Breast augmentation and liposuction in Switzerland: rebalancing the figure

Many women considering breast augmentation are not thinking only about their breasts. They look at their figure as a whole: breasts they find too small above an abdomen that keeps a slight bulge, a waist with little definition, or hips and thighs where fat resists exercise. Enlarging the breasts alone would sometimes accentuate this imbalance; slimming the figure without touching the breasts would too. Combining implant augmentation and liposuction responds to this search for harmony: it adds volume where it is lacking and removes it where it is in excess, in a single procedure. This page explains how this rebalancing is reasoned, which liposuction areas are suitable, how implant volume is chosen according to the future figure, what harvested fat can bring to the cleavage, how the procedure and recovery unfold, the risks specific to the combination, and how provision and prices vary between Swiss cities and cantons.

The procedure is generally performed under general anaesthesia and takes two and a half to four hours depending on the areas. The surgeon places two breast implants, usually through a short incision in the fold under the breast, in front of or behind the pectoral muscle, and performs liposuction of one or more areas: abdomen, flanks, saddlebags, inner thighs, knees, arms or back. Part of the harvested fat can be reinjected into the cleavage to soften the transition around the implants. A night in hospital is common. A support bra and a compression panty or girdle are worn for four to six weeks. The breasts take their final shape in three to six months, and so does the figure. It is cosmetic surgery, at the patient's expense; budget differences are presented on the page on breast augmentation with liposuction prices in Switzerland.

Implant breast augmentation involves placing two implants filled with silicone gel, under the gland or under the pectoral muscle, to increase the volume and projection of the breasts. Liposuction involves suctioning excess fat from certain areas of the body through small incisions. Together, they act on the figure in opposite directions: the first adds volume at the top, the second removes it in the middle and at the bottom.

This crossed effect is the main benefit of the combination. A slimmer waist makes the breasts look more generous; augmented breasts make the waist look slimmer. The surgeon can thus achieve visible rebalancing with implants of reasonable volume and measured liposuction, rather than pushing either procedure too far.

Silicone breast implants have been used since the 1960s, liposuction since the late 1970s. For a long time, these procedures were performed separately. As techniques and anaesthesia improved and surgeons adopted a more global view of the figure, combining them became widespread. More recently, the development of fat transfer has added a further dimension: fat removed from one area can be used to improve the integration of the implants. Today, the combination is one of the most frequent pairings in women's cosmetic surgery.

Demand has evolved over the years. Very large volumes, long in fashion, have given way to a search for naturalness and proportion. Many women want breasts that look like their own, in harmony with their build, and a slimmer figure without a spectacular transformation. This trend has favoured well-reasoned combinations such as this one, where moderate volumes and targeted liposuction give a more convincing overall result than a single procedure pushed to the extreme.

The eye does not assess breasts in isolation. It compares breast volume with the width of the shoulders, the waist and the hips. A so-called hourglass figure is characterised by breasts and hips of comparable width, separated by a clearly slimmer waist. A pear-shaped figure has hips wider than the breasts; an H-shaped figure, a waist with little definition.

The combination makes it possible to act on these ratios. In a woman with a pear-shaped figure, moderate implants and liposuction of the saddlebags bring the width of the upper and lower body closer together. In a woman with an H-shaped figure, implants and liposuction of the flanks and abdomen hollow the waist and make the breasts stand out. The surgeon reasons with you in terms of figure, not just cup size.

These examples are indicative; every figure is unique and the plan is always individualised.

Some surgeons use simple measurements: bust, waist at its narrowest and hips at their widest. The waist-to-hip ratio is often cited as a reference for a harmonious female figure. These figures are not targets to be reached at all costs, but they help visualise the effect of liposuction of the flanks or saddlebags and choose a consistent implant volume. Repeating them after the procedure allows the change to be measured objectively.

Combining the procedures means a single anaesthetic, a single recovery period and a single period off work, with an overall cost generally lower than that of two separate procedures. But the benefit is also aesthetic: by planning the volumes added and removed together, the surgeon chooses implants knowing the final figure, which avoids oversizing the breasts to compensate for a waist or hips that would remain unchanged.

The combination is not always the best option. Very extensive liposuction, a patient with risk factors or the wish to judge the breast result first may lead to separating the procedures. The surgeon discusses this with you.

The value of reasoning in terms of the figure is easy to understand with an example. In a woman with little waist definition, liposuction of the flanks that hollows the waist by a few centimetres changes the perception of the breasts as much as a significant increase in volume. Conversely, in a woman with wide hips, liposuction of the saddlebags reduces the width of the lower body and makes the breasts look more present. The surgeon combines these effects to reach the goal with measured procedures, rather than relying on a single lever pushed to the extreme.

This reasoning has a safety advantage: implants of moderate volume carry fewer long-term complications, such as tissue thinning or malposition, than very large implants.

This combination mainly suits a woman in good shape, whose weight has been close to her usual weight for several months, who wants larger breasts and has localised fat deposits that resist diet and physical activity. Her skin is of good quality, which allows both good implant placement and retraction after liposuction. She does not smoke or agrees to stop, and she understands that breast implants are not placed for life and will require surveillance.

She may be a young woman whose breasts never really developed and who still has family saddlebags, a mother whose breasts have lost volume after pregnancies and whose abdomen and flanks have kept some curves, or a sporty woman who has hit a wall with stubborn areas and wants breasts more in keeping with her figure.

Skin plays a dual role in this combination. On the breasts, it must cover and hold the implant: thin, stretched skin increases the risk of visible edges and sagging over time. In the liposuction areas, it must retract: firm, elastic skin gives clean contours, lax skin may leave folds. The surgeon assesses the skin area by area and may adapt the plan, for example by limiting a liposuction or proposing a lift.

In young women, the request often concerns breasts that never developed and family fat areas. The skin is generally of very good quality, which favours good results. It is nevertheless important to make sure that the breasts and figure have stabilised and that the decision is personal and well considered. Surgeons take time to discuss this, particularly when the request is strongly influenced by idealised images.

After forty, the skin is less elastic, the breasts have often lost volume and fat is distributed more on the abdomen and waist. The combination remains entirely possible, but the surgeon more carefully assesses the need for a combined lift and the skin's ability to retract after liposuction. Breast imaging before the procedure is routine at this age.

The choice of areas depends on your fat distribution, your priorities and a reasonable length for the procedure.

Saddlebags are a fat deposit on the outer thighs, often familial and very resistant to sport and diet. They widen the lower part of the figure and accentuate the contrast with small breasts. Their liposuction generally gives good results, with skin that retracts well in young women. It is performed with the patient lying on her side or front. The surgeon takes care to preserve the natural curve of the hip and the transition with the buttock, to avoid a hollow.

Liposuction of the hips and lower back also changes the shape of the buttocks, setting them apart from the waist. Some patients ask for the harvested fat to be reinjected into the buttocks rather than the breasts. This is a different procedure, buttock fat transfer, which carries its own risks and strict safety rules. It is not generally combined with breast augmentation at the same time, notably because recovery requires avoiding pressure on the buttocks while protecting the breasts.

The inner thighs and knees are a common area of request. The skin there is thin and slackens easily, which requires careful liposuction, with fine cannulas and a preserved layer of fat. In women whose skin is already lax, liposuction can accentuate folds; a thigh lift is then sometimes discussed. The knees, particularly their inner side, are easy to treat and slim the line of the leg.

Liposuction removes deep fat but does not treat cellulite, which is linked to the structure of superficial fat and the fibrous septa that hold it. On thin skin, cellulite may even look more visible after thigh liposuction. It is important to discuss this before the procedure so that expectations are realistic. Specific cellulite treatments exist, with variable results.

The backs of the arms sometimes accumulate fat that makes the upper body look heavy. Liposuction there slims the arms and harmonises the figure with augmented breasts. The skin of the arms is thin, and retraction is less predictable after forty. Compression sleeves must be worn for several weeks. When the skin is very lax, liposuction alone is not enough.

In some women, a small roll of fat appears above and below the bra band, on the back and at the sides. It is visible in fitted clothing. Its liposuction smooths the back and improves bra comfort. Combined with an augmentation, it extends the work on the upper body and gives a cleaner figure from behind and in profile.

In many women, a small roll of fat sits between the outer edge of the breast and the armpit, visible at the edge of a bra or vest top. After an augmentation, this roll may look more marked if the implant pushes the breast outwards. Careful, superficial liposuction there refines the transition between the breast and the arm and improves the profile. It is a short procedure, often combined, which contributes greatly to the harmony of the upper body.

The abdomen is often the first area mentioned. Liposuction gives good results there when the skin is firm and the muscles are not separated: it slims and flattens. After pregnancies, however, the skin below the navel is often lax and the rectus abdominis muscles separated. Liposuction alone would then leave empty, creased skin and an abdomen that still bulges. In this case, combining augmentation with an abdominoplasty, often called a mommy makeover, is more suitable; our page on the mommy makeover in Switzerland describes it.

Abdominal liposuction suits women whose skin is firm, with no excess when sitting, and whose muscles are not separated. A simple test is to lean forward: if the skin of the lower abdomen hangs clearly, liposuction alone risks leaving empty skin. The surgeon also looks at stretch marks, a sign of skin that has been stretched. When skin quality is good, liposuction flattens the abdomen and, combined with the flanks, defines the waist.

Stretch marks show that the skin has been stretched. They disappear with neither liposuction nor implants. On thin breasts, the increase in volume may even cause new ones to appear, particularly in young women whose skin is still changing. The surgeon takes this into account when choosing the volume. Some treatments, such as lasers, can soften their appearance.

Some women have always had small breasts, sometimes with a narrow base and a high fold. Implants give them the volume and projection they lacked. In these underdeveloped breasts, tissue coverage of the implant is thin, which often points towards placement behind the muscle, at least in the upper part, and towards reasonable volumes. Fat harvested by liposuction can also be used to thicken the tissues of the cleavage and make the implant edges less noticeable.

A difference in volume between the two breasts is very common. It can be corrected by choosing implants of different volumes, adding fat on one side, or combining both. When the shape also differs, with one areola lower than the other for example, an additional procedure may be needed. The surgeon explains what can be corrected and what can only be partly corrected; a slight asymmetry often persists.

Tuberous breasts are a developmental malformation: narrow base, high fold, wide, puffy areola, tube shape. An implant alone is not enough to correct them: the gland must be released at its base, the fold lowered and the areola often reduced. Fat transfer is very useful for reshaping the lower part of the breast. In these cases, the combination with liposuction provides the necessary fat, but the plan is more complex and sometimes performed in two stages. Partial coverage may be discussed for marked forms, on prior request.

After pregnancy and breastfeeding, the breasts often lose volume, especially in their upper part, and may sag slightly. Implants restore this volume. If the sagging is marked, with an areola that drops below the fold, a lift must be combined, which adds scars around the areola and sometimes under the breast. Curves on the abdomen and flanks can be treated with liposuction, provided the abdominal skin has remained of good quality. It is better to allow six to twelve months after weaning, so that the breasts regain a stable volume and weight settles.

Very active women — runners, swimmers or fitness enthusiasts — often have low body fat, small breasts and a few areas of stubborn fat, typically on the hips or inner thighs. The combination can meet their request, with a few precautions. Placement behind the muscle can cause the breast to distort when the pectorals contract, which bothers some sportswomen; placement in front of the muscle or in a dual plane may be preferred. The volume must remain compatible with sport. Finally, as the fat reserve is limited, liposuction is often targeted and fat transfer modest.

• A current pregnancy, recent breastfeeding or a planned pregnancy in the near future.
• Ongoing weight loss or unstable weight.
• Active smoking, which increases the risk of infection and contracture around the implants.
• A breast abnormality on imaging that must be investigated first.
• A poorly controlled chronic illness or clotting disorders.
• A current infection, even distant, such as a dental or urinary infection.
• Excessive preoccupation with appearance that goes beyond the body itself.
• Being under eighteen for a cosmetic augmentation.

These situations do not rule out the procedure, but they require it to be postponed or the plan adapted.

The consultation begins with a discussion of your expectations: what volume, what breast shape, which areas of your figure bother you, and what matters most to you. The surgeon takes your medical history, pregnancies and breastfeeding, weight changes, treatments, family history of breast cancer, smoking and plans for pregnancy.

The examination covers the breasts, with precise measurements, and the planned liposuction areas, assessing fat thickness and skin quality. The surgeon observes your figure from the front, in profile and from behind. Photographs are taken. They then present a plan: type, volume and position of the implants, incision approach, liposuction areas, possible fat transfer, length of the procedure, and a detailed quote.

It is useful to arrive at the consultation with a clear idea of what you want: what volume, what cleavage shape, what degree of naturalness, which areas of the figure, and what you do not want. Words are often ambiguous: a natural result does not mean the same thing to everyone. Photographs of breasts and figures you like and dislike help a great deal in understanding each other.

The surgeon measures the base width of each breast, the distance between the nipple and the fold under the breast, the thickness of the tissues above the breast, the gap between the breasts and the position of the areolas. These measurements determine the maximum width of the implants, the volume compatible with your tissues and any need to move the fold. The breast base is the most important element: an implant wider than the base risks overflowing to the sides or towards the armpit.

The implant rests on the ribcage, whose shape influences the result. A rounded chest naturally projects the implants forwards and outwards; a sunken breastbone can spread the breasts apart or point them outwards; rib asymmetry gives asymmetrical breasts even with identical implants. The surgeon observes these features, shows them to you and takes them into account when choosing the implants.

The breast base, that is, its width at chest level, is the main criterion for choosing the implant. An implant that is too wide extends beyond the sides, towards the armpit, or brings the breasts too close together; an implant that is too narrow leaves a gap at the sides. For a given base, projection can then be varied to obtain more or less volume. That is why, beyond a certain volume, a higher projection should be chosen rather than a base wider than the breast.

The surgeon pinches the skin and gland above the breast, in the upper part, to estimate the thickness of the tissues that will cover the implant. Low thickness points towards placement behind the muscle, a moderate volume and, often, fat transfer. Sufficient thickness allows placement in front of the muscle. This simple measurement is one of the most useful for preventing the implant edges from showing.

For a given base, implants come in several projections, from low to very high. A higher projection gives more forward volume without widening the breasts. It is useful when the breast base is narrow and a marked gain is wanted; but excessive projection can give a less natural look and thin the tissues over time. The surgeon chooses the projection according to the base, the desired volume and your tissues.

In an augmentation alone, the volume is chosen according to the breasts and chest. In the combination, the figure after liposuction must also be anticipated. A slimmer waist and narrower hips make the breasts look larger than before the procedure. Choosing a volume based on the current figure sometimes leads to breasts that look too generous once the liposuction is complete.

The surgeon takes this into account and may propose a slightly more modest volume than you would have chosen for augmentation alone. Trying sizers in a bra at the consultation does not reflect this change in figure; it is useful to discuss this frankly and look at photographs of patients who have had the same combination.

Implant volume is expressed in cubic centimetres. This figure does not translate directly into a cup size: the same implant gives a different effect depending on the width of the chest, the natural volume of the breasts and the position of the implant. Cup sizes also vary from one brand to another. It is better to think in terms of the desired effect, illustrated by photographs and trials, than in figures.

It is tempting to focus all attention on implant volume. Yet long-term satisfaction depends at least as much on shape, breast softness, the absence of complications and harmony with the figure. Patient studies show that regrets more often concern excessive volume, which makes the figure heavier or is a nuisance in daily life, than a volume that is too modest. In the combination with liposuction, the gain in figure makes it easier to be satisfied with a reasonable volume. Taking time to try, compare and think about what you really want is the best guarantee of a result that suits you.

Several tools exist to help you picture the volume: trying sizers in an unwired bra, looking at photographs of patients with a comparable body shape, using a 3D simulation. These tools help, but none is perfect. Trials show the added volume but not the effect of placement under the muscle; simulations give an overall impression but do not exactly reproduce how the tissues react. They are mainly useful for ruling out what you do not like.

Bringing inspiration photographs is useful, provided you choose women with a body shape similar to yours: same shoulder width, same build, same figure. Breasts that seem moderate on a tall, broad woman may look large on a petite woman. The surgeon helps you translate these images into realistic volumes and a surgical plan.

Current implants are filled with cohesive silicone gel, which does not leak in the event of rupture. They differ in shape — round or anatomical (teardrop) — surface — smooth or microtextured — projection and base. The choice depends on your anatomy, the desired result — more natural or rounder in the upper part — and the surgeon's practice. The technical details, as well as the different placement planes and incision approaches, are presented on our page on breast augmentation in Switzerland.

Implant surfaces have been the subject of much debate. Textured implants, whose rough surface adheres to the tissues, were widely used to limit rotation of anatomical implants and, it was thought, contracture. The link between heavily textured surfaces and the rare implant-associated lymphoma led to some models being withdrawn and to changes in practice. Today, many surgeons favour smooth or microtextured implants. Ask your surgeon what type of surface they use and why; this information also appears on your implant card.

Each implant carries a serial and batch number allowing it to be traced in the event of a safety alert concerning a model. This information appears in your file and on your implant card. In several countries, registries record the implants placed in order to follow their long-term outcome; ask your surgeon whether your implants are registered and how you will be informed in the event of an alert. Keep a copy of your implant card in a safe place.

The operative report describes the procedure precisely: type, volume and position of the implants, incision approach, liposuction areas, volumes suctioned, amount of fat transferred and any particular features. Ask for a copy and keep it with your implant card. This document will be valuable if you consult another doctor, if further surgery is considered or if imaging needs to be interpreted.

Fat transfer can partly compensate for thin tissues when the implant is placed in front of the muscle.

When the implant is placed behind the pectoral muscle, contraction of the muscle compresses it and can move it upwards or outwards, briefly distorting the breast. This phenomenon, visible during certain movements or exercises, is generally discreet. It can, however, bother women who do intensive weight training or certain sports. This is a reason to discuss the placement plane according to your activity, and sometimes to prefer placement in front of the muscle or in a dual plane.

In the combination, liposuction provides fat that can be put to use. Purified and reinjected in small amounts around the implant, particularly in the upper and inner breast, it thickens the tissues, softens the edges of the implant and improves the cleavage. This is called hybrid or composite augmentation. This technique is particularly useful in slim women, whose tissues are thin and where the implant risks being visible or palpable.

Fat transfer lengthens the procedure slightly, and some of the injected fat is resorbed in the following months. It does not replace the implant: it improves its integration. Augmentation using fat alone, without an implant, is another option, described on our page on breast fat transfer and liposuction.

The gap between the two breasts depends on the natural position of the breasts on the chest and the width of the breastbone. Implants cannot be brought closer together beyond certain limits without risk of complications. Fat transfer to the inner part of the breast can improve the cleavage, particularly in slim women. It is important to discuss this: a very tight cleavage, as seen with some padded bras, is not always achievable surgically.

The decision depends on your fat reserve, the thickness of your tissues, the desired volume and how you feel about implants.

Choosing implants also means accepting long-term surveillance. Implants are not guaranteed for life: rupture, contracture or changes in the breasts can lead to them being replaced after several years, sometimes more than ten. A check-up ultrasound or MRI is recommended regularly. Implants do not prevent breast cancer screening, but you must tell the radiologist they are there. Finally, rare implant-specific complications exist, such as a very rare lymphoma associated mainly with textured implants; your surgeon must inform you about this. This information is part of the consent.

After the consultation, a reflection period of at least two weeks is recommended. It allows you to re-read the information document, review the quote, ask further questions, talk to those close to you and, if necessary, consult another surgeon. A second consultation, devoted to the final choice of volume and type of implant, is often offered. Informed consent is signed after this reflection period.

Before an implant augmentation, the surgeon gives you a detailed information document about the chosen implants, their lifespan, the need for surveillance, possible complications, including rare and late ones, and the alternatives. You then sign a consent form. Take time to read this document, ask your questions and keep a copy. It is an important step, with long-term implications.

Before an augmentation, a breast examination is recommended, generally an ultrasound, combined with a mammogram depending on age and family history. It checks for any abnormality and serves as a reference for future surveillance. If an abnormality is found, it must be investigated before the procedure.

The pre-operative assessment generally includes a blood test, sometimes an electrocardiogram depending on age and history, and breast imaging. Iron deficiency, common in women, is worth looking for and correcting, as it accentuates fatigue after liposuction. Chronic illnesses such as diabetes or high blood pressure must be well controlled. The anaesthetist may request a specialist opinion if necessary.

The weeks before the procedure are used to bring together the best conditions. The tests requested by the anaesthetist are carried out. Smoking is stopped at least four weeks beforehand. Medicines and supplements that encourage bleeding are suspended on medical advice. Any current infection, even dental or urinary, must be treated, as it increases the risk of implant contamination.

On the practical side, you need to arrange one to two weeks off work, someone for the journey home and the first few days, buy the support bra and the compression garment for the liposuction areas, and plan loose clothing.

The combined contraceptive pill slightly increases the risk of thrombosis. For an augmentation combined with limited liposuction, in a woman with no other risk factors, many surgeons do not ask for it to be stopped; for a longer procedure or with other risk factors, stopping it a few weeks beforehand can be discussed with the gynaecologist. Always mention your contraception at the anaesthesia consultation.

Any current infection, even a minor one, increases the risk of bacteria reaching the implant via the bloodstream. A dental, urinary or skin infection must be treated before the procedure. A dental check-up in the preceding months is also recommended. After the procedure, some surgeons recommend mentioning the implants before invasive dental treatment.

In the first few days, raising your arms and carrying should be avoided. Place what you use every day at chest height, prepare easy meals, clothes that open at the front and pillows to sleep with your upper body raised. If you have young children, arrange help to carry them for two to three weeks.

Smoking increases the risk of infection, poor healing and contracture around the implants, and slows recovery after liposuction. Stopping all forms of nicotine, including e-cigarettes and heated tobacco, is required at least four weeks before the procedure and until healing is complete.

A weight that has been stable for several months is important for both procedures. Significant weight loss after the procedure would reduce the natural volume of the breasts and could reveal the edges of the implants; it would also change the figure achieved by liposuction. Weight gain would increase breast volume and thicken the treated areas again. It is better to have surgery at a weight you know you can maintain.

The combination is generally performed under general anaesthesia. For limited liposuction, deep sedation combined with local anaesthesia is sometimes possible, but placing implants behind the muscle in particular is more comfortable and safer under general anaesthesia. The anaesthetist meets you before the procedure, assesses your health and treatments, and explains the comfort and safety measures. Local anaesthetic infiltration around the implants and in the liposuction areas reduces pain on waking.

• What type of anaesthesia is planned, and why?
• How will pain be treated on waking and at home?
• Should I stop any of my medicines or my contraception?
• What measures are taken against nausea and getting cold?
• Does my risk of thrombosis justify injections after the procedure?
• When can I drink and eat after waking?

You arrive having fasted. The surgeon makes the markings with you standing: they draw the fold under the breasts, the midline of the chest, the incision site and the limits of the implant pocket, then the liposuction areas, outlining those to slim and those to preserve. They show you the drawing, and this is the time to ask a last question.

In theatre, positioning depends on the areas: on your back for the breasts and abdomen, sometimes turned onto your side or front for the flanks, saddlebags or back.

Marking is an essential step. On the breasts, the surgeon draws the midline, the current fold and the future fold if it needs to be lowered, the incision site and the limits of the pocket. On the liposuction areas, they outline the areas to slim, the transition zones and the areas to preserve, such as natural hollows or certain adhesions. This drawing is made standing, as lying down changes the distribution of fat.

If only the front of the body is treated, the patient stays on her back. If the saddlebags, flanks or back are involved, she is first placed on her front or side for these areas, then turned onto her back for the abdomen and breasts. Each turn is carried out under anaesthesia, with care. Starting with the back areas makes it possible to finish on the back and check breast symmetry in a semi-sitting position.

The order of the steps is important for implant safety. An implant is an implanted body that the body cannot defend in the event of contamination; an infection in contact with it often requires its removal. Liposuction, for its part, handles large quantities of fluid and fat, sometimes in areas close to the pubis or skin folds.

Many surgeons therefore perform the liposuction first — the back and side areas first if turning is needed — then change gloves, drapes and instruments before placing the implants under maximum aseptic conditions. Others place the implants first, close and protect the incisions, then perform the liposuction. In all cases, strict precautions are taken; it is legitimate to ask your surgeon how they proceed.

Several measures limit the risk of implant contamination. The skin is carefully disinfected, an antibiotic is given before the incision, the pocket is irrigated with antiseptic or antibiotic solutions, gloves are changed just before handling the implants, and the implants are introduced with as little contact with the skin as possible, sometimes using a sleeve. The nipple may be covered with adhesive film. These precautions, known as no-touch techniques, have helped reduce the frequency of infections and contractures.

The surgeon injects into each area an infiltration solution made of saline, local anaesthetic and adrenaline, which limits bleeding and makes suction easier. They then introduce fine cannulas through incisions of a few millimetres placed in natural creases and suction the fat in a fan pattern, leaving a regular layer under the skin. They take care with the transitions between treated and untreated areas to avoid steps. Assistive technologies, such as cannula vibration or ultrasound, can make the procedure easier in fibrous areas; our page on VASER liposuction describes one of them in detail.

No technology replaces the surgeon's experience. They sometimes increase the cost, and heated fat is generally not used for transfer.

Liposuction uses cannulas of various diameters: wider for thick areas, finer for areas with thin skin such as the inner thighs or arms. The surgeon works in a fan pattern, with crossing passes, leaving a layer of fat under the skin. For harvesting intended for transfer, they use cannulas with small holes and gentle suction. This finesse of technique determines how even the result is.

When several liposuction areas are treated, the surgeon generally begins with those that require turning, such as the back, saddlebags or flanks seen from behind, then finishes with the front areas. They check the continuity between areas at each change of position. This order also allows the implants to be placed last, on the back, under renewed aseptic conditions.

When transfer to the breasts is planned, part of the fat is harvested with finer cannulas and gentler suction to preserve the cells. It is then purified, by decanting, filtration or centrifugation, to remove blood, infiltration fluid and oil from ruptured cells. Only good-quality fat is reinjected. This preparation takes time and care, as it determines the proportion of fat that will survive.

For transfer to the cleavage, the surgeon preferably harvests fat from areas where it is abundant and soft, such as the abdomen, flanks or inner thighs. Fat quality, preparation and injection technique influence the proportion that survives. In smokers, survival is poorer, which is another reason to stop smoking. Fat harvested from areas treated with thermal technologies is generally avoided for transfer.

Through a four-to-five-centimetre incision, usually in the fold under the breast, sometimes at the edge of the areola or in the armpit, the surgeon creates a pocket to the precise dimensions of the implant, in front of or behind the pectoral muscle. They control bleeding, irrigate the pocket with antiseptic solutions and introduce the implant while limiting its contact with the skin, sometimes using an insertion sleeve. They check symmetry by raising the patient on the table, then close in several layers.

Once the implants are in place, the surgeon raises the table to place you in a semi-sitting position. They then compare the height, volume and shape of both breasts, the position of the folds and the gap between the breasts. If necessary, they adjust the pocket before closing. They also check the evenness of the liposuction areas by palpation. These quick checks avoid many touch-ups.

Once the implants are in place, the purified fat is injected in small amounts, in multiple passes, into the tissues above and around the implant, particularly in the upper and inner breast. The surgeon avoids injecting in direct contact with the implant or into the pocket itself. The aim is not to add much volume, but to thicken the tissues where they are thin and soften the transition between the chest and the breast.

The amount of fat injected around the implants is modest, often a few tens of millilitres per breast. The aim is not to add volume but to cover the edges and thicken thin tissues. Injecting too much fat in the same place increases the risk of nodules and cysts, as fat needs to be in contact with well-vascularised tissues to survive. The surgeon therefore distributes small amounts in multiple passes.

Beyond a certain liposuction volume or duration, the surgeon may prefer to separate the procedures.

When the plan includes many liposuction areas, significant fat transfer or a lift, the procedure can become long. The surgeon may then propose performing the augmentation and part of the liposuction first, then the rest a few months later. This strategy reduces the length of anaesthesia and fatigue, allows the breast result to be assessed before completing the figure, and makes any second fat transfer more effective.

Surgeons set a maximum volume of fat suctioned in one session, depending on the patient's weight and health. Combined with breast augmentation, liposuction generally remains moderate. If the plan exceeds these limits, the surgeon proposes spreading the areas over two procedures. This choice, sometimes frustrating, is above all a safety choice.

When not all the desired areas can be treated at once, choices have to be made. The areas that bother you least, those with the thinnest skin or those that could benefit from another technique are good candidates for a second stage. It often happens that once the breasts are augmented and the waist slimmed, the concern about other areas lessens and the second stage becomes less necessary.

Some patients, happy with the result of the combination, want to complete the work a few months later on an area that was left out, such as the arms, inner knees or back. This second procedure, limited to liposuction, is shorter and lighter than the first. It is generally scheduled at least six months later, when the figure obtained has stabilised and what remains to be improved can be judged precisely. The surgeon then ensures continuity with the areas already treated, so that the whole remains harmonious. Conversely, it is not unusual for the concern about these secondary areas to fade on its own once the breasts are augmented and the waist slimmed, and for the patient to forgo this second stage, happy with the balance already achieved. In both cases, the decision is best made calmly, after the one-year review. There is no hurry: a well-stabilised figure allows an accurate judgement of what still deserves improvement.

The breast incisions are closed with fine, often absorbable stitches and protected by dressings or strips. The small liposuction incisions are left open or closed with a stitch. The support bra and compression garment are put on before you wake up. Drains are rarely needed for implants; they may be used after extensive liposuction.

When a night is planned, the team monitors pain, blood pressure, the appearance of the breasts and liposuction areas, and drainage from the incisions. They help you get up for the first time and ensure you stay hydrated. A haematoma, if it occurs, is usually detected during this night and treated immediately. The surgeon visits the next morning before discharge.

On waking, the breasts feel tight, high and tense, especially if the implants were placed behind the muscle, with a feeling of weight on the chest. The liposuction areas are sore, as after an intense sports session. Pinkish fluid may drain from the small liposuction incisions for one to two days. Painkillers relieve most patients well. The first time you get up is a few hours later, with assistance.

Discharge generally takes place the next morning. You leave with a prescription for painkillers, written instructions, the number to call if there is a problem and the date of the first check-up. You travel home accompanied; the seat belt may press on the chest, and a small cushion improves comfort. At home, alternate rest and short walks.

• Two support bras and two compression garments.
• The compression band, if prescribed.
• The prescribed painkillers and, if necessary, the anticoagulant.
• Pillows to sleep with your upper body raised.
• Loose clothes that open at the front.
• Bed protection for the first few nights, in case of leakage from the liposuction incisions.
• The team's number and the date of the first check-up.

A relative present in the first few days helps you get up, dress, prepare meals and look after children. They can also reassure you when the breasts look too high or the liposuction areas are swollen. Explaining the course of recovery and the signs that require calling the surgeon to them in advance is useful.

The first two to three days are the most uncomfortable. The breasts are tight and painful, especially when moving the arms, and the liposuction areas ache. Avoid raising your arms above your shoulders, carrying loads and pushing up on your arms to get up. Walking several times a day is encouraged. Bruising appears on the liposuction areas and sometimes on the breasts; it disappears within two to three weeks.

For two to three weeks, avoid raising your arms above your shoulders, carrying loads of more than a few kilos, pushing or pulling forcefully, and pushing up on your arms to get up. Washing your hair, dressing or reaching for something high up requires a little organisation. These precautions limit pain and the risk of haematoma, and help the implants stabilise.

The first shower is generally allowed after twenty-four to forty-eight hours. Take it lukewarm, removing the bra and compression garment, preferably with someone nearby, as you may feel slightly faint. Gently wash the scars without rubbing, pat dry, change the dressings if necessary and quickly put the support garments back on.

Fatigue is common for one to two weeks, linked to the anaesthetic, healing and swelling of the liposuction areas. It is more marked when several areas have been treated. Naps, good hydration and a gradual return to activities help you get through it. Intense fatigue with breathlessness must be reported.

Bruising is common in the liposuction areas, particularly on the thighs and hips, and sometimes moves down towards the knees under the effect of gravity. On the breasts, it is generally limited. It changes colour from purple to yellow and disappears within two to three weeks. Wearing the compression garment regularly and avoiding blood-thinning products reduce its extent.

The support bra, without underwiring and fastening at the front, supports the implants, limits swelling and protects the scars. It is worn day and night for four to six weeks. Some surgeons add an elastic band above the breasts, which helps implants placed behind the muscle settle gradually into their pockets. Underwired bras wait several weeks, until the fold scar has fully consolidated.

When implants are placed behind the muscle, they tend to remain high in the first few weeks. Some surgeons prescribe an elastic band worn above the breasts, which exerts gentle downward pressure and encourages them to settle into the pocket. It is worn with the bra, day and night or during the day as instructed. It should not be tightened excessively.

It is advisable to wait two to three months, until the implants have settled and the shape has stabilised, before buying permanent bras. Underwired styles are resumed in agreement with the surgeon. The cup size changes, but sometimes so does the band size, if liposuction has slimmed the upper body.

The liposuction areas are supported by a suitable garment: a panty for the hips, thighs and buttocks, a girdle for the abdomen and waist, sleeves for the arms. It reduces swelling, helps the skin retract and limits irregularities. It is worn day and night for three to four weeks, then often during the day for a few weeks. It must be compatible with the bra: a girdle that rides up too high can rub on the fold scar.

In the first few weeks, loose tops that open at the front and soft bottoms compatible with the compression garment are the most practical. Fitted clothes wait until the swelling decreases. Many patients look forward impatiently to wearing outfits that show off their new figure; this generally comes after one to two months.

The breasts are often the most painful area in the first few days, especially when the implants have been placed behind the muscle: it feels like severe aching of the pectorals, accentuated by arm movements. The liposuction areas are tender to the touch and under pressure. Pain decreases markedly after three to five days. If one breast starts to swell and become increasingly painful, on one side only, contact the team without delay: it may be bleeding under the implant.

In the first few weeks, the breasts look high, firm and sometimes slightly apart or asymmetrical. The implants gradually settle into their pockets as the muscle and skin relax: this is sometimes called the implants "dropping". It generally takes two to three months for the breasts to take on a natural shape. The liposuction areas are swollen and sometimes firm; the figure takes shape over the weeks.

In the first few weeks, the breast skin is stretched by the implant, especially in women whose breasts were small and whose skin was firm. This tension can give a feeling of tightness, sometimes pulling in the fold. It decreases as the skin adapts. Gentle skin massage, once the scars have closed, and regular moisturising improve comfort. Very tight skin can also cause a few stretch marks in young women.

In the first few weeks, it is common to have doubts: the breasts look too high, too firm or asymmetrical, the liposuction areas are swollen and hard, and the figure does not yet look as hoped. This stage is normal and temporary. Taking regular photographs under the same conditions helps you see the progress. If you are worried, the surgeon can reassure you at a check-up.

Recovery requires patience. In the first few weeks, it is easy to become discouraged by breasts that are too high, swollen thighs or a waist that still looks thick. The result of the combination emerges gradually, between the second and sixth months, as the implants settle and swelling disappears. Setting milestones, such as the three-month check-up, and comparing photographs rather than looking in the mirror every day help you get through this period calmly.

Taking regular photographs from the front, in profile and at three-quarters, in the same lighting and posture, allows you to follow the implants settling and the figure changing. Comparing week three with the day before surgery is often discouraging; comparing month three with month one generally shows clear progress.

You must sleep on your back, with your upper body slightly raised, for four to six weeks, so as not to press on the implants and to let them stabilise. If the hips or thighs have been treated, some positions are uncomfortable in the first few days; a cushion under the knees helps. Sleeping on your side becomes possible again at around four to six weeks, on your front later.

After four to six weeks, sleeping on your side generally becomes possible again, with a pillow between your arms to support the breasts. Sleeping on your front resumes later, often after two to three months, once the implants have stabilised and the breasts are no longer tender. Some women find this position less comfortable than before, particularly with larger implants.

For a self-employed woman, time off work for a cosmetic procedure is generally not compensated. For a job that uses the arms, such as hairdressing, care work or handling, returning often takes two to four weeks. Scheduling the procedure during a quiet period avoids compromising recovery.

Intimate life can resume when pain allows, often after two to three weeks, avoiding any pressure on the breasts and liposuction areas. The breasts remain tender for a few weeks. For many women, a new relationship with their body also makes intimacy more relaxed.

The support bra and compression garment are easy to hide under clothes. Most patients go out again after one to two weeks. Activities that require undressing, such as the pool or beach, wait until the scars have fully closed and the bruising has gone, about four to six weeks.

Some activities deserve particular attention. Climbing, rowing, front-crawl swimming and racket sports place heavy demands on the pectorals and shoulders: they resume after six to eight weeks, later if the implants are behind the muscle. Yoga and Pilates can resume gradually, avoiding weight-bearing on the chest and postures that compress it. Contact sports expose the chest to impacts; protection may be useful. A physiotherapist or coach can adapt the exercises.

A balanced diet rich in protein, fruit and vegetables promotes healing. Drinking enough helps the body clear swelling in the liposuction areas. Limiting salt in the first few weeks reduces water retention. It is better to postpone any diet until later; once recovery is over, a stable weight is what will best protect the new figure.

The breast scar generally measures four to five centimetres and is located in the fold under the breast, where it is hidden by the breast itself and by underwear. When it is placed at the edge of the areola or in the armpit, it blends into the pigmented border or the creases. The liposuction incisions measure a few millimetres and are placed in natural creases. All are pink at first, then fade over twelve to eighteen months. Gentle massage, silicone gels and strict sun protection help them mature.

Once the scars have closed, generally after two to three weeks, gentle daily massage with a moisturising cream softens them. Silicone gels or sheets, applied for several months, help flatten and lighten them. Sun protection is essential. If a scar becomes thick, red and itchy, tell the surgeon: specific treatments exist.

Well-cared-for skin adapts better to the implant and retracts better after liposuction. Before and after the procedure, daily moisturising of the breasts and treated areas, a diet rich in protein and vitamins, stopping smoking and regular sun protection all contribute to its quality. These simple habits are nothing spectacular, but they contribute to the quality of the result over time and to the appearance of the scars.

In the first few weeks, creams are not applied directly to scars that have not closed. Once they have fully closed, a fragrance-free moisturising cream can be used for gentle massage. The liposuction areas also benefit from this massage, which helps soften firm areas and gives a better sense of how the contours are changing.

Recent scars must be protected from the sun for at least a year to prevent them from darkening. For swimming, saunas and steam rooms, wait one to one and a half months. The liposuction areas, whose sensation is reduced for a while, should not be exposed to direct heat, such as a hot-water bottle.

Many patients prefer to have surgery when the days are getting shorter: jumpers and coats hide the compression garments, the sun is kind to the scars, and the figure has several months to take shape before the summer. Scheduled in May or June, by contrast, the procedure would rule out swimming for a good part of the summer.

Manual lymphatic drainage can speed up the resolution of swelling in the liposuction areas, particularly on the thighs and hips, where swelling moves down with gravity. It generally starts after one to two weeks. The breasts are not massaged in the first few weeks, unless the surgeon instructs otherwise. After that, gentle massage of the treated areas helps soften firm areas.

In the following weeks, the liposuction areas may be numb, then become the site of tingling, small shooting sensations or tenderness to touch as the nerves recover. Indurations, firmer areas under the skin, are also common; they soften within a few months. These sensations are normal and should not cause concern unless they are accompanied by redness, warmth or fever.

The surgeon usually sees you at one week, then at one, three, six and twelve months, to examine the scars, the position of the implants, their symmetry, breast softness, the liposuction areas and, where applicable, the survival of transferred fat. After that, regular implant follow-up is recommended, with clinical examination and imaging at the frequency indicated by the surgeon.

The first check-up generally takes place after a week. The surgeon checks the scars, the absence of haematoma, the position of the implants, how well you are tolerating the bra and compression garment, and the appearance of the liposuction areas. They clarify the instructions for the following weeks, notably wearing the band, resuming arm movements and drainage.

It is useful to note, in the weeks after the procedure, how the pain, bruising, breast shape and liposuction areas are changing, as well as your questions. In the longer term, a notebook containing the date of the procedure, the implant details, and the dates and results of imaging examinations makes it easy to follow the recommended surveillance.

Your GP can handle part of the follow-up, particularly if the clinic is far away. They are also the contact for breast cancer screening and can prescribe imaging for implant surveillance. Sending them the operative report and a copy of the implant card makes this follow-up easier.

After the procedure, you receive a card or document identifying the implants: manufacturer, model, volume, batch number. Keep it carefully. It will be needed at any breast examination, in the event of a question about the safety of a model, or if further surgery is considered. It may also be requested for certain imaging examinations.

Implant surveillance relies on clinical examination and imaging. Ultrasound is the most common test; MRI is the reference test for detecting silent rupture. The recommended frequency varies between learned societies and manufacturers, often with a first check a few years after placement and regular checks thereafter. This surveillance is in addition to the usual breast cancer screening, which remains necessary. Your surgeon tells you the schedule suited to your implants.

Implants do not increase the risk of breast cancer and do not prevent screening for it. Mammograms remain possible, with adapted views, and ultrasound and MRI complement the examination. You must tell the radiologist about the implants. Fat transfer can leave small benign calcifications, which the radiologist can generally distinguish; it must also be mentioned.

After fat transfer, small areas of fat that did not survive can form nodules or calcifications. They are benign, but they may appear on ultrasound or mammography and sometimes require further investigation to be characterised. Telling the radiologist about the fat transfer and, if possible, providing previous examinations makes interpretation much easier.

The combination brings together the risks of breast augmentation and those of liposuction. Most are rare or benign; some are specific to implants and can occur years after the procedure.

Infection is rare, but it is the most feared complication. It shows as redness, warmth, increasing pain, swelling, sometimes fever, most often in the weeks following the procedure. Antibiotic treatment may be enough in early forms; if the implant is affected, it generally has to be removed, the breast heals, and a new implant is placed several months later. The precautions taken in theatre, particularly the organisation of the order of steps, aim to reduce this risk.

The body forms a thin membrane, the capsule, around each implant. In some cases, this capsule thickens and contracts, making the breast firm, sometimes distorted and painful. This contracture can occur in the first few months or years later. Its frequency has decreased with modern implants and placement techniques, but it remains one of the main reasons for further surgery. It is treated by a procedure that removes or opens the capsule, often with implant exchange.

This classification helps describe the course and decide on possible further surgery.

An implant may sit too high, too low or too far to the side, or the two breasts may be too far apart or too close together. Some malpositions are visible from the first few weeks, others appear over time. Pre-existing asymmetry of the breasts or chest may persist. Anatomical implants can rotate in their pocket and distort the breast. Most of these situations are corrected by revising the pocket.

Modern implants, filled with cohesive gel, are resistant but can rupture over the years, often without symptoms. The gel generally stays within the capsule. Rupture is detected during a check-up imaging examination and leads to the implant being replaced. It is one of the reasons for regular surveillance.

A very rare type of lymphoma, called breast implant-associated anaplastic large cell lymphoma, has been described in women with implants, especially heavily textured implants. It most often shows, years after placement, as significant swelling of a breast due to fluid accumulating around the implant. Diagnosed early, it is generally treated by removing the implant and its capsule. This risk is very low, but any sudden increase in the volume of a breast, long after the procedure, requires medical attention.

Significant, rapid swelling of a breast occurring more than a year after placement often corresponds to fluid accumulating around the implant, called a late seroma. It can have several causes, including, very rarely, implant-associated lymphoma. It requires a consultation, an ultrasound and, if fluid is present, aspiration with analysis. In the vast majority of cases the cause is benign, but this examination is essential.

Some women with implants describe systemic symptoms, such as fatigue, joint pain or difficulty concentrating, which they attribute to the implants. A cause-and-effect link has not been scientifically established, and these symptoms have many other possible causes. In some patients, removal of the implants has been followed by an improvement. If you experience such symptoms, talk to your doctor and your surgeon, who can look for the cause.

In the liposuction areas, hollows, bumps or rippling may appear, especially on the thighs, where the skin is thin. In the first few months, swelling and firmness can give a false impression of irregularity. Those that persist after six to twelve months can be corrected with a small additional liposuction or fat reinjection.

Besides irregularities, liposuction carries specific risks: overly superficial suction that leaves the skin adhering in hollows, excessive suction that leaves loose skin, asymmetry between two sides, prolonged numbness. Rarely, very extensive liposuction causes significant fluid loss, anaemia or, exceptionally, fat embolism. The surgeon limits the volume suctioned in one session and the number of areas to reduce these risks.

Part of the fat injected around the implants is resorbed in the following three to six months, often between a third and a half. The volume that persists after six months is generally stable. If the effect obtained is insufficient, a second session can be considered. More rarely, small nodules or oil cysts form; they are benign but may be palpable and must be mentioned at breast examinations.

If, after six months, an implant edge remains visible or the cleavage looks slightly hollow, a second fat transfer session may be proposed. It is often performed under light anaesthesia, with fat harvested from an area not yet treated. Fat often survives better in the second session, as the tissues have been prepared by the first.

Nipple sensation may change after augmentation: reduced or, conversely, increased for a few weeks or months. It usually returns, but a lasting change is possible, particularly with large implants. The liposuction areas may remain numb for a while, then become the site of tingling as the nerves recover.

In a small minority of cases, pain persists beyond a few months around an implant or in a liposuction area. It may be linked to an irritated nerve, early contracture, malposition or, in the liposuction areas, firmness. It deserves to be reported and investigated, as treatments exist, from simple painkillers to surgical revision when the cause is mechanical.

The risk of thrombosis is low for augmentation alone, but it increases with the length of the procedure and the extent of the liposuction. Prevention is adapted to the level of risk: compression stockings, leg compression during the procedure, getting up early, hydration and sometimes an anticoagulant. The combined contraceptive pill increases this risk; it is discussed with the doctor. A painful or swollen calf, sudden breathlessness or chest pain require a call to 144.

Fat embolism is a very rare complication of liposuction, in which fat particles enter the circulation and reach the lungs. It shows as breathlessness and respiratory distress, generally in the hours or days that follow. Its extreme rarity should not obscure the fact that it justifies limiting the volume suctioned and performing the procedure in a facility equipped to respond.

• Rapid, painful swelling of a breast.
• Redness, warmth or discharge at a scar.
• Fever above 38.5 degrees.
• Pain that increases instead of decreasing.
• A painful or swollen calf, breathlessness, chest pain.
• Years later, a sudden increase in the volume of a breast.

Keep the number the team gave you for the recovery period with you.

During recovery, do not hesitate to contact the team with any question, even if it seems minor. Sending a photograph, if the team offers this, often allows a quick response to a concern about a scar or bruise. Also report any new medication, any fever or any unusual symptom. Good communication is part of safety.

An early touch-up is sometimes needed to correct a malposition or a liposuction irregularity. In the longer term, further surgery may be prompted by contracture, rupture, changes in the breasts with age, pregnancy or weight variation, or the wish to change volume. It is important to know this from the outset: implant augmentation is a long-term commitment, and further surgery has a cost. The surgeon's policy and any manufacturer's warranties should be known.

Over the years, further surgery may be needed for several reasons: rupture, contracture, malposition, changes in the breasts with age, pregnancy or weight, or simply the wish to change. It involves replacing the implants, removing or opening the capsule, and sometimes combining a lift or fat transfer. It is generally simpler than the first procedure, but it has a cost that is wise to anticipate.

Some women want smaller or larger breasts years later. A change of volume is possible, but it must take into account the condition of the tissues: going to a clearly smaller volume can leave lax skin, requiring a lift; going to a larger volume can thin the tissues further. Fat transfer can help harmonise the result.

Permanent removal of the implants is also possible. It may be prompted by complications, symptoms or a change of mind. After removal, the breasts may look empty and sagging; a lift, fat transfer or both are often proposed at the same time. The capsule is removed completely or partially depending on the case.

When the combination is successful, the figure looks more balanced: fuller, better-proportioned breasts, a slimmer waist, and lighter hips and thighs. The most appreciated result is often this balance rather than the volume itself. Many patients describe greater comfort in clothes, outfits that hang better and renewed ease in a swimsuit.

Several elements contribute to a natural result: a volume suited to the breast base and build, an implant well covered by the tissues, a shape that respects the natural slope of the upper breast, and a cleavage that does not look forced. Liposuction also contributes: a slimmer waist and harmonised hips enhance the breasts without them needing to be large. When looking at the figure, the eye perceives balance rather than an isolated detail.

Several observations come up repeatedly in testimonials. In the first few days, the breasts are more painful than the liposuction areas. The breasts look too high for several weeks, then settle into place. The change in figure becomes apparent gradually as the swelling decreases. And many say that it is the overall harmony, more than breast volume, that satisfies them most.

A year after the procedure, the surgeon reviews the shape and softness of the breasts, the position of the implants, the survival of transferred fat, the liposuction areas and the scars. They set out the implant surveillance schedule. It is also the time to discuss a possible touch-up, which is rarely needed.

Once recovery is over, many women rediscover their wardrobe. A slimmer waist changes how dresses and trousers hang, and fuller breasts change the size of tops. It can be useful to sort through things gradually, once the figure has stabilised, rather than replacing everything in the first few weeks, when swelling still distorts the contours. This moment is often experienced as one of the rewards of recovery.

Repeating the measurements taken before the procedure — bust, waist and hips — at three, six and twelve months allows the change in figure to be measured objectively. The figures complement the photographs and help you see how far you have come, particularly when swelling has long masked the result.

The suctioned fat does not come back, and the figure is maintained as long as weight remains stable. Implants, however, age: the breasts change with age, pregnancies and weight variations, and the implants may need to be changed after many years. Many women keep their implants for more than ten years without problems; others need further surgery sooner. Regular surveillance allows this to be anticipated.

Once the figure has been reshaped, weight stability is essential. Weight gain can thicken untreated areas and, to a lesser extent, treated areas, and increase the natural volume of the breasts. Significant weight loss can reduce natural volume and make the implants more visible. Regular physical activity and a balanced diet preserve the result.

At menopause, the mammary gland decreases and the breasts slacken. The implants keep their volume; the breasts may then look rounder at the top and emptier around them. A lift or implant exchange can be considered at this stage of life. The figure also changes, with fat distributed more on the abdomen.

Pregnancy remains possible after breast augmentation. The breasts enlarge during pregnancy and may then lose volume or sag, which changes the result. Breastfeeding is generally possible, especially when the incision was made in the fold and the implant is placed behind the muscle, as the gland and ducts are preserved. The figure achieved by liposuction may also be altered by pregnancy weight gain. If a pregnancy is planned in the short term, it may be preferable to wait.

If you plan to breastfeed one day, tell the surgeon. An incision in the fold rather than around the areola and an implant placed behind the muscle better preserve the gland and ducts. Fat transfer, performed in the tissues around the gland, does not prevent breastfeeding. Most women with implants breastfeed normally.

There is no strict timeframe, but most surgeons recommend waiting at least six months to a year, until healing is complete and the result is stable. A pregnancy will change the breasts in any case; the later it comes, the more time the result will have had to settle. If you are planning several closely spaced pregnancies, it may be wiser to postpone the procedure.

For many women, the combination brings greater confidence in their body. It is nevertheless important to keep realistic expectations: the procedure improves a figure; it does not change a life. The women who get the most satisfaction from it are often those whose request was personal, well considered and concerned specific aspects of their figure. If preoccupation with appearance is overwhelming or several procedures have brought no relief, psychological support is often more useful than further surgery.

Those around you often notice a change in your look without always identifying exactly what has changed, particularly when the volume is reasonable and the liposuction harmonious. Whether to talk about it is a personal choice. If comments make you uncomfortable, remember that the decision is yours and that it was carefully considered.

Sometimes satisfaction with a first procedure makes you want to have others. This is legitimate when it is a matter of completing a well-thought-out plan. But when dissatisfaction moves from one area to another, the perceived flaws are minimal or preoccupation with appearance becomes overwhelming, some reflection is needed. An attentive surgeon will speak frankly about this and may refer you for psychological support, which often helps more than an additional procedure.

The surgeon must present these options to you and explain which one they recommend.

If the breasts have sagged, with an areola at or below the fold, an implant alone is not enough: it would fill the upper breast without lifting the areola, and the breast could slide below the implant. A lift is then combined, with a scar around the areola and often a vertical one. The combination then becomes longer and more complex; the liposuction may be limited or performed in a second stage. Our page on the breast lift describes these techniques.

To compare options without quoting amounts, each one is expressed relative to a base of 100, representing breast augmentation with round implants combined with liposuction of two areas, for example the flanks and abdomen, performed in Geneva.

Details of the differences between cities and the items in the quote are on our page on breast augmentation with liposuction prices.

The number of liposuction areas, the type and brand of implants, fat transfer, the use of an assistive technology, the length of stay and the clinic are the main factors. The surgeon's experience and the region also count. Follow-up consultations, compression garments and the policy on further surgery may or may not be included. Comparing two quotes only makes sense for equivalent services.

The quote should detail the surgeon's and anaesthetist's fees, the cost of the operating theatre and any overnight stay, the model and volume of the implants, the liposuction areas, any fat transfer, compression garments, follow-up consultations included and the policy in the event of a touch-up or complication. It also states its period of validity. Ask for each item to be explained.

The quote is sometimes supplemented by additional compression garments, drainage sessions, painkillers, new bras once the shape has stabilised and, in the longer term, imaging and possible further surgery. Adding these elements together gives a realistic view of the investment.

Cosmetic breast augmentation and liposuction are not covered by compulsory health insurance. An exception may concern certain malformations, such as absence of development of a breast, after a prior request. Complications of a cosmetic procedure, such as an infection or contracture years later, also raise coverage questions; it is wise to check with your insurer and ask the surgeon whether they offer insurance covering complications.

The cost of implant augmentation is not limited to the initial procedure. Regular imaging check-ups and, eventually, the likelihood of further surgery — to exchange the implants, treat contracture or adapt the breasts to changes in the body — must be factored in. Some manufacturers offer warranties in the event of rupture or contracture; their conditions vary. Factoring these elements into your thinking allows a calmer decision.

Some clinics offer staggered payment. Before accepting, calculate the total amount repaid and check that the instalments remain compatible with your budget, including future implant costs.

Breast augmentation is one of the most frequently performed cosmetic procedures in Switzerland, and liposuction often accompanies it. Provision is therefore wide, but experience of the combination, and particularly of fat transfer around implants, varies from one practitioner to another. The table compares provision and price levels in twenty-one cities.

These differences are trends for comparable services, not fees. The implant model and the number of areas often weigh more than the city.

In cantons where choice is limited, most patients consult in a neighbouring centre, then arrange check-ups and, where applicable, drainage close to home.

The Lake Geneva region, from Geneva to Montreux via Nyon, Morges and Lausanne, has a large share of the French-speaking surgeons who regularly perform this combination. Central Valais, around Sion, has its own provision, complemented by the Riviera for the Chablais and Lower Valais. Neuchâtel, La Chaux-de-Fonds, Fribourg, Bulle and Yverdon have plastic surgeons experienced in breast augmentation. Patients from Jura often choose Delémont, Biel/Bienne or Basel.

Zurich offers the widest choice and attracts patients from Winterthur, Schaffhausen, Thurgau and the small neighbouring cantons. Basel and Bern are two other major hubs; Lucerne and Zug serve central Switzerland, St. Gallen eastern Switzerland. Aarau, Baden, Olten and Solothurn offer a local alternative in the Mittelland.

Lugano concentrates provision in Ticino, with surgeons also present in Locarno and Bellinzona. Consultations are in Italian, and often in French or German. In Graubünden, Chur and the Upper Engadine have a few practitioners; Zurich, St. Gallen and Lugano are often chosen for the procedure.

Choosing the volume, shape and areas requires a nuanced discussion, and the post-operative instructions must be fully understood. In French-speaking Switzerland, everything takes place in French; in Biel/Bienne, Fribourg and bilingual Valais, often in French and German. In the major German-speaking cities, many practitioners see patients in French or English. In Ticino, Italian predominates, with good French. Ask for written documents in your language.

For augmentation combined with liposuction, choosing a surgeon in another region is common. There are fewer check-ups in the first few weeks than for an abdominoplasty, but the first check-up, at one week, is important for checking the position of the implants and the scars. You need to arrange to be accompanied home and have a local contact in case of a problem. Long-term implant follow-up by imaging can be done near home, provided you have the implant card and the operative report.

A second opinion is useful, particularly for choosing the volume and deciding on the role of fat transfer. It allows approaches to be compared and checks that the proposed plan is consistent with your figure. If the recommendations differ, ask each surgeon to justify their choices: their arguments will help you decide.

Breast augmentation is a common procedure, but the result depends greatly on the surgeon's aesthetic sense and ability to think in terms of the figure. Look for a surgeon who regularly performs augmentation and liposuction, who can show you results for patients with a body shape close to yours, and who takes time to discuss volume in relation to your future figure. A practitioner who advises you against an excessive volume or overly extensive liposuction is doing you a favour.

The procedure involves a team: surgeon, anaesthetist, theatre nurses, recovery room team and ward team. After discharge, a drainage therapist may treat the liposuction areas. Find out who to contact once you are home, including outside working hours.

The online federal register allows you to check that your surgeon holds the specialist title in plastic surgery. For a procedure under general anaesthesia combining implants and liposuction, the surgeon must operate in a facility with an anaesthesia team, strict aseptic conditions and post-operative monitoring. Also ask which implant models they use and why.

Ask for photographs of results at several months, from the front, in profile and at three-quarters, in women with a comparable body shape. Check that the lighting, posture and framing are identical before and after. For the combination, look at the whole figure: harmony between breasts, waist and hips matters as much as the breasts themselves. Observe the appearance of the cleavage, the visibility of the implant edges and the transitions in the liposuction areas.

• What volume and type of implant do you propose, given my figure after liposuction?
• Will you place the implant in front of or behind the muscle, and why?
• Through which incision?
• Which liposuction areas do you recommend, and which do you advise against?
• Is fat transfer to the cleavage useful in my case?
• In what order do you perform the steps, and what precautions do you take against implant infection?
• What implant surveillance do you recommend?
• What is your policy in the event of a touch-up or complication?

The procedure takes place in a clinic or hospital with an operating theatre, an anaesthesia team and post-operative monitoring. For a combination, the possibility of staying overnight is an element of comfort and safety. Find out how complications are handled at night or at weekends.

• Choosing the implant volume based on the current figure, without anticipating the effect of liposuction.
• Requesting very extensive liposuction at the same time as the implants.
• Thinking that liposuction replaces an abdominoplasty for a lax abdomen.
• Neglecting to stop smoking.
• Raising your arms or carrying loads too soon.
• Abandoning the bra or compression garment before the planned time.
• Forgetting implant surveillance over the years.

The pear-shaped figure

A twenty-nine-year-old woman has small breasts and wide hips, with family saddlebags. The surgeon proposes moderate-volume implants, liposuction of the saddlebags and inner knees, and a light fat transfer to the upper cleavage. The figure looks more balanced, without excessive breasts.

The mother of two

A thirty-six-year-old woman has lost breast volume after breastfeeding twice and still has curves on her flanks. Her abdominal skin is firm and her muscles are not separated. A combination of augmentation and liposuction of the flanks and abdomen is proposed. If her abdomen had been lax, an abdominoplasty would have been discussed.

The slim sportswoman

A very slim thirty-two-year-old runner wants slightly more defined breasts and complains of a small excess on her inner thighs. Her tissues are thin. The surgeon proposes small-volume implants in a dual plane, targeted liposuction and fat transfer to cover the implant edges.

The request that needs redirecting

A forty-year-old woman wants large implants and liposuction of five areas at once. The surgeon explains the volume limits compatible with her tissues and the reasonable length of a procedure, and proposes a more moderate volume with two liposuction areas, keeping the others for later if she wishes.

• I know which areas of my figure I want treated and why.
• The implant volume was chosen with my figure after liposuction in mind.
• I know the type of implant, its position and the incision approach.
• I understand that implants require surveillance and sometimes replacement.
• My weight is stable and I am not planning a pregnancy soon.
• I have stopped smoking or I commit to doing so.
• I have a detailed quote and know the touch-up policy.
• I have organised my recovery.

Combining implant breast augmentation with liposuction rebalances the figure by adding volume to the breasts and removing it from areas of localised fat. It allows the implant volume to be chosen with the future figure in mind, often with a more moderate volume, and the harvested fat to be used to soften the cleavage. It offers a single anaesthetic and a single recovery, of one to two weeks for office work.

The risks are those of implants — notably infection, contracture and the need to monitor and sometimes replace the implants over the years — and those of liposuction. The procedure is cosmetic and remains at the patient's expense; fees can be up to fourteen per cent lower than in Geneva depending on the canton. The choice of surgeon and a plan designed around the whole figure remain the keys to the result.

If you want fuller breasts and a more harmonious figure, a consultation will review the volumes, areas and techniques suited to your body shape. Take time to try, compare and ask your questions. Medespoir Suisse can put you in touch, free of charge and without obligation, with a plastic surgeon experienced in this combination, in the region that suits you.

Budget

Price differences between cities and cantons, the quote breakdown and ways to save are detailed on our page Breast augmentation and liposuction: prices in Switzerland.

Related procedures

• Pectoral implants and Full HD liposuction in Switzerland
• Full HD liposuction and BodyTite for men in Switzerland
• Gynaecomastia and 360 liposuction in Switzerland
• Breast reduction and liposuction in Switzerland
• RibXcar and 4D HD liposuction in Switzerland
• Breast fat transfer and liposuction in Switzerland

The procedures that make up this combination

• Breast augmentation in Switzerland
• Liposuction in Switzerland
• VASER liposuction in Switzerland
• J-Plasma liposuction in Switzerland
• 4D HD liposuction in Switzerland

Our guides

• Combined procedures in Switzerland
• Cosmetic surgery in Switzerland

Answers to the questions most often asked by women who want to enlarge their breasts and slim their figure in a single procedure.

Understanding the combination

Why combine breast augmentation and liposuction? To rebalance the figure: the breasts gain volume while the waist, hips or thighs are slimmed, under a single anaesthetic.

Is the combination riskier than augmentation alone? It is a little longer and adds the risks of liposuction. In a healthy patient with reasonable liposuction, the risk remains low.

Can any area be treated at the same time? The most common areas are the flanks, abdomen, saddlebags and thighs. The number of areas is limited to keep the duration reasonable.

What is hybrid augmentation? It is the combination of an implant and fat transfer around it, to soften the cleavage and hide the edges of the implant.

Is the harvested fat always used? No. It is only reinjected if the surgeon considers it useful to thicken the tissues around the implants.

How is it different from a mommy makeover? A mommy makeover generally includes an abdominoplasty for a lax abdomen. Here, the abdomen is treated with liposuction, which requires firm skin.

Why think in terms of the figure? Because the eye compares the breasts with the waist and hips. A slimmer waist makes the breasts look more generous.

For whom?

What is the ideal profile? A woman in good shape, whose weight is no longer changing, who wants more breast volume and has localised fat deposits, with good-quality skin.

Is fat needed for a transfer? Yes, a sufficient reserve is necessary. In very slim women, the transfer is often modest.

Can I have surgery after pregnancies? Yes, generally six months to a year after breastfeeding ends, once the breasts and weight have stabilised.

My abdomen is lax; will liposuction be enough? No. Lax skin or separated muscles call for an abdominoplasty.

My breasts are sagging; is an implant enough? If the areola is at or below the fold, a lift must be combined.

Is there a minimum age? Eighteen for a cosmetic augmentation, and many surgeons prefer to wait until the breasts and figure have stabilised.

Can sportswomen benefit from it? Yes, with a suitable volume and a well-considered choice of implant position, to limit discomfort during exercise.

Can I have surgery if I am overweight? Moderate excess weight does not prevent the procedure, but liposuction is not a weight-loss method. A stable weight is essential.

Implants

Which volume should I choose? A volume compatible with the width of your breasts and your tissues, thinking about your figure after liposuction. It is often a little more modest than for augmentation alone.

Round or anatomical implant? A round implant gives more volume in the upper breast, an anatomical one a teardrop shape. The choice depends on your tissues and the desired look.

In front of or behind the muscle? Behind the muscle or in a dual plane when tissues are thin; in front of the muscle in some women with sufficient tissue or who are very athletic.

Where is the scar? Usually in the fold under the breast, sometimes at the edge of the areola or in the armpit.

Do implants need to be changed? Not systematically, but they may be after some years in the event of rupture, contracture or changes in the breasts.

How are implants monitored? By regular clinical examination and imaging, ultrasound or MRI, at the frequency recommended by the surgeon.

What is the implant card? A document that identifies your implants. It must be kept and presented at breast examinations.

Can the gel leak if an implant ruptures? Modern implants contain a cohesive gel that generally stays within the capsule.

Liposuction and fat

Which areas are most often treated? The flanks, abdomen, saddlebags, inner thighs and sometimes the arms or back.

How much fat is removed? It depends on the areas and the excess. The surgeon limits the total volume for safety.

How much of the transferred fat remains? Often half to two thirds. What persists after six months is generally stable.

Can fat form nodules? Sometimes small benign nodules or oil cysts. They must be mentioned at breast examinations.

Does liposuction leave scars? Small incisions of a few millimetres, placed in creases and barely visible over time.

Are irregularities common? They are possible, especially on the thighs. Many soften over time; others can be touched up.

The procedure

How long does the procedure take? From about two to four hours depending on the number of areas and the fat transfer.

Do I need to stay at the clinic? One night is common. For a limited combination, going home the same day is sometimes possible.

Which procedure is done first? It depends on the surgeon. Many perform the liposuction before placing the implants, after changing drapes and instruments, to protect the implants.

How is the risk of implant infection reduced? Through strict asepsis, an antibiotic, irrigation of the pocket, limiting contact between the implant and the skin, and organising the order of the steps.

Is general anaesthesia needed? Generally yes, especially if the implant is placed behind the muscle.

Are drains used? Rarely for implants. They may be used after extensive liposuction.

Recovery

Is the pain significant? The breasts are the most sensitive, especially with an implant behind the muscle. The liposuction areas ache. Painkillers are generally enough.

How long should the support bra be worn? Day and night for four to six weeks.

And the compression garment? Day and night for three to four weeks, then often during the day for a few more weeks.

When can I return to work? One week to ten days for office work, longer for physical work.

When can I raise my arms? Movements above the shoulders are limited for two to three weeks.

How should I sleep? On your back, with your upper body slightly raised, for four to six weeks.

Why are my breasts so high? This is normal in the first few weeks. The implants gradually settle into their pockets over two to three months.

When can I drive? Generally after about a week, when arm movements are no longer painful.

Is lymphatic drainage useful? Yes for the liposuction areas, especially the thighs. The breasts are not massaged in the first few weeks.

When can I wear an underwired bra? After several weeks, with the surgeon's agreement, when the fold scar has fully consolidated.

Sport

When can I resume sport? Walking immediately, running at around four to six weeks, pectoral exercises at around six to eight weeks.

Do implants interfere with sport? With a suitable volume, most sports are possible. An implant behind the muscle can distort when the pectorals contract.

When can I swim? After about six weeks, once the scars have fully closed.

Do I need a special sports bra? A well-supporting sports bra is recommended for all high-impact activities.

Risks

What is the most feared risk? Infection of an implant, which is rare and often requires temporary removal.

What is capsular contracture? Hardening of the membrane surrounding the implant, making the breast firm, sometimes distorted or painful.

Can an implant move? It may sit too high, too low or to the side. Revision of the pocket corrects most of these situations.

What is implant-associated lymphoma? A very rare lymphoma, described mainly with heavily textured implants, which shows as swelling of a breast years later. It is generally treated by removing the implant and its capsule.

Does nipple sensation change? It may be altered for a few months, and usually returns.

Is there a risk of thrombosis? It is low but increases with the length and extent of the liposuction. Appropriate prevention is put in place.

What should I do if a breast suddenly swells? Call the surgeon promptly, whether in the days following the procedure or years later.

Results

When is the result final? The breasts take shape in three to six months, and so does the figure. Everything has stabilised at one year.

Is liposuction permanent? The suctioned fat does not come back. The figure is maintained as long as weight remains stable.

Is pregnancy possible afterwards? Yes. It may, however, change the breasts and the figure.

Will I be able to breastfeed? Generally yes, especially with an incision in the fold and an implant behind the muscle.

Will the result look natural? With a volume suited to your tissues and possibly fat transfer, the result generally looks natural.

Will mammograms be possible? Yes, by telling the radiologist about the implants, who adapts the technique.

Price and insurance

Does insurance reimburse it? No, it is a cosmetic procedure, except for rare malformations after a prior request.

Does the combination cost less than two procedures? Generally yes, thanks to a single anaesthetic and a single stay.

Why do prices vary? Depending on the number of areas, the implant model, fat transfer, the stay, the clinic and the region.

Where are fees highest? Rather in Geneva and Zurich. In other cantons, fees up to fourteen per cent lower are observed.

Are the implants included in the price? Generally yes. Check the model and brand indicated on the quote.

Should I plan for future costs? Yes: imaging check-ups and, eventually, possible further surgery for the implants.

Do manufacturers offer warranties? Some guarantee implants in the event of rupture or contracture, under varying conditions.

Is staggered payment possible? Some clinics offer it. Compare the total cost before committing.

Choosing

How do I choose the surgeon? Check their specialist title, look at results for figures similar to yours and make sure they think in terms of proportions.

Is a second opinion needed? It is useful, particularly for choosing the volume and deciding on fat transfer.

Can I consult in French in German-speaking Switzerland? Yes, many surgeons in the major cities see patients in French or English.

Are implant trials reliable? They help you picture the volume, but show neither the effect of placement under the muscle nor that of liposuction.

Practical questions

Which season should I choose? Autumn and winter are practical: covering clothes hide the compression garments and protect the scars from the sun.

Do I need someone with me? Yes, for the journey home and ideally the first few days.

What should I prepare for the consultation? Photos of breasts you like, a list of your treatments, the history of your pregnancies and weight, and your questions.

Does my employer need to know? No, a sick note is enough.

What if I do not like the result? Wait six months to a year, then talk to the surgeon. A touch-up can be considered.

How can Medespoir Suisse help me? By directing you, free of charge and without obligation, to a plastic surgeon experienced in this combination.

Particular situations

Can breast asymmetry be corrected? Yes, by choosing implants of different volumes or adding fat on one side. A slight difference may persist.

And tuberous breasts? They require a particular technique, with reshaping of the gland. The surgeon adapts the plan, and liposuction remains a complement.

Can a double chin be treated at the same time? It is possible, but it lengthens the procedure. The surgeon discusses it according to the total duration.

Can the knees be treated? Yes, the inner knees are a common area, often combined with the saddlebags or inner thighs.

Should I stop the pill? The combined pill increases the risk of thrombosis. Stopping it is discussed with the doctor according to the length of the procedure and other risk factors.

Can a dental infection be a problem? Yes, any current infection must be treated before the procedure to reduce the risk of implant infection.

Can the implants be removed later? Yes. Removal can be combined with a lift or fat transfer to avoid empty-looking breasts.

Can I change volume later? Yes, with a further procedure, taking into account how the tissues have changed.

Is weight loss after the procedure a problem? Significant weight loss can reduce the natural volume of the breasts and make the implants more visible.

Does cellulite disappear with liposuction? No. Liposuction removes deep fat but does not improve cellulite, which may even look more visible if the skin is thin.

Can I sunbathe afterwards? The scars must be protected for at least a year. The liposuction areas can tan normally once the bruising has gone.

Do implants set off security scanners? No, silicone implants contain no metal.

Do I need a special bra to sleep in? The support bra is worn at night for the first few weeks, then a soft model can be used if you find it comfortable.

Can I do pectoral training? Yes after six to eight weeks, knowing that an implant behind the muscle may distort during exertion.

Can a mammogram damage an implant? The risk is very low. The radiologist adapts the compression when informed that implants are present.

What happens to the breasts at menopause? The gland decreases and the breasts may sag. The implants keep their volume, which can change the appearance over time.

What if I have pain years later? Consult the surgeon or your GP, who will request imaging if necessary to check the condition of the implants.

Do stretch marks disappear with liposuction? No, and an increase in volume may even cause new stretch marks on thin skin.

How long should I wait before a second fat transfer session? At least three to six months, until the fat from the first session has stabilised.

Can I travel by train soon afterwards? A short journey is possible after a few days. For a long journey, take breaks to walk and discuss it with the surgeon.

Describe the breast volume you want, the areas of your figure that bother you, your weight and the region where you would like to consult. We will direct you to a plastic surgeon experienced in this combination, free of charge and without obligation.