Breast Reconstruction in Hamburg
Breast reconstruction may be necessary after accidents, burns, infections and benign diseases of the breasts. Most often, however, the need for breast reconstruction arises in the context of breast cancer. Statistically, one in eight women in Germany will suffer from breast cancer in during their lifetime. Breast rebuilding after cancer is possible in many cases. Find out more about breast reconstruction methods here.
Treatment of the cancer always comes first before reconstruction of the diseased breast. Therapy should always be interdisciplinary. This means that after the initial diagnosis, which is usually made by the gynecologist, oncologists, pathologists and radiologists, for example, should be involved in the diagnosis and treatment. Only then does the plastic surgeon reconstruct the breast.
A reconstruction is not always necessary. However, if it is necessary, it should be done by a plastic surgeon in any case. This is because only this specialist has mastered the entire repertoire of reconstructive methods, including microsurgical options. This is the only way to achieve the best possible individual aesthetic result in addition to oncological safety.
Thorsten Sattler, MD, is proficient in all standard breast reconstruction procedures, including microsurgery and fat transfer. He has perfected these very advanced techniques at major university breast centers in Germany, North America, Taiwan and Japan. In the UK, he has also received an award from the largest breast center in Europe for his microsurgical skills.
Breast Reconstruction: Overview
- Breast Rebuilding: Before your Surgery
- Surgical Methods of Breast Reconstruction
- Breast Reconstruction with Breast Implants
- Breast Reconstruction by Expanders followed by Breast Implants
- Breast Reconstruction by Fat Grafting
- Breast Reconstruction by “pedicled” Flap Surgery
- Breast Reconstruction by “free” Flap Surgery
- Treatment of the other, Healthy Breast
- Reconstruction of the Nipple and Areola
- Breast Reconstruction Results
- Breast Reconstruction: Aftercare
- Breast Reconstruction Frequently Asked Questions (FAQ)
Certified Breast Reconstruction
Dr. med. Thorsten Sattler is one of only a few plastic surgeons in Northern Germany with the additional qualification “Breast Medicine (Senology)” and is a member of the “German Society for Senology (DGS)”.
Feel free to call our practice “Plastic Surgery Dr. Sattler” in Hamburg to schedule a consulting appointment. Or use our contact form.
1. Breast Rebuilding: Before your Surgery
Not every breast needs to be reconstructed after breast cancer and not all women wish to have such a procedure. Sometimes breast rebuilding is not advisable from a medical point of view, e.g. in the case of far advanced cancer with poor general condition of the patient. In most cases, however, breast reconstruction is possible and useful.
For the majority of women, the breasts are a part of their own identity. It is important for self-esteem, one’s body schema, and last but not least, sexuality. Especially for young female patients, fashion aspects, sports and visits to collective changing rooms and communal showers, e.g. in gyms, also play a role.
Clarify Cost Coverage by Health Insurance before Surgery
No woman should be denied access to skilled breast reconstruction by a plastic surgeon if appropriate surgery is desired. Health insurance companies usually cover the costs of breast reconstruction, but a written confirmation of coverage by the health insurance company should always be obtained before a planned operation. This is especially true for those cases where cancer is not the basis for the need for breast reconstruction.
Multidisciplinary Treatment of Cancer
Before the surgery, the extent of the cancer must be analyzed in detail by a multidisciplinary team (so-called “staging”) to determine the local spread of the cancer.
It is also important for targeted therapy to detect any metastases or lymph node involvement as early as possible. The corresponding diagnostic data are then discussed by an interdisciplinary team of specialists from the respective disciplines and the best therapy for this particular case is proposed.
If, for example, chemotherapy or radiation therapy is necessary, it is important to coordinate the appropriate breast reconstruction with the other doctors. This is the only way to achieve the best possible result. At the same time, however, the cancer is confronted with the highest efficiency and thus the individual prognosis of the diseased patient is arranged in the best possible way.
Individual Consultation for your Breast Reconstruction
Dr. med. Thorsten Sattler usually holds two very detailed consultations with you before a surgical procedure. In the process, he examines you personally. You should bring all existing diagnostic data, documents, images, surgery reports, etc. with you to these appointments.
Each person is unique in terms of anatomy and desires. The progress of cancer can also vary greatly from one individual to the next. Therefore, a personalized treatment plan for your breast reconstruction will be created for you, based on the latest methods and expertise in plastic surgery. Photographs are taken and with the help of drawings and photos the procedure is explained in detail. Dr. Sattler will also discuss limitations, possible risks, and alternative treatment methods with you and create an individualized post-treatment plan with you.
The main goal of breast reconstruction is to create relatively symmetrical breasts. In this way, the patient’s self-esteem can be restored. Also, fashionable tight clothing can be worn again without having to wear attached prostheses. In short, the quality of life increases.
Combine breast reconstruction with other procedures
To achieve the best possible aesthetic result, breast reconstruction can be combined with other procedures, such as breast reduction or breast lift of the other (healthy) breast. The nipple of the operated breast can also be reconstructed if the original nipple could not be preserved in the process of cancer treatment.
2. Surgical Methods of Breast Reconstruction
Only safe and modern surgical methods are used. Breast reconstruction in Hamburg is done under general anesthesia, a hospital stay for several days is usually required.
Many different techniques for performing breast reconstruction are known and have proven successful. The best and safest surgical method for you will be chosen, depending on anatomy, extent of disease, health status, prognosis, and your goals and desires. Each surgical procedure has its advantages and disadvantages. Individually and after a detailed explanation, we decide together which technique should be chosen for you.
Some of the surgical methods are very complex and cannot be fully described here. Breast biopsies, tumor removal itself, possible lymph node or metastasis removal cannot and should not be discussed in the context of this short overview. Neither do the oncological, radiological, pathological and radiotherapeutic aspects.
Various techniques of breast reconstruction, on the other hand, will be mentioned in a very abbreviated form and without any claim to completeness. In this way, we would like to make it clear to affected patients that breast reconstruction is possible for almost every woman, if she wishes it and her state of health permits it.
There are several rules of behavior you should commit to as part of your breast reconstruction with Dr. Sattler. Click here to access the rules of behavior.
Breast Reconstruction with Breast Implants
This method seems to be the simplest at first, but it is rarely used. On the one hand, the skin mantle must be wide enough and stretchable to accommodate the implant. On the other hand, the skin must be of good quality, which is usually not the case after any irradiation that may have taken place.
Good symmetry with the opposite side can often only be achieved if a (smaller) implant is also placed on the opposite side. Additional fat transfer can compensate for asymmetries and improve skin quality. Wound healing disorders, infections and capsular fibrosis occur more frequently after breast reconstruction with implants than after breast reconstruction with breast implants for aesthetic reasons.
The advantages of breast reconstruction with implants include:
- Short surgery time
- Usually little blood loss
- Relatively small scars
- Short hospital stay, possibly even outpatient treatment
- Usually little pain
- Often fast recovery
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Breast Reconstruction by Expanders followed by Breast Implants
Breast reconstruction with expanders can pre-stretch excessively tight tissue before an implant is inserted. An expander is like a balloon that is successively filled with saline solution via a valve until the skin mantle is sufficiently stretched. The expander is then removed in a second surgery and the definitive breast implant is placed in its place.
The implant can be additionally embedded in a special matrix during breast reconstruction with expander. However, this procedure can also cause problems, as an additional foreign object is inserted into tissue that is usually poorly perfused. The risks and limitations of this procedure are similar to those of breast reconstruction using breast implants.
Breast Reconstruction by Fat Grafting
If the skin mantle of the diseased breast is stretchy enough and of good quality, fat transfer can be performed. The additional volume to be achieved in the process of breast augmentation with autologous fat is ideally about one cup size, but usually less. Therefore, it is a good idea to use this method if the other breast is relatively small.
The fat transfer can be repeated several times to successively equalize the volume of the operated breast with that of the healthy breast. Of course, the larger breast can also be reduced or tightened to optimize symmetry.
The advantage of fat transfer is that only the body’s own material is used. In addition, damaged skin, e.g. after radiotherapy, recovers due to the stem cells in the transferred fat. If there is excess fat, not only will the breasts become more symmetrical as a result of the fat transfer. The body silhouette will also improve when liposuction is performed on the abdomen, waist and thighs, for example. Another advantage of fat transfer is that the scars left behind are very small and usually only a short hospital stay is necessary without intensive medical monitoring. Sometimes the procedure can even be performed on an outpatient basis.
The disadvantage is that several operations may be necessary to achieve the target volume. In general, of course, there must be enough fatty tissue to be able to transfer it. This is not always the case after chemotherapy.
Breast Reconstruction by "pedicled" Flap Surgery
In this transfer of autologous tissue, tissue is swung from a site on the body on a vascular pedicle to the breast to be reconstructed. Thus, the term “pedicled” flap plasty. In the past, breast reconstruction with autologous tissue often involved dissecting part of the straight abdominal muscle and beating it upwards along with the overlying soft tissue. This method is now considered obsolete in modern plastic surgery and is therefore not used by Dr. Sattler.
Unfortunately, this technique is still promoted in some forums, although there are significant disadvantages for patients, such as:
- Frequent circulatory disturbances of the folded tissue
- Contour problems at the handling point
- a noticeable abdominal wall weakness, because part of the abdominal musculature, which is important for the stability of the trunk, has been removed
Another alternative in breast reconstruction with stemmed autologous tissue is to guide the large back muscle along with a skin spindle under the armpit towards the front of the breast. A new breast is formed from the muscle tissue of the large back muscle. The nipple can then be reconstructed in a second operation.
If the muscle is too small to achieve good symmetry with the opposite side, a breast implant can additionally be inserted under the muscle. The advantage of the transfer of the large back muscle is that this operation is very safe and provides reproducible good results. A disadvantage is a rather large additional scar on the back, but with good planning this can usually be hidden by the bra.
Breast Reconstruction by "free" Flap Surgery
Nowadays, in modern plastic surgery, breast reconstruction by so-called “free” flap surgery is considered the gold standard, at least in the rich industrialized nations. However, these microsurgical techniques also require:
- a significantly longer duration of surgery,
- a specially equipped hospital with an intensive care unit,
- a longer hospital stay of the patients
- and a very well trained team of anesthesiologists, nurses and surgeons.
The material and personnel costs are significant. The surgical technique is complex, requiring an expensive surgical microscope and specific microsurgical instruments. Therefore, even within Europe, this procedure is currently not (or no longer) offered to every patient. The microsurgeon, almost always a plastic surgeon, must be very extensively trained and skilled in a variety of microsurgical procedures. This is the only way he can also change the procedure within the planned operation if the vessels prove to be too bad, too short or too small.
Procedure of the “free” Flap Plasty
In a “free” flapplasty, a piece of tissue is taken from the patient’s body and then grafted to the breast. All blood vessels in this piece of tissue are clipped during this transfer. The cut blood vessels are then later reconnected microsurgically to vessels in the breast area, usually to vessels near the sternum or axilla.
Regions of the Body suitable for Tissue Sampling
For example, tissue can be removed from the lower abdomen without having to sacrifice the abdominal muscles. In this way, the stability of the torso is maintained and a tummy tuck is a nice side effect after the closure of the extraction site. However, there is a relatively large scar on the lower abdomen.
If this is not desired, tissue can also be removed from the buttocks or thigh, for example. Dr. Sattler likes to use a special tissue transfer from the thigh, but this is usually only useful for reconstruction of a relatively small breast.
Many different sampling points are described in the literature. What they all have in common is that the level of difficulty, and therefore the failure rate, increases under the following conditions:
- the smaller and shorter the blood vessels of the removed tissue become
- the worse the recipient vessels are (e.g. after radiation and chemotherapy)
- the more previous operations have taken place, since scarred tissue is poorly perfused and important blood vessels may have already been destroyed in advance.
In cases of advanced disease with poor general condition of the patient and pessimistic prognosis, microsurgical procedures are often not performed. Likewise with smokers, since nicotine damages the vessels and the surgical result becomes unpredictable. The advantage of microsurgical techniques is that only the body’s own tissue is used and the musculature is usually not weakened or hardly weakened at all.
Treatment of the other, healthy Breast
The human body is not symmetrical – not even a woman’s breasts. If a breast has been operated on in the context of cancer, this asymmetry is usually increased. Various techniques for breast reconstruction are known. However, most of them have in common that no very large breasts can be reconstructed or the shape of the reconstructed breast differs from the other breast.
It may therefore be advisable to align the healthy breast with the operated breast in order to optimize symmetry. A breast lift or breast reduction, for example, is suitable for this. At least in underwear and when wearing tight clothes, the breasts then ideally look very similar. And for the environment of the patients it is not recognizable that breast cancer was present. In the undressed state, there will usually be a small deviation in the shape of the breast, since, for example, the scar line of a breast reconstruction is practically never identical to the scar lines after a breast lift. Differences in breast volume can be compensated for by autologous fat transfer, but this may then require further surgery.
Reconstruction of the Nipple and Areola
After reconstruction of the breast, the nipple can be reconstructed in another procedure, in special cases this is also possible in the same procedure. Reconstructing the nipple together with the areola is beneficial for the symmetry and overall appearance of the denuded breast.
Nipple and areola can be reconstructed by local displacement plasty of local tissue. Sometimes it is also advisable to use the opposite side as a source, especially in the case of breasts with large areolas or nipples. Pigmented tissue can also be taken from a completely different location and transplanted to mimic the pigmentation of the nipples. The groin or the labia are ideal for this purpose. Especially the labia is very suitable, because the scars are later almost invisible. During a personal consultation, Dr. Sattler will provide you with detailed information on the various options for nipple and areola reconstruction.
Since there are many different surgical techniques and combinations of different methods, Dr. Sattler will discuss with you before the procedure exactly which techniques will best and most safely achieve your goals and wishes. Two detailed consultations are usually required. Dr. Sattler is a master of all the above techniques and can therefore offer you the entire repertoire of current reconstructive methods. This includes the perforator flap (e.g. DIEP and ALT flaps), the most technically challenging form of microsurgical transfer of autologous tissue.
3. Breast Reconstruction Results
The complexity of the topic of breast reconstruction cannot be grasped in its entirety within the context of explanations in a text such as this one. Therefore, patient images are intentionally omitted because the initial surgical situation, individual severity of disease, and the reconstructive techniques then chosen are too different. The results could simply not be classified correctly by the non-professionals.
Since we are not allowed to show before/after pictures of breast reconstructions at this point for legal reasons, this problem would be further exacerbated. Photos can be shown to you in the course of a personal consultation with Dr. Sattler, together with a corresponding explanation.
4. Breast Reconstruction: Aftercare
A hospital stay for several nights is usually required after breast reconstruction. After free tissue transfer, initially also in an intensive care unit for optimal monitoring of the reconstructed breast and patient. Reconstruction using the patient’s own fat or implants can also be performed on an outpatient basis if necessary. Post-treatment schedules vary greatly depending on the reconstructive procedure chosen and therefore cannot be explained for all situations in this context. However, Dr. Sattler will provide you with detailed information about what will happen after your surgery as part of your personal consultation and care.
In order to support wound healing and maintain the achieved results in the best possible way, attention should be paid to a balanced and healthy diet. Alcohol and nicotine should also be avoided completely.
Since Dr. Sattler is not only a specialist in plastic and aesthetic surgery, but also a nutritionist, he will also advise you in this regard. If there are partnership problems or sexual identity disorders, Dr. Sattler can also advise you in this regard, as he also has an additional qualification in sexual medicine.
It is essential to follow the follow-up intervals carefully and to report any abnormalities to the treating physicians immediately. This is the only way to detect progressive disease, recurrence or disease of the other breast as soon as possible!
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5. Breast Reconstruction Frequently Asked Questions (FAQ)
If the breast is reconstructed by autologous fat transfer, the fat is taken from parts of the body that have fat reserves, such as the abdomen, waist and thighs. As a side effect of breast reconstruction, this improves the body silhouette at the removal sites and rather small breasts appear better overall. If the breast on the opposite side is very large or saggy, a lift or reduction of this breast can significantly improve the overall result in terms of symmetry. Health insurance companies usually pay for such corrective surgery, but a written confirmation of coverage by the health insurance company should always be obtained before the surgery.
If breast reconstruction is not successful, for whatever reason, there are practically always alternative methods that can be used. If breast reconstruction has been successful, but the breast still appears too small, a fat transfer can be used to further enlarge the breast. In implant-based reconstruction, a larger implant can sometimes be used. However, this procedure increases the risk of wound healing disorder, infection or capsular fibrosis and must therefore be carefully considered. Matching the opposite side with a breast lift or breast reduction may be a better option in these cases.
The human body is not symmetrical, neither are a woman’s breasts. If a breast has been operated on in the treatment of cancer, this asymmetry can be further increased. Reconstructed breasts are usually smaller than the original breast and may also have a different shape and feel. Especially after irradiation, skin and tissue show structural changes that cannot be reversed.
It may therefore be advisable to adjust the opposite side, e.g. by means of a breast lift or breast reduction. In this way, symmetry can be improved, but it will never be perfect, if only because of the different incision patterns and the scars that accompany them. When wearing tight clothing, the breasts ideally look very similar and it is then not recognizable to the environment that there was breast cancer.
No, it is imperative to strictly follow the follow-up intervals with your gynecologist, oncologist, and radiologist if you have breast cancer, even if plastic surgery treatment should have already been completed. Report any abnormalities to the treating physicians immediately, even if an official follow-up appointment is not yet scheduled. Only in this way can a progression of the disease, a recurrence or an affection of the other breast be detected as quickly as possible and you can be given adequate therapy within the shortest possible time!
Dr. Sattler on focus.de: Breast augmentation in Hamburg
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