Breast Augmentation / Breast Enlargement
Breast Augmentation using the Tebbets method (John B. Tebbetts, MD - Dallas)
A beautiful breast is an essential feature of feminine attractiveness and plays a crucial role for both the female identity and the self-confidence of women.Unfortunately, the female breast in shape and size often does not correspond to a women’s own ideal image.
If the breasts are felt to be too small, these are mostly small, firm breasts. If you want bigger breasts, naturally with a beautiful breast shape I recommend you seek advice about breast augmentation with breast implants.
If after weaning, a diet or due to the natural aging process your breasts sag due to a loss of volume loss (reduction of the gland and adipose tissue), then the breasts can be raised again by a breast lift. In this case, a breast augmentation using breast implants is also possible.
Modern breast implants are available in two shapes with different shells and fillings as well as in different sizes.
The Shape of the Breast Implants
In breast augmentation breast implants can be round or anatomically-shaped. With round breast implants the implant width corresponds to the implant height and with anatomical breast implants there are three different height dimensions available for breast augmentation: full height, moderate height and low height.
The shape also includes the profile and depth of the breast implant. In breast enlargement, the higher the profile of an implant, the more it pushes the breast up and to the front; this applies equally to both round and anatomical breast implants. The more the implant profile pushes up and forward, the more pressure the implant exerts on the patient’s own breast tissue in breast augmentation.
Breast Implant Shell
In breast augmentation breast implants with a smooth and textured surface as well as implants with a polyurethane coating are available.
Breast Implant Filling
For fillings of modern breast implants there is a distinction between saline and a cohesive, more resistant silicone gel.
Breast Implant Size
In breast augmentation the size of the implant depends on the height, width and depth (the profile).
For breast augmentation we use only certified breast implants, for which the manufacturer offers a lifetime warranty (guarantee) for material defects of the breast implant. Therefore, if there are no complaints there is no need to change the breast implants after a given time, but this can be done at any time for aesthetic reasons.
Breast Augmentation - Consultation
Small breasts can be enlarged and droopy breasts can be lifted again through breast augmentation. A prerequisite for an optimal result from breast enlargement is consultation. During detailed consultation we can also show you before and after pictures. We will also take the necessary measurements and inform you of the possible risks of breast augmentation. Health risks, which would argue against breast augmentation, should be clarified in advance. In this case, pre-existing illnesses are as important as medications taken regularly or occasionally. Blood thinners that contain acetylsalicylic acid (e.g. Aspirin®) or phenprocoumon (e.g. Marcumar®) must be discontinued, after consultation with the family doctor, before breast augmentation.
Possible Risks of Breast Augmentation
There are general risks with breast augmentation such as bleeding, infection, healing problems and unsightly scarring. Asymmetry is not actually regarded as a risk because the left and right breasts are never the same in terms of shape and size. The question is rather how visible the difference is. Special risks of breast enlargement are rotation of the implants, visible and palpable breast implants as well as the formation of capsular fibrosis.
Breast Augmentation and Capsular Fibrosis
In breast augmentationa delicate cover is built around each foreign body, a capsule from the body’s own connective tissue as well as around a silicone implant. If this is thicker than normal due to increased connective tissue formation, this is capsular fibrosis or capsular contracture. The connective tissue skin hardens in a spherical shape and due to the implant this results in a palpable and visible deformity that can even be painful. The risk for the formation of capsular fibrosis is about 3% and is greatest in the first year after the breast augmentation. There does not seem to be a clear cause for the formation of capsular fibrosis – there are many different factors that can promote or inhibit its formation after breast enlargement. Considered as factors that hinder capsular fibrosis formation are breast implants with a rough surface as well as the implant position under the pectoral muscle. The well-vascularized pectoral muscle could contribute to protection against bacteria and the constant movement of the muscle to a lower capsular contracture rate.
Capsular fibrosis after breast augmentation is divided into different grades:
Grade I –the breast appears natural in size and shape and is soft
Grade II – the breast appears natural in size and shapeand is a little firm
Grade III –the breast appears abnormal in size and shape and is firm
Grade IV – the breast appears abnormal in size and shape, is hard and is painful to the touch
Treatment is only necessary for Grades III and IV. The capsule can be cut in several spots to increase the form-changing tensions around the capsule. This is called a capsulotomy. If the capsule (partially) has to be removed, this is a capsulectomy. If no new breast implant is inserted, a breast lift is often needed to shape the breast. If implants are reinserted the implant must preferably be placed under the pectoral muscle and/or breast implants with a polyurethane shell must be used.
An integral part of the consultation is the selectionof the optimal breast implant for the two types of breast augmentation: 1. the excessive filling of the breast without taking account of available tissue (in which the desired result is decided by the tissue) and 2.the moderate filling and shaping (where in the selection of the breast implant is made based on the given breast dimensions and tissue characteristics).
Selection of the Breast Implantsfor Breast Augmentation
You must select your breast implants carefully for breast augmentation because you will spend your life with them.
Thus, breast enlargement can result in a naturally shaped, ideally filled breast, an „underfill“ with an empty upper pole, or an „overfill“ with strong protrusion in the upper pole. We will determine together during the personal consultation the size of the breast implants. For this purpose, we have special sample implants (so-called sizers) in various sizes. We thus imitate the breast augmentation. You will immediately see the expected result of the breast augmentation.
Shape of the Breast Implants
In particular, round breast implants can lead to an unnatural fullness in the upper chest portion in breast augmentation. Anatomical implants are modeled on the female breast and hence are more likely to support the natural shape. Also,in breast augmentation with anatomical breast implants,the given implant volumes can be exactly distributed and the breasts shaped better, this in particular with the implants with full and moderate height. Breast implants with a strong profile push from behind against the breast’s own tissue and this can lead to loss of this tissue after breast enlargement. Therefore, implants with low to medium profile should be selected for breast augmentation.
Size of the Breast Implants
Breast augmentation brings with it the best breast fullness,the desired aesthetic image with the best long-term results and the lowest rate of subsequent operations. In breast augmentation large implants with a strong profile increase the irretrievable loss of natural breast tissue through pressure atrophy. Large breast implants also increase the risk that they will be palpable and visible at the edges, if their base diameter is larger than the original breasts to be enlarged.
Shell of the Breast Implants
In breast enlargement breast implants with a textured shell on the one hand lead to a lower rate of capsular contracture than implants with a smooth shell. On the other hand, in breast enlargement with textured implant shells, the distribution of the filling is better controlled. Breast implants with a smooth shel lare more likely to collapse in the upper implant pole and to form wrinkles. Wrinkles in turn can clearly reduce the life expectancy of the breast implants.
Filling of the Breast Implants
The filler material also has a significant influence on the distribution of the filling within the breast in breast augmentation. The volume distribution may best be controlled in breast augmentation with shape-stable breast implants that are filled with cohesive gel.
Selection of Breast Augmentation Approach
In breast enlargement the breast implants can be inserted through different access points into the breast (armpit, nipple and the inframammary fold). In most cases, the breast implants are inserted through an incision in the inframammary fold.
Inserting the Breast Implants through the Armpit
If the armpit approach is selected for breast augmentation, the scar is veryunassuming outside the breast. Smooth, round breast implants can be easily inserted via this access. For this access special instruments are needed during breast enlargement. Also, the duration of the operation and thus the anesthesia, compared to the access through the inframammary fold, are usually longer.
Insertion of the Breast Implants via the Nipples
In breast augmentation this approach usually results in very inconspicuous, fine scars. However, it requires a sufficiently large areola. A disadvantage here is considered to be the higher risk for wetting of the breast implants with bacteria.
Insertion of the Breast Implants via the Inframammary Fold
In breast enlargement via the inframammary fold the scars are initially clearly visible as a reddish scar. But over the course of months these fade to inconspicuous line-shaped scars, which are covered by the breast. With this breast augmentation approach the implant pocket can be prepared most accurately. It provides the greatest clarity, the least tissue damage as well as the least risk for bleeding and thus the best conditions for optimal result of the breast augmentation. Furthermore, the time of the operation and the duration of anesthesia are usually shorter than with the other approaches so that patients recover faster after the breast augmentation.
During consultation, I will inform you about the different breast augmentation approaches as well as about the position of the breast implants (implant pocket under the muscle or between the muscle and the mammary gland – which would also be subglandular). With sufficient subcutaneous fatty tissue it is possible to insert the breast implant under the glandular bodies. With a poor soft tissue layer placement of the breast implants under the muscle is preferable. With breast enlargement there are many reasons in general for the insertion of the breast implants under the pectoral muscle.
Reasons for Submuscular Position of the Breast Implants
In this approach no special instruments are needed for the breast augmentation as are needed for the armpit approach. The enhanced soft tissue coverage of the breast implants around the large pectoral muscle creates a harmonious shape and the implant is less palpable. Furthermore, the result after breast augmentation remains stable for longer (the chest sinks less rapidly) and the capsular fibrosis rate is lower than in a subglandular position.
Breast Augmentation – Flow of the Operation
We perform the breast augmentation at our private clinic in Böblingen. The professional aftercare in this modern clinic is as much a part of the medical standard as our gentle breast enlargement.
Before the breast augmentation, we will once again discuss the whole flow of the operation and clarify any remaining questions. The breast augmentation will be performed under general anesthesia and takes about 60 minutes. The insertion of redon drains (suction drains for draining wound secretions) may be necessary. After the breast augmentation you will return to your room. One night is usually sufficient after breast enlargement so you can leave the Clinic on the day after the operation.
Breast Augmentation – Behavior after the Operation
Mild analgesics usually suffice after breast augmentation. These are only needed for a few days until the swelling has subsided significantly. For your safety weare of course available after the surgeryby telephone.In order not to jeopardize the success of breast augmentation, the rules of conduct must be observed.This includes in particular giving yourself peace and quiet. The total recoverytime after breast enlargement is a few weeks, and you will be fully able to socialize and go back to work after about 1-2 weeks.
Breast Augmentation – Scar Formation and Suture Removal
The formation of a scar is a completely natural process after an injury to the skin from an accident or an operation such as breast augmentation. The wound closure begins with self-dissolving deep sutures, which take the tension out of the wound. Then there are superficial skin sutures, which are also self-dissolving, that pull the wound edges close together. With the use of self-dissolving suture materials, there is no need to remove the stitches. Minimal height differences of the wound edges are treated with special plaster strips, such as Steri-Strip™. After breast enlargement a fine gap remains that is closed by a blood clot. Later, new connective tissue is formed at this spot. It leaves a scar that initially appears reddened after the breast enlargement, but over the course of months it fades to a fine, inconspicuous scar. Scar care after breast augmentation consists mainly of scar massage, supported by greasy creams that contain e.g. Dexpanthenol. So the initially rough scar will become fine and soft.