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09.11.2018 15:20:28
Chief physician Steffen Handstein speaks at the SZ patient forum about chances, risks and costs of the surgery.
Whether for cancer or for cosmetic reasons: Steffen Handstein is one of the leading specialists for breast surgery. For the SZ patient forum on 10 October in Dresden, the chief physician and specialist in plastic and aesthetic surgery, the reader questions on the subject.
The French manufacturer had used material in a part of his implants that had not been declared for medical use. This shows that, unfortunately, in the medical industry people are on the move, which is about maximizing profits. The PIP scandal has at least led to more intensive controls on manufacturers. All comply with the appropriate standards. But there are problems on another level.
The breast implant can lead to a so-called capsular contracture - regardless of the manufacturer. Studies prove that this is the case in 12 to 15 percent of patients within 10 years. The implant is a foreign body around which a connective tissue capsule forms. In fibrosis, this capsule becomes hard and presses on the implant. This can lead to deformities of the chest and pain. At a symposium in Bochum in mid-September we discussed possible causes. The problems seem to have something to do with colonization of the implant surface with bacteria that cause chronic inflammation. But the evidence is still relatively small here. Another problem is so-called anaplastic large cell lymphomas, short ALCL. Worldwide, about 300 cases of this malignant tumor disease are described in women with breast implants. In Germany, eight cases are known to date, in the United States in proportion significantly more. The prognosis for early treatment is very good.
Apart from women who have lost their breasts after cancer, why do women volunteer to take such risks? Because the man at home is dissatisfied with the cup size?
That also happens, but it is very rare. In most cases women opt for breast surgery because they feel severely impaired in their quality of life and well-being. For example, because the skin coat hangs down after a major weight loss or after breastfeeding of several children. Some do not even dare to put on a dress or T-shirt because they can not find a bra that will form a proper décolleté. With a breast augmentation, however, it is often not enough in such cases.
Usually it also needs a tightening surgery. The volume must be brought to the right place, the position of the nipple corrected. However, significantly larger scars develop around the areola and then at least from the lower edge of the nipple to the breast fold. That does not like everyone.
If there are no problems, it can last a lifetime. Of course, every breast changes with age. In general, the larger the implant, the greater the risk that the shape will not last for a long time.
There was one company that made implants with 1 000 to 1 200 milliliters of silicone gel on request. It's now off the market. In essence, we're talking about plus / minus 250 milliliters. Up to 700, 800 milliliters are possible, but medically not useful and aesthetically in one step often not feasible. If a 1.72-meter woman weighs 65 kilos and has a small breast, the skin can only be stretched to a limited extent.
If you are ready to save on the surgeon's safety and expertise, the cost may be reduced to such sums. However, that seems questionable to me. Alone an implant costs 500 euros net. There are costs for preparation, for the laboratory, for the anesthesiologist, for the operating room with the necessary instruments and hygiene precautions, for the surgeon and for emergency systems in case something goes wrong. If the surgery is not done on an outpatient basis, which I recommend, you must have a clinic with appropriate staff. All in all, this can not be displayed under 5 500 to 7 000 euros.
As an alternative to silicone pillows for some time own fat is praised: What is too much on the hips, comes to where it is missing. Sounds great. What is the catch?
There has been a significant technical development in the area of autologous fat over the past 15 years. For example, one removes adipose tissue on the abdomen or the inside of the knee, prepares it and injects it on the breast. You can get good results this way. Because the autologous fat contains a high number of adult stem cells with growth factors that promote tissue regeneration. The downside: Fatty stem cells can move in different directions, and we're not sure if we're also potentially triggering unwanted reactions, such as the growth of cancer cells. In addition, a portion of the autologous fat is lost again, because the cells find no connection to the blood supply and die off. Realistic is a loss of 15 to 35 percent. In very slim women, it is also difficult to remove any autologous fat. All this shows that a decision for an OP is not general or through a consultation of Dr. Google meets.
