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ATOS Privatklinik München
Effnerstr. 38
81925 Munich
Phone: +49 (0) 89 / 20 4000 201/2
info@atos-aesthetic.de
Prof. Dr. med.
Charlotte Holm Mühlbauer
Prof. Dr. med. Wolfgang Mühlbauer
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Breast Surgery
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If you are dissatisfied with your breast size, breast augmentation surgery is a choice to consider. Breast augmentation can:
- Increase fullness and projection of your breasts
- Improve the balance of your figure
- Enhance your self-image and self-confidence
Also known as augmentation mammaplasty, the procedure involves using implants to fulfill your desire for fuller breasts or to restore
breast volume lost after weight reduction or pregnancy.
What it won't do
Breast augmentation does not correct severely drooping breasts. If you want your breasts to look fuller and to be lifted due to sagging, a breast lift may be required in conjunction with breast augmentation.
Breast lifting can often be done at the same time as your augmentation or may require a separate operation. Your plastic surgeon will assist you in making this decision.
Is it right for me?
Breast augmentation is a highly individualized procedure and you should do it for yourself, not to fulfill someone else's desires or to try to fit any sort of ideal image. Breast augmentation may be a good option for you if:
- You are physically healthy
- You have realistic expectations
- Your breasts are fully developed
- You are bothered by the feeling that your breasts are too small
- You are dissatisfied with your breasts losing shape and volume after pregnancy, weight loss, or with aging
- Your breasts vary in size or shape
- One or both breasts failed to develop normally
Breast Augmentation Procedure Steps
What happens during breast augmentation surgery?
Step 1 - Anesthesia
Breast augmentation is performed under general anesthesia as an in-or outpatient procedure. If your breast augmentation is performed on an outpatient basis, be sure to arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery.
Step 2 - The incision
Incisions are made in inconspicuous areas to minimize visible scarring. Incision options include:
- Inframammary incision
- Transaxillary incision
- Periareolar incision
Incisions vary based on the type of implant, degree of enlargement desired, your particular anatomy, and patient-surgeon preference.
Step 3 - Inserting and placing the breast implant
After the incision is made, a breast implant is inserted into a pocket either:
- Under the pectoral muscle (a submuscular placement), or
- Directly behind the breast tissue, over the pectoral muscle (a submammary/ subglandular placement)
The method for inserting and positioning implants depends on the type of implant, degree of enlargement desired, your body type, and your surgeon's recommendations.
Step 5 - Closing the incisions
Incisions are closed with layered sutures in the breast tissue and with sutures, skin adhesive or surgical tape to close the skin. Over time the incision lines will fade.
Step 6 - See the results
The results of breast augmentation surgery are immediately visible. Over time, post-surgical swelling will resolve and incision lines will fade. Satisfaction with your new image should continue to grow as you recover and realize the fulfillment of your goal for fuller breasts.
Although there potentially may be complications with breast implants, they do not impair breast health. Careful review of scientific research conducted by independent groups such as the Institute of Medicine has found no proven link between breast implants and autoimmune or other systemic diseases.
Other important considerations:
- Breast implants are not guaranteed to last a lifetime and future surgery may be required to replace one or both implants.
- Pregnancy, weight loss and menopause may influence the appearance of augmented breasts over the course of your lifetime.
Recovery Time for Breast Augmentation
Following your physician's instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.
The results of your breast augmentation surgery will be long-lasting. You will find it easier to wear certain styles of clothing and swim wear. Like many women who have had breast augmentation, you may also have a boost in self confidence.
Implants may need to be replaced or revised
It's important to know that after receiving breast implants, results are not permanent and they may require replacement during your lifetime. You should expect to have future visits with your plastic surgeon to discuss changes in your breasts.
Over time, your breasts can change due to aging, weight fluctuations, hormonal factors and gravity. If, after a period of years, you become dissatisfied with the appearance of your breasts, you may choose to undergo a breast lift or implant exchange to restore a more youthful contour.
Continue to follow your plastic surgeon's instructions to ensure the best results for breast enlargement or breast enhancement, and attend follow-up visits as scheduled.
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A woman's breasts often change over time, losing their youthful shape and firmness. These changes and loss of skin elasticity can result from:
- Pregnancy
- Breastfeeding
- Weight fluctuations
- Aging
- Gravity
- Heredity
Also known as mastopexy, a breast lift raises and firms the breasts by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour.
Sometimes the areola becomes enlarged over time, and a breast lift will reduce this as well. A breast lift can rejuvenate your figure with a breast profile that is youthful and uplifted.
What it won't do
Breast lift surgery does not significantly change the size of your breasts or round out the upper part of your breast. If you want your breasts to look fuller or smaller, you might want to consider either breast augmentation or breast reduction surgery.
A breast lift is a good option for you if:
- You are physically healthy and maintain a stable weight
- You have realistic expectations
- You are bothered by the feeling that your breasts sag, have lost shape and volume
- Your breasts have a flatter, elongated shape or are pendulous
- When unsupported, your nipples fall below the breast crease
- Your nipples and areolas point downward
- You have stretched skin and enlarged areolas
- One breast is lower than the other
What happens during breast lift surgery? Your breast lift surgery can be achieved through a variety of incision patterns and techniques. The appropriate technique for you will be determined based on:
- Breast size and shape
- The size and position of your areolas
- The degree of breast sagging
- Skin quality and elasticity as well as the amount of extra skin
Procedural Steps
Step 1 - Anesthesia
Breast lift is performed under general anesthesia on an in-or outpatient basis. If your breast lift is performed on an outpatient basis, be sure to arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery.
Step 2 - The incision
There are three common incision patterns:
- Around the areola
- Around the areola and vertically down from the areola to the breast crease
- Around the areola, vertically down from the breast crease and horizontally along the breast crease
Step 3 - Reshaping your breasts
After the incisions are made:
- The underlying breast tissue is lifted and reshaped to improve breast contour and firmness.
- The nipple and areola are repositioned to a natural, more youthful height.
- If necessary, enlarged areolas are reduced by excising skin at the perimeter.
- Excess breast skin is removed to compensate for a loss of elasticity.
Step 4 - Closing the incisions
After your breasts are reshaped and excess skin is removed, the remaining skin is tightened as the incisions are closed.
Some incision lines resulting from breast lift are concealed in the natural breast contours; however, others are visible on the breast surface. Incision lines are permanent, but in most cases will fade and significantly improve over time.
Sutures are layered deep within the breast tissue to create and support the newly shaped breasts. Sutures, skin adhesives and/or surgical tape may be used to close the skin.
Step 5 - See the results
The results of your breast lift surgery are immediately visible. Over time, post-surgical swelling will resolve and incision lines will fade.
Satisfaction with your new image should continue to grow as you recover and realize the fulfillment of your goal for breasts which have been restored to a more youthful and uplifted position.
My Recovery
After your breast lift procedure is completed, dressings or bandages will be applied to the incisions. You'll need to wear an elastic bandage or support bra to minimize swelling and support your breasts as they heal.
A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid that may collect.
Following your physician's instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.
The results will be long-lasting
The final results of your breast lift will appear over the next few months as breast shape and position continue to settle. Incision lines are permanent, but will continue to fade over time.
The results of your breast lift surgery will be long-lasting. Over time, your breasts can continue to change due to aging and gravity. But, you'll be able to retain your new look longer if you:
- Maintain your weight
- Keep a healthy lifestyle
Special note: While a breast lift does not usually affect breast function, if you are planning to become pregnant, discuss this with your plastic surgeon. Changes that occur in the breasts during pregnancy can minimize or reverse the improvement a breast lift provides. Likewise, plans for significant weight loss should also be discussed.
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Overly large breasts can cause some women to have both health and emotional problems. In addition to self image issues, you may also experience physical pain and discomfort.
The weight of excess breast tissue can impair your ability to lead an active life. The emotional discomfort and self-consciousness often associated with having large pendulous breasts is as important an issue to many women as the physical discomfort and pain.
Also known as reduction mammaplasty, breast reduction surgery removes excess breast fat, glandular tissue and skin to achieve a breast size in proportion with your body and to alleviate the discomfort associated with overly large breasts.
Is it right for me?
Breast reduction is a good option for you if:
- You are physically healthy
- You have realistic expectations
- You are bothered by the feeling that your breasts are too large
- Your breasts limit your physical activity
- You experience back, neck and shoulder pain caused by the weight of your breasts
- You have regular indentations from bra straps that support heavy, pendulous breasts
- You have skin irritation beneath the breast crease
- Your breasts hang low and have stretched skin
- Your nipples rest below the breast crease when your breasts are unsupported
- You have enlarged areolas caused by stretched skin
Breast Reduction Procedural Steps
Breast reduction surgery is usually performed through incisions on your breasts with surgical removal of the excess fat, glandular tissue and skin.
The technique used to reduce the size of your breasts will be determined by your individual condition, breast composition, amount of reduction desired, and your personal preferences.
Step 1 - Anesthesia
Breast reduction surgery is performed under general anesthesia as an inpatient procedure.
Step 2 - The incision
Incision options include:
- A circular pattern around the areola
The incision lines that remain are visible and permanent scars, although usually well concealed beneath a swimsuit or bra.
- A keyhole or racquet-shaped pattern with an incision around the areola and vertically down to the breast crease
- An inverted T or anchor-shaped incision pattern
Step 3 - Removing tissue and repositioning
After the incision is made, the nipple-which remains tethered to its original blood and nerve supply-is then repositioned. The areola is reduced by excising skin at the perimeter, if necessary.
Underlying breast tissue is reduced, lifted and shaped. Occasionally, for extremely large pendulous breasts, the nipple and areola may need to be removed and transplanted to a higher position on the breast (free nipple graft).
Step 4 - Closing the incisions
The incisions are brought together to reshape the now smaller breast. Sutures are layered deep within the breast tissue to create and support the newly shaped breasts; sutures, skin adhesives and/or surgical tape close the skin. Incision lines are permanent, but in most cases will fade and significantly improve over time.
Step 5 - See the results
The results of your breast reduction surgery are immediately visible. Over time, post-surgical swelling will resolve and incision lines will fade. Satisfaction with your new image should continue to grow as you recover.
Recovery Time for Breast Reduction
When your breast reduction procedure is complete, dressings or bandages will be applied to the incisions. An elastic bandage or support bra may be worn to minimize swelling and support the breasts as they heal.
A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid
Following your physician's instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Your will be given specific instructions on how to care for yourself and minimize breast reduction surgery risks.
Breast Reduction and Results
- The results of breast reduction surgery will be long-lasting. Your new breast size should help relieve you from the pain and physical limitations experienced prior to breast reduction.
- Your better proportioned figure will likely enhance your self image and boost your self-confidence.
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Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other condition. It is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy.
The creation of a new breast can dramatically improve your self-image, self-confidence and quality of life. Although surgery can give you a relatively natural-looking breast, a reconstructed breast will never look or feel exactly the same as the breast that was removed.
Is it right for me?
Breast reconstruction is a highly individualized procedure. You should do it for yourself, not to fulfill someone else's desires or to try to fit any sort of ideal image.
Breast reconstruction is a good option for you if:
- You are able to cope well with your diagnosis and treatment
- You do not have additional medical conditions or other illnesses that may impair healing
- You have a positive outlook and realistic goals for restoring your breast and body image
Breast reconstruction typically involves several procedures performed in multiple stages. It can:
- Begin at the same time as mastectomy, or
- Be delayed until you heal from mastectomy and recover from any additional cancer treatments
It's important that you feel ready for the emotional adjustment involved in breast reconstruction. It may take some time to accept the results of breast reconstruction.
A note about symmetry: If only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry of the size and position of both breasts.
Important facts about the safety and risks of breast reconstruction
The decision to have breast reconstruction surgery is extremely personal. You'll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable.
The possible risks of breast reconstruction include, but are not limited to, bleeding, infection, poor healing of incisions, and anesthesia risks. You should also know that:
- Flap surgery includes the risk of partial or complete loss of the flap and a loss of sensation at both the donor and reconstruction site.
- The use of implants carries the risk of breast firmness (capsular contracture) and implant rupture.
Breast implants do not impair breast health. Careful review of scientific research conducted by independent groups such as the Institute of Medicine has found no proven link between breast implants and autoimmune or other systemic diseases. Visit www.breastimplantsafety.org for current information.
Where will my surgery be performed?
Surgery for your breast reconstruction is performed under general anesthesia as an inpatient procedure. Some follow-up procedures may be performed on an outpatient basis, and local anesthesia with sedation may be used.
Procedural Steps
What happens during breast reconstruction surgery?
Step 1 - Anesthesia
Breast reconstruction surgery is performed under general anesthesia as an inpatient procedure.
Step 2 - Flap techniques reposition a woman's own muscle, fat and skin to create or cover the breast mound.
Sometimes a mastectomy or radiation therapy will leave insufficient tissue on the chest wall to cover and support a breast implant. The use of a breast implant for reconstruction almost always requires either a flap technique or tissue expansion.
A TRAM flap uses donor muscle, fat and skin from a woman's abdomen to reconstruct the breast. The flap may either remain attached to the original blood supply and be tunneled up through the chest wall, or be completely detached, and formed into a breast mound.
Alternatively, the DIEP or SGAP flap techniques may be used which do not use muscle but transport tissue to the chest from the abdomen or buttock.
A latissimus dorsi flap uses muscle, fat and skin from the back tunneled to the mastectomy site and remains attached to its donor site, leaving blood supply intact.
Occasionally, the flap can reconstruct a complete breast mound, but often provides the muscle and tissue necessary to cover and support a breast implant.
Step 3 - Tissue expansion stretches healthy skin to provide coverage for a breast implant.
Reconstruction with tissue expansion allows an easier recovery than flap procedures, but it is a more lengthy reconstruction process.
It requires many office visits over 4-6 months after placement of the expander to slowly fill the device through an internal valve to expand the skin.
A second surgical procedure will be needed to replace the expander if it is not designed to serve as a permanent implant.
Step 4 - Surgical placement of a breast implant creates a breast mound.
A breast implant can be an addition or alternative to flap techniques. Saline and silicone implants are available for reconstruction.
We will decide what is best for you. Reconstruction with an implant alone usually requires tissue expansion.
Step 5 - Skin flaps and other specialized techniques create a nipple and areola.
Breast reconstruction is completed through a variety of techniques that reconstruct the nipple and areola
My Recovery
Following your surgery for flap techniques and/or the insertion of an implant, gauze or bandages will be applied to your incisions.
An elastic bandage or support bra will minimize swelling and support the reconstructed breast. A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid.
A pain pump may also be used to reduce the need for narcotics.
Healing will continue for several weeks as swelling decreases and breast shape and position improve. Continue to follow your plastic surgeon's instructions and attend follow-up visits as scheduled.
Results and outlook
The final results of breast reconstruction following mastectomy can help lessen the physical and emotional impact of mastectomy.
Over time, some breast sensation may return, and scar lines will improve, although they'll never disappear completely.
There are trade-offs, but most women feel these are small compared to the large improvement in their quality of life and the ability to look and feel whole.
Careful monitoring of breast health through self-exam, mammography and other diagnostic techniques is essential to your long-term health.
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