Female breast

Many patients suffer from overly large breasts. Chronic back, neck and headaches as well as an unpleasant feeling of heaviness are part of this clinical picture. Painful constriction of the bra straps can also torment patients. The overly large breasts prevent patients from exercising, the choice of clothing is severely restricted and patients find their breasts disturbing. Quality of life can be severely restricted.

Depending on the size of the volume by which the breast is to be reduced, different surgical techniques are available, e.g. the so-called scar-sparing technique according to Léjour. The technique determines the number and position of the scars. The areola with the nipple is usually moved upwards and reduced in size if desired.

We will be happy to inform you about the different techniques that are suitable for you and advise you on the decision for a harmonious shape of your breasts that suits your body.

In medically justified cases, the operation is covered by health insurance.

Stay: 1-2 nights

Operation duration: approx. 2-3 hours

Anesthesia: general anesthesia

Stitches: mainly self-dissolving, around the nipple not self-dissolving

Drains: 2 pieces, one per side

Postoperative: 6 weeks support bra, able to work after approx. 2 weeks

Scars: fade after 6-12 months

Pregnancy, breastfeeding, weight changes or changes in the connective tissue under the influence of time and gravity can cause the youthful shape of the breasts to change and sag. The areola often enlarges and a volume deficit develops in the upper part of the breast. A breast lift raises the breasts and restores their youthful position. Excess skin is removed to achieve a tightening effect. In a pure breast lift, the glandular tissue is not reduced. If desired, the procedure can be combined with the implantation of a prosthesis to gain additional volume for a fuller décolleté.

Stay: 1-2 nights

Operation duration: approx. 2-3 hours

Anesthesia: general anesthesia

Sutures: mainly self-dissolving, not self-dissolving around the nipple

Drains: usually none

Postoperative: 6 weeks support bra, able to work after approx. 2 weeks

Scars: fade after 6-12 months

The desire for an augmentation of the female breast for aesthetic reasons is one of the most common reasons for consultation in plastic surgery. Augmentation with prostheses or autologous tissue is very often performed in aesthetic and reconstructive surgery.

The reason for breast augmentation is often the patient's personal desire. Some women have naturally small breasts and want a fuller cleavage, in many cases the breast shape changes after pregnancy (involution), or there may be a congenital asymmetry or asymmetry caused by tumor surgery. Congenital malformations, e.g. tubular malformation, are less common.

In principle, you can choose between silicone implants and the use of your own fatty tissue (so-called liposculpturing) to shape and enlarge the breast.
We will be happy to advise you on the best solution for you. In medically indicated cases, the operation may be covered by health insurance.

There is a large selection of shapes and sizes of silicone implants to choose from. We give you the opportunity to try implants in your bra and compare them.

A word about safety: modern silicone implants contain so-called cohesive gels in a stable silicone shell. These implants can be cut in the middle without silicone leaking out. The shells have also been significantly improved in terms of safety and wearing comfort. The cohesive gel implants feel natural and are also very safe. The incisions are usually made in the underbust crease (submammary approach). Alternatively, the incision can be made at the lower edge of the nipple (periareolar approach) or in the anterior armpit (transaxillary approach). Special suturing techniques are used for optimal, inconspicuous scarring. The implant can be placed under the large pectoral muscle (subpectoral), under the mammary gland (subglandular) or, if the gland and muscle are no longer present, e.g. after tumor surgery, directly under the skin (subcutaneous).

Stay: outpatient or 1 overnight stay

Operation duration: approx. 1 hour

Anesthesia: general anesthesia

Stitches: self-dissolving

Drains: usually none

Postoperative: 4-6 weeks support bra, 4-6 weeks no sport and no heavy lifting,

able to work after approx. 1-2 weeks

Scars: fade after 6-12 months

In liposculpturing, the patient's own fatty tissue is removed, e.g. from the thighs or lower abdomen, and injected into the breast tissue during the same procedure after special preparation. This gives very natural results, as the fatty tissue grows and is integrated into the breast tissue. The results are therefore permanent. Only a certain amount can be transplanted per session, so that several sessions are necessary if a significant increase in volume is desired. If very large increases in volume are desired, a silicone implant is preferable.

Stay: outpatient or 1 overnight stay

Operation duration: approx. 2 hours

Anesthesia: general anesthesia and tumescent anesthesia at the donor site

Stitches: self-dissolving

Drains: usually none

Postoperative: 4-6 weeks support bra and possibly compression pants, able to work after approx. 1-2 weeks

Scars: fade after 6-12 months

The reconstruction of a female breast that has had to be completely or partially amputated due to a tumor is one of our main areas of treatment. The first consultation with a plastic surgeon should take place early after diagnosis so that the reconstruction can be planned. Thanks to the Breast Center at the University Hospital Basel, you as a patient can benefit from the well-established cooperation between doctors from different specialties. Discussing the reconstruction options with the plastic surgeon at an early stage is very important for many patients, as it can be reassuring to know that "something can be done".

The timing of the start of reconstruction can be chosen either immediately in an operation with the removal of the breast (immediate reconstruction) or after months to years (late reconstruction). The timing of the reconstruction depends on the extent of the tumor removal and the planned follow-up treatment. As a rule, several surgical steps are necessary. In the case of immediate reconstruction, the individual reconstruction steps must be timed to coincide with the chemotherapy or radiotherapy treatment cycles. The patient has to accept a longer anesthetic and operation time for the main procedure, but has a reconstructed breast straight away.

Late reconstruction after completion of tumor therapy allows you to decide on one of the reconstruction techniques only after a longer period of time to come to terms with your illness. Surveys carried out at a later date show that patients who have undergone late reconstruction are more satisfied with the result.

Reconstruction with autologous tissue, with prostheses or with a combination of both techniques
Breast reconstruction with autologous tissue can be performed by transferring muscles, fatty tissue and skin. This tissue is either rotated around a vascular pedicle and formed into a new breast on the upper body, or it is completely separated from the body and microsurgically reconnected to vessels on the upper body and then formed into a new breast. The main donor sites are the abdomen and back.

These autologous tissue techniques can be used together with an implant to gain more volume.

Reconstruction with prostheses alone is less complex than reconstruction with autologous tissue. The operation and hospital stay are shorter and the recovery process is faster.

In breast augmentation with prostheses, these are placed under the pectoral muscle or under the remaining skin and subcutaneous fatty tissue. The prostheses usually contain silicone gel. There is a variety of shapes and sizes, which you can compare during the planning phase and try out in a bra. The first step is the implantation and filling of a tissue expander to prepare a pocket under the skin to accommodate the implant later. In a second operation, the expander is replaced with the silicone implant.

Stay: 1 night each

Duration: 2 operations, 1-2 hours each

Anesthesia: general anesthesia

Stitches: self-dissolving

Drains: usually none

Postoperative: support bra for 6 weeks, able to work after approx. 2 weeks, outpatient filling of the expander

Expander filling, may temporarily cause a feeling of tightness in the skin

Scars: fade after 6-12 months

The latissimus dorsi flap

The donor site is the back. The latissimus dorsi muscle is detached together with a skin spindle and the subcutaneous fatty tissue and brought to the front of the chest via a vascular pedicle under the armpit. The donor site is closed directly. The muscle is relatively thin, so that volume reconstruction is only performed with the latissimus dorsi flap alone if the breast is small. This technique is often combined with an implant to achieve more breast volume.

Length of stay: approx. one week, 1 night in the intensive care unit

Operation duration: 2-3 hours

Anesthesia: general anesthesia

Stitches: self-dissolving and non-self-dissolving

Drains: yes

Postoperative: physical rest for 4-6 weeks

Scars: fade after 6-12 months

The TRAM rag

One half of the straight abdominal muscles is separated at the lower end and turned upwards with an overlying skin spindle and the subcutaneous fatty tissue. The vascular supply of the tissue block is not severed at the upper part. A transverse scar remains at the donor site, about the same height as a caesarean section scar, but longer. A major advantage of the TRAM flap is the good volume that can be brought to the upper body to shape the new breast. A tummy tuck is performed together with the removal of the skin spindle on the lower abdomen. A disadvantage of the TRAM flap is the weakening of the abdominal muscles due to the displacement of one half of the straight abdominal muscle.

Length of stay: approx. one week, 1 night in the intensive care unit

Operation duration: 4-5 hours

Anesthesia: general anesthesia

Stitches: self-dissolving and non-self-dissolving

Drains: yes

Postoperative: physical rest for 4-6 weeks, no sport for 6-8 weeks

Scars: fade after 6-12 months

The DIEP rag

The DIEP flap is the most frequently performed flap in our department. It is a further development of the TRAM flap. A skin spindle on the lower abdomen with the underlying subcutaneous fatty tissue is removed. The vessels that supply this tissue block are also removed. These run through the straight abdominal muscle and are detached from it. The vessels are microsurgically reconnected to vessels in the upper body. This ensures that the freely transferred tissue block is supplied with blood.

The DIEP flap has the great advantage of a good volume and a good shape of the new breast. At the same time, there is significantly less weakening of the abdominal wall than with the TRAM flap, as the muscles are not displaced. However, a transverse scar remains at the donor site, approximately at the level of a caesarean section scar, but for longer. A tummy tuck is performed together with the removal of the skin spindle on the lower abdomen. A disadvantage of the DIEP flap is the slightly increased susceptibility to circulatory problems in the first few days after the operation.

Length of stay: approx. 10 days, 1-2 nights in the intensive care unit

Operation duration: 5 hours

Anesthesia: general anesthesia

Stitches: self-dissolving and non-self-dissolving

Drains: yes

Postoperative: physical rest for 4-6 weeks

Scars: fade after 6-12 months