular advantage for larger implants and for a subglandular placement as the weight of the implants does not pull so hard on the skin.

Shape of implants

There are round and teardrop (anatomically) shaped breast implants in various diameters and projections – low, moderate, high or extra high profile.  For teardrop shaped implants, another distinction is made between a round base or a longitudinal/transverse-oval shape. There are more than 200 different implants that we can choose from. Therefore, the choice of the right implant is the key to the “breasts you have always dreamed of”.

If you are dreaming of beautiful, large and full breasts with a great cleavage, you should choose round implants. If you prefer breasts that look “as naturally as possible”, teardrop (anatomically) shaped implants are the better choice. Precise measurements of your chest and the desired breast shape are important to select the most suitable implant.

Whatever shape of implant you decide on, the shape and condition of your breasts before surgery is crucial.  A comprehensive consultation and discussion of your wishes and ideas is key to a result that matches your expectations.

Alternatives to silicone implants: breast augmentation with your body’s own fat

Instead of silicone gel implants, saline implants or a breast augmentation using your own body fat may be chosen.  Nowadays, saline implants are hardly ever used as they are much harder than silicone implants. They can reduce in volume after a certain period of time or even burst. Saline is not dangerous or harmful, but surgery would be required in any case to remove the outer shell that always consists of silicone, anyway.

breast augmentation using your own body fat is performed in conjunction with liposuction. With the help of our suction method, your fat cells remain “alive” and connect quickly with their new environment. Therefore, your breasts feel very natural. A one-off treatment under local anaesthetic can increase your chest by up to one cup size. Compared to the usual surgery with implants, patients undergoing a breast augmentation with their own body fat tend to recover much more quickly. However, one potential disadvantage is that your body may break down its own fat in time and the procedure may have to be repeated.

What happens during a breast augmentation at Dr. Bodo’s practice in Berlin?

There are three options for inserting the breast implants:

  • The most common option is an incision in the inframammary fold. This is very gentle on the breasts. In addition, the glandular tissue is hardly touched.
  • Less frequent, but still popular, is an incision around the nipple. The scar is very discreet, but there is a slight risk that the ability to breastfeed may be impaired. Therefore, women who have just given birth or still want to have children often decide against this option.
  • An incision in the armpit is an option we only use for smaller implants. Larger silicone pads may slip and with implants of a certain size an exact placement of the implant is technically almost impossible when using this kind of incision.

During our comprehensive consultation, we will discuss with you which option is the right one for the breast surgery you desire.

Implants can be placed either above (prepectoral/subglandular) or under the pectoral muscle (subpectoral/submuscular). A subfascial placement is another option, where the implant is placed under the fascia (connective tissue). This achieves a slightly greater coverage than the purely subglandular placement of the implant.
When placing the implant under the pectoral muscle, we distinguish between a complete placement under the muscle or a placement only under the M. pectoralis major (the large pectoral muscle). After detaching the muscle, there is a variety of options – e.g. the dual plane technique grade 1-3: partly under and partly above the muscle.

Whether an implant is placed under or above the muscle depends on your tissue, the skin thickness and also the choice of model. We normally recommend placement under the pectoral muscle, as the implant is covered better in the long term and does not slip.

We usually perform a breast augmentation under general anaesthetic. In theory it is possible to administer a local anaesthetic to the breasts, but this would require an injection of larger doses of anaesthetics, resulting in changes to the tissue and the implant slipping more easily. As the ribs (bones) cannot really be anaesthetised locally, placing a breast implant under the muscle using local anaesthetic is very uncomfortable. For this reason, a local anaesthetic is only possible when the implant is placed above the muscle. In such cases, we additionally administer an intravenous sedative. We do not recommend this method. However, in case of legitimate reasons against a general anaesthetic this option would be available after consultation with the anaesthetist.

The surgery usually takes around one hour and is therefore significantly shorter than a breast reduction. If the breast augmentation is combined with breast lifting, surgery takes proportionately longer. After surgery, you will usually have to stay in the clinic for 24 hours so we can keep an eye on you overnight. However, there are patients who feel so comfortable here that they have stayed for 2 nights.

Of course, we can also perform your surgery on an outpatient basis. Depending on how the surgery went, you can be discharged approximately 3 hours after surgery and go home, accompanied by a person you trust. However, as each patient reacts differently to anaesthetics, we recommend you stay at our comfortable private clinic for one night to receive aftercare. We have good food, a comprehensive TV and video programme, our team will look after you 24/7 and when you sleep the night nurse will watch over you to make sure you are comfortable. Should you experience unexpected pain or feel a little queasy, we will be on hand in an instant. How many people have that kind of service at home?

Advice after breast augmentation surgery

After your breast surgery, you will need to wear a support bra day and night for 6 weeks. For the first 10-14 days you should take it easy and avoid any exertion. We also recommend that you do not consume nicotine or alcohol during that time. After 2 weeks you can resume your daily chores. However, you should avoid any heavy strain on your pectoral muscles (sports, heavy lifting), skipping or jumping as well as working for extended periods with your arms lifted above your head.  You should also avoid lying on your stomach during this time. After removing the plasters, we recommend you apply cream and massage the scars every day to help with the healing process – if necessary with special scar care that you can obtain from us.

Will the breast augmentation leave scars?

Yes. Despite surgical techniques involving minimal scarring a breast correction will always leave a scar when we insert an implant. Depending on the size of the implant, this is usually only a few centimetres long and is placed in such a way as to be barely visible later on.

What are the potential risks and side effects of breast surgery?

During the consultation you will be asked about any allergies, pre-existing conditions etc.  Blood clotting disorders and a pregnancy must be ruled out. Depending on the placement and size of the implant you will feel some pain in the chest area during the first 4-5 days after surgery, possibly accompanied by slight swelling. We can counteract these complaints by administering light medication.

During the first 6 weeks after your treatment, until the implants have become attached, the implant may slip due to incorrect postoperative behaviour. Therefore, it is very important that you wear the special bra and avoid any strain on your pectoral muscles.

Capsular contracture (hardening of the implant), which is a potential risk, hardly ever occurs with the implants used by us. During the healing process the body forms a capsule around the implant. The attaching tissue is usually very soft and feels natural.  In rare cases, this capsule may harden, which can result in the implant becoming deformed. Treatment of a capsular contracture is not a problem, but requires surgery again.

Further risks, like with any surgery, are inflammations, thrombosis, numbness or bleeds. We will inform you extensively about all potential complications before your surgery.

Is it possible and sensible to have a breast augmentation without surgery?

There is no reputable, officially accredited and above all lasting and effective method for breast augmentation without surgery, even if many women would like that for fear of scars after a breast augmentation. Filling the breasts, e.g. by injecting Hyaluronic acid or other so-called fillers, including a Macrolane breast augmentation, has the distinct disadvantage of the effect wearing off very quickly and the treatment potentially having to be repeated every 1-2 years.  At present, breast augmentations with Hyaluronic acid are not permitted in Germany.

Breast augmentation by means of injecting saline only have a very short-term effect and bear the risk of heavy pain and the breasts literally wearing out. This procedure is therefore not officially offered or performed in Germany – it is exceedingly dubious and shady.