Setting

The operation is always performed under general anaesthetic and is usually performed as a day surgery procedure.

Duration

1 h

Surgical Technique

Certain aspects of the surgical technique may vary from patient to patient. The different possibilities with regards to skin incision, implant size, shape and position will be discussed with you in detail during your preoperative consultation in order to choose the ideal approach for your individual case.

Implant Type

The implants we use are exclusively made from silicone and manufactured by reputable, medically certified companies.  Implants are available in a wide range of sizes and typically come in two different shapes, namely round and anatomical (or “tear drop”). Your surgeon will advise you as to the ideal shape and size to accommodate your desires and expectations based on your existing breast shape and size. However the final decision on the implant used will be left to you.

 

 

Skin incision

The implant needs to be inserted through a skin incision measuring approximately 5 cm. In most cases this incision will be placed in the fold underneath your breast. Under certain circumstances the implant may be inserted through an incision along the bottom of the areola. Irrespective of the approach, all scars can be hidden in underwear or a bikini.

Implant position

The implant can either be placed in a pocket between the pectoral muscle and the breast tissue, or behind the pectoral muscle. Each position has advantages and disadvantages that may or may not apply to each individual patient. Your surgeon will advise you which the most suitable implant position is for you.

 

 

Suture material

The skin incisions are usually closed with self-absorbing sutures.

Aftercare

You will be encouraged to wear a fitted bra day and night for 4-6 weeks after surgery.

The dressings can usually be left intact until your first follow-up appointment with your surgeon. The wounds will be covered with water-proof dressings allowing you to get the area wet in the shower.

You will be able to resume most every-day activities within immediately after surgery. We recommend refraining from sport or any strenuous upper body activities for at least 6 weeks after surgery.

Follow-up

Regular follow-up appointments with your surgeon will be scheduled at 2 weeks, 6 weeks, 3 months and 1 year after surgery. 

As with every surgical procedure breast augmentation is associated with both anaesthetic and surgical risks. Preexisting conditions such as Diabetes, obesity, heart and blood vessel diseases, immune diseases and smoking significantly increase the risk of complications.

General complications of all surgical procedures include:

Bleeding/Hematoma, infection, thrombosis (including pulmonary embolism)

The most common surgical complications after breast augmentation include:

- postoperative bleeding, hematoma

- infection

- implant displacement or rotation

- unsightly or asymmetrical scars

- delayed wound healing or wound breakdown

- visible or palpable implant

Rare complications after breast augmentation include:

- Implant failure/rupture

- seroma

- permanent numbness of the nipple/areola

 

Capsular contracture

So-called capsular contracture is not really a complication, but more an unavoidable long-term consequence of implant based breast augmentation.

When a foreign body is placed anywhere under the skin the human body’s normal reaction is to form a scar-like tissue layer around it also termed “capsule”. This also happens in the case of breast implants where over time (usually years to decades) where the capsule slowly gets thicker and causes the implant to become more and more palpable and with time even visible. Capsular contracture is not dangerous, but it can become unpleasant and lead to symptoms like tightness or pain and it can lead to changes in the breast shape or position of the implant.

Capsular contracture usually presents itself after 10-15 years, however in rare cases it can occur much sooner.

Surgical treatment of capsular contracture is recommended either when it is causing symptoms such as pain or tenderness or the breast shape has become significantly distorted. Treatment involves removing part or all of the scar capsule and replacing the implant.

 

Do I need to stop my own medication prior to surgery?

Most medication can be continued normally. Some drugs such as blood thinners (e.g. Aspirin or Warfarin/Marcoumar) can increase the risk of postoperative bleeding and may need to be stopped or replaced before the procedure. We ask you to bring a complete list of all your medication and their dosages to your first consultation.

Does my GP need to perform or organize any special investigations or tests before surgery?

Usually not. The surgical team including the anaesthetist will need to be aware of any preexisting conditions (especially cardiovascular or lung diseases) which may be associated with an increased anaesthetic risk. We ask you to provide as much detailed information on your past medical history as possible when you come for your preoperative consultation so we can coordinate any necessary tests with your GP.

Do I need to stop smoking before surgery?

We seriously recommend stopping all nicotine consumption, including smoking at least 6 weeks before any surgical procedure. One of the most common complications following any type of surgery is delayed wound healing or wound breakdown. The main cause of this is usually bad blood circulation to the skin and tissues in the operated area. Nicotine is a chemical substance, which causes blood vessels in the body to constrict (narrow). This lowers the blood circulation to the wound and significantly increases the risk of complications.

Do silicone implants cause cancer?

Silicone has been used in many different areas of medicine for over 40 years. Multiple long-term studies have been able to confirm that medical grade silicone inside the body can be considered harmless. The risk of any individual developing breast cancer is identical before and after breast augmentation with implants. Therefore the same recommendations for breast cancer screening can and should be applied after surgery.

There have been a small number of case reports where a very rare form of lymphoma (Anaplastic Large Cell Lymphoma, or ALCL) have occurred in woman with silicone breast implants. According to current scientific knowledge the absolute risk of developing ALCL after breast augmentation with silicone implants is estimated to be between 1 in 5000000 and 1 in 3 million. The Swiss Society of Plastic Surgery (SGPRAC) has published the following recommendations in 2015:

• Regular self-guided observation/examination of the breast and immediate consultation of a doctor in case of changes
• Regular screening mammography
• Regular MRI (magnetic resonance imaging) of the implants to exclude rupture (3 years after surgery and every 2 years thereafter)

You can read the official publication online under the following link:

http://plasticsurgery.ch/patienten-oeffentlicher-bereich/wichtige-mitteilungen-aufrufe-warnungen/

Is silicone poisonous or dangerous?

No. Silicone is neither poisonous nor dangerous. Silicone implants contain medical grade silicone which is a cohesive gel. Even in the event of an implant rupture the silicone does not spread around the body but remains within the tissue pocket where the implant lies.

How common are implant ruptures?

Implant ruptures are very rare (current scientific studies report an incidence of below 10% over a 10 year period). The most common causes are manufacturing defects or advanced capsular contracture. Implant ruptures after extensive physical activity or trauma are exceedingly rare.

An implant rupture itself is not dangerous and certainly not a medical emergency. It does however cause the breast to lose its shape and the implant should be replaced.

What happens if the implant gets infected?

An infected implant will need to be surgically removed followed by a course of antibiotics. Once the infection has subsided and the tissues have recovered (approximately 6-8 weeks later) a new implant can be inserted in a second procedure.

Do you use PIP implants?

No. PIP implants have been withdrawn from the market. We only use medically certified implants from reputable manufacturers.

Will I be able to breast feed after a breast augmentation?

Your ability to breast feed will not be affected by the implants as neither the breast gland nor the milk ducts are damaged during surgery.

How long can breast implants stay in?

Implants do not have an expiry date. The lifespan of the newer generations of breast implants can easily extend 30 years. How long a breast implant can stay in place is usually not determined by the implant itself, but more by changes in the tissues around it. Capsular contracture or changes in the breast shape and size after pregnancy or aging are the most common reasons to replace the implant.

Can I still have a mammogram after breast augmentation?

Yes. The size of the breast and the implant can however make performing a mammogram technically more difficult. Nowadays MRI (Magnetic Resonance Imaging) is becoming increasingly commonplace for breast cancer diagnostics and can be performed without restrictions after breast augmentation with implants.

Will I be able to feel the implant?

Possibly. Especially in very slim patients where the implant is only covered by a thin layer of soft tissue the implant will most likely be palpable along the lower border of the breast. This cannot be prevented technically.

Can you correct breast asymmetry with implants?

Nearly all women naturally have a certain degree of breast asymmetry. Whereas large differences in breast size can be corrected to a certain degree by adapting the size and shape of the implant, small differences cannot be corrected surgically. This is particularly true for differences in the position of the nipple where small differences in height may even become slightly more apparent after surgery.

Are there activities I will no longer be able to do after surgery?

No. You will be encouraged to refrain from strenuous physical activities for 6 weeks after surgery. This includes exercise such as jogging and lifting heavy objects. After this period when the implant and the tissues around it have settled there will be no restrictions.

How long before I can go back to work after surgery?

This depends on your work. Light duties, such as office jobs can usually be resumed after about a week. Lifting heavy objects and activities that strain the upper body and chest muscles should be refrained from for at least 6 weeks. Especially if you have small children it is important for you to plan and ensure enough support for their care other household chores during your recovery period.

Will I get a sick certificate for the time I am off work?

No. Sick certificates cannot be issued for cosmetic procedures. You will need to take annual leave for the entire period that you are absent from work.

Will my health insurance cover the costs for the surgery?

No, breast augmentation is a cosmetic procedure which is not covered by health insurance.

In the case of severe asymmetry or breast malformation your health insurance may cover some of the costs for the procedure. Written confirmation of approval to cover the costs by your insurer will need to be obtained prior to the procedure.

Will my health insurance cover the costs of treatment if I develop any complications requiring medical treatment, hospitalization or even further surgery?

Yes, provided the complication is purely medical, e.g. an infection. In case of capsular contracture your health insurance will usually cover the cost for removal of the capsule, but you will be required to pay for any new implant yourself. Corrections of aesthetic complications (e.g. unsatisfactory shape, size, implant rotation or malposition etc. ) are not covered.