A breast augmentation surgery is a voluntary operation, a decision you have thought about carefully. That is why it is important for you to get thoroughly informed during your decision-making process. The decision in favour or against the surgery though, is your personal decision which should be made solely by you !

Please take into consideration that breast augmentation surgery is an operation. Even the very best surgeon will never guarantee you a 100% outcome. Despite this fact such a surgery is relatively uncomplicated. However, there are the usual risks like adverse reaction to the anaesthesia or the possibility of infection. The quality of the aesthetic result may be reduced by specific complications like capsular contraction.

You should not hesitate to ask about our experience in your initial discussion. You will get a complete consultation including clinical pictures of former patients. We recommend you write down all your open questions before your initial discussion with us.

A thorough pre-operative evaluation includes information about any allergies or chronic diseases, if anticoagulant medication is taken or if there is an increased tendency to form scars. A mammogram is recommended to women over 35 prior to breast augmentation surgery to exclude the existence of any tumour.

The operation usually takes about one to two hours to complete. Which surgical techniques are most appropriate depends on anatomical factors as well as on your individual desires.

Typical anatomical factors are:

• genetically predetermined small breasts (Mammahypoplasy)
• abnormally small, hardly developed breasts (Juvenile Mikromasty)
• normal-sized breasts that need more volume
• small breasts due to loss of weight
• sagging breasts due to age (Ptosis)
• tubular breasts
• breasts that differ in size (Asymmetry)
• genetically predetermined under-development of one breast (e.g. Poland Syndrom)

Following procedures are available in breast augmentation surgery:

		The transareolar or periareolar augmentation procedure is the most concealed but is associated with a higher likelihood of inability to successfully breast-feed and might cause a disturbance of sensation. The armpit (transaxillary) incision offers a scarless breast since the incision site is in the armpit. With this procedure you have a limited choice of implant size and shapes, because anatomic implants are more difficult to position. The skin incision along the inframammary crease gives the surgeon optimal visibility while working and is suitable for large-sized implants and all shapes and is therefore the most frequently chosen procedure.
		The surgeon makes the incision and creates pockets in which to place the breast implant, that means he makes space for it. This space and the implant must have the same size. Breast implants may be placed subglandular which is between the chest muscle and the breast tissue or submuscular which is below the chest muscle. Either placement has got advantages and disadvantages which we shall explain to you.
subglandulär	submuskulär

Women with highly sagging breasts might need a breast lift additional to the implant. The removing of excess skin and a possible repositioning of the nipples may cause scars to widen more than it would be the case with breast augmentation. Please see the link Breast Reduction as well.

4. Types of implants

		Silicone - a natural decision Silicone implants of the new generation are determined to be absolutely safe and offer the most natural looking breasts. In our clinic we use only high quality gel-filled implants manufactured by leading producers according to EC standard.
round-shaped silicone implant	drop-shaped silicone implant

Previously applied hydro-gel implants are not used any more because there is no sufficient long-term data available to fully assess safety and a possible interaction between implant and filling. Soja bean filling in breast implants proved not to be stable and deteriorated after some time thus being suspected to cause cancer.

Silicone-filled implant is the most frequently used type of implant in breast enlargement as well as breast reconstruction surgery in Europe and in the USA. The cross-linked silicone implant keeps its anatomical shape because of the cross link inside the silicone gel and in case of deformation regains its initial shape due to a so-called “memory-function”.

Such implants do not leak even if the outer shell is injured they remain firm. Implants are available with a smooth, textured or polyurethane-coated surface. A human organism is able to react to any foreign body by modifying the surface. The body's natural healing process creates a capsule around the breast implant, just as it would around any other foreign object. This might lead to a capsular contraction (capsular fibrosis) resulting in pain, hardening of the breast and deformation of the implant.

Contraction of connective tissue capsules is mainly influenced by the arrangement of its fibres. The more regularly they are arranged the greater the risk of a capsular fibrosis. To avoid formation of a capsule with regular woven fibres around the implant, the surface of the outer shell is modified thus disturbing the arrangement of the fibres so that they cannot be woven linearly around the implant. The result is minor or no contraction of the fibres.
Capsular fibrosis rates of 50% have been reduced to less than 3 %.

To avoid blood-clotting or serum fluid it is very important to add compression to the operated part. This is achieved through special compression bras. The pressure they provide prohibits the built-up of lymph and blood between implant and tissue. Otherwise this could lead to scarring, capsular fibrosis and bad healing. For the same reason the drainage is left for some time after the operation in order to allow surplus serum and blood to drain thus accelerating the healing process. After the operation an appointment will be made to discuss all relevant themes, where you can ask any questions which have arisen.

What is silicone?
Silicone is used in various products in medicine like tubes, catheters, coatings of cannulation needles and pace makers, gloves and wound plasters. In surgery implants are used for body contouring. Silicone polymere was first developed and patented in1958.
The chemical terminology for silicone is polydimethylsiloxane. It is used in the production of silicone gel, silicone elastomer or silicone oil. In silicone compounds the bond between oxygen and silicon is the same as it is in stones and glass. Moreover methyl groups are attached to the silicon atoms. Except for pyrogenic silicic acid (amorpheous silica) which is a highly stabilising filling material there are no more additional components especially no softening agents. That means silicone is a stable, chemically exactly defined implant material.

How long does an implant last?
For a single implant we cannot answer this question because of the various reactions of an individual organism to a foreign object. We can only use the statistics of medical studies on this theme. This reliable data is derived from studies of implants which had to be extracted due to various reasons. It showed that the average expiry date was more than 10 years. The continuous improvement of modern implants enabled this durability to be extended. Especially young women should, however, be aware of the fact that a replacement of the implant may be necessary disregarding implant type or make. We recommend a medical check-up every six months to one year.

Implant pass and documentary
After the operation you get an implant pass which you should carry at all times, so that type and size of the implant is readily accessible. For your own safety please inform your GP about your implant.

Are safety tests presently being conducted?
Yes. For many years reliability and health risks of implants have been constantly checked. The safety profile is based on experience of over 35 years. All over Europe there are certain specifications concerning norm and standard of medical products which also apply to these implants. Strict rules concerning material, product development, production sterilisation and packing have been laid down as well.

Is there a higher risk of breast cancer due to breast implants?
It was proved in a wide study that women with implants were not more susceptible to breast cancer than women without an implant.
Neither in animals nor in people were cancer-cells observed due to smooth, textured or polyurethane-coated implants. Scientists are constantly discussing theoretical reasons though.

Is there a bigger risk for Autoimmune disease?
No! Up to now no connection has been found between silicone-filled implants and Autoimmune disease.

Can silicone gel seep through the implant?
In comparison to earlier implants there is a constant gel consistency because of the improved outer layer and only a small percentage of gel in the connective tissue capsule around the implant has been found.

Your mednord Clinic doctor will decide how often a check-up is necessary.
We suggest post-operative check-ups after one month, three months, six months ending with a regular check-up every half year or full year depending on the situation.

It is possible to have a mammography with implants, with the help of the so-called “Eklund technique”. In the case of a tumour modern screening methods like Sonography, Magnetic resonance imaging (MRI) or Computerized tomography (CT) help to detect the tumour in the early stages.