Breast augmentation
At our centre, we perform breast augmentations based on our vast experience with both silicone implants and with autologous fat. We only use established, high-quality silicone implants and the facilities where they are manufactured have been personally visited by Dr. Wedler. Depending on the anatomic conditions, round or tear-shaped breast implants may be chosen (anatomically), with each model again including subtypes with different heights, projections, widths and volumes (>300 models). The “autologous fat method” uses excess fat from another region of the body (the legs or the abdomen) obtained by means of standard liposuction (see also: “lipofilling”) and reinjected under/around the breast.
Breast augmentation using silicone implants
Breast augmentations using silicone implants are most often performed in young women with very small breasts after puberty, between the 19th and 25th year of life, and after pregnancy at the age of 30-45 years. Depending on the findings, the augmentation may be performed alone or in combination with lifting (mastopexy). This procedure, in most cases performed under general anaesthesia, can be planned in an outpatient setting or with overnight stays. The silicone implants are inserted either via an access route from the fold under the breast (submammary) 3.5-5 cm in length or an incision along the areola (periareolar). It would also be possible to gain access in the region of the armpits (transaxillary).
Depending on the anatomic conditions, the wishes of the patient and in accordance with the informed consent discussion, the silicone implants are placed either directly under the mammary gland (subglandular/epipectoral), under the pectoralis major muscle (subpectoral) or under the muscular fascia (subfascial). Should the breasts show moderate to strong sagging (ptosis) already prior to surgery, the lifting effect is achieved either via the volume or by additional lifting (see also under “mastopexy”).
Following surgery, a breast band and a brassiere are prescribed to secure the implants in place for 3-4 weeks. Likewise, the patient should not engage in any athletic activities for 3-4 weeks and the informed consent discussion will detail any potential complications and address the patterns of behaviour to follow.
Since silicone implants are foreign material, the body will recognize them as such and will surround them with a covering (capsule), which in rare cases may harden as a late complication (capsule fibrosis).
Breast augmentation with autologous fat
With this technique, the patient’s own fat is removed in other parts of the body – if there is sufficient fat tissue available – by liposuction and injected sterile under the mammary gland. This technique is useful for a moderate enlargement (e.g. enlargement by half a cup size) in one session. For a bigger enlargement, it is expressly mentioned in the consultation that the “take rate” cannot be guaranteed and that several interventions must be planned to reach the treatment goal. An unlimited amount of fat tissue cannot be transplanted, as the tissue must primarily develop a vascular connection and thus sufficient blood circulation. In the literature the take rate is given as 50-80% and we can share this experience. For this reason, 2-3 procedures can be performed with this technique. Due to the fact that the patient’s own tissue is natural without a rejection reaction, this method is of great advantage. A combination with the PRP technique (see Platlet Rich Plasma) improves the growth rate of fat tissue.
