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Ästhetik

Brustvergrößerung – das musst du wissen

Brustimplantate kommen häufig in der Plastischen und Rekonstruktiven Chirurgie zum Einsatz. Neben der rein ästhetischen Indikation werden sie oft zu rekonstruktiven Zwecken, z.B. nach Tumoroperationen eingesetzt. Das Ziel einer Brustvergrößerung sollte eine Kombination aus Proportionen, Form und Größe sein.
Welche Implantate gibt es?
Die ersten Versuche, die man als Brustimplantat zählen kann wurden um 1900 mit Paraffin Wax und flüssigem Silikon durchgeführt. Seitdem hat dich gottseidank einiges verändert. Nach einem Zwischenschritt, in dem Kochsalz-Implantate eingesetzt wurden, wechselte man in den 80ern vollständig zu Silikon-Implantaten. Nachdem die ersten Silikon-Implantate eher hart anmuteten und die tatsächliche weibliche Brust nur schwer bis gar nicht imitieren konnten, brachte die Verwendung von einer härteren Silikonschicht als äußere Schicht und eine flüssigere innere Schicht deutliche Verbesserungen. Im Laufe der Zeit wurde die äußere Schicht immer dünner und passte sich dadurch dem Gewebe immer besser an. Dadurch wurden die Implantate immer realitätsnäher. Mittlerweile gibt es eine Vielzahl von unterschiedlichen Implantaten.
Grundsätzlich unterscheidet man zwischen Anatomischen und Runden Implantaten.
Beide Formen, können, unter den geeigneten Umständen, zum gewünschten ästhetischen Ergebnis führen. In die Entscheidung, welche Implantatform schlussendlich gewählt wird, fließen mehrere Faktoren ein.
Was sollte man bei Implantaten bedenken?
Anatomisch oder Rund?
Einerseits spielt der Wunsch bzw. die Vorstellung der Patientinnen eine entscheidende Rolle. Dies muss jedoch in Kombination mit den anatomischen Voraussetzungen und auch den bereits erfolgten Operationen betrachtet werden, um schlussendlich das gewünschte Ergebnis erzielen zu können.
Je nach Wunsch der Patientin bezüglich der Form der Brust ergibt sich bereits eine Richtungsweisung in der Entscheidungsphase.
Anatomische Implantate:
Der gerade abfallende oder auch leicht konkave obere Pol entspricht der Form einer natürlichen Brust, ebenso wie der dichte, konvexe untere Pol die Projektion dieser widerspiegelt.
Diese tropfenenförmige Form der Brustimplanate wird oft von Patientinnen gewählt, welche das höchste Maß an Natürlichkeit wünschen.
Runde Implantate
Runde Implantate punkten mit größerem Volumen und der Möglichkeit, auch den oberen Pol der Brust zu betonen. Wer ein volles Dekolletee wünscht, wird eher zu runden Implantaten tendieren. Auch Sportlerinnen greifen häufiger zur runden Form. Dies hat den Grund, dass die Implantate nicht immer vollständig mit dem umliegenden Gewebe verwachsen und sich bei starker körperliche Aktivität durchaus drehen können. Eine Drehung bei runden Implantaten ist weniger dramatisch, bei anatomischen Implantaten wäre dann allerdings die „Ausbeulung“ des Tropfens oben würde sofort is Auge fallen.
Wichtig ist es, immer die anatomischen Voraussetzungen der Patientinnen in die Entscheidung miteinzubeziehen. Zu den anatomischen Faktoren, die zu berücksichtigen sind, zählen: die Form der Brust, die Gewebsbeschaffenheit oder Dicke des Gewebes, das Vorhandensein einer tuberösen Brust (Schlauchbrust), eine etwaige Brustsymmetrie, eventuelle Brustwanddeformitäten und auch Herabsacken einer Brust.

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Einige Plastische Chirurgen verwenden eine Simulations-Software, welche die Brust nach der Operation mit dem jeweiligen Implantat simuliert. Passt das Ergebnis nicht, kann man in der Software das Implantat austauschen und größer oder kleiner machen.
Bei jedem Beratungsgespräch sollte der Chirurg jedoch immer verschiedene Probe-Implantate vor Ort haben, welche in einen speziellen BH eingelegt werden und somit die neue Brust am Körper simuliert werden kann. Dies trägt enorm zur Entscheidungsfindung von Größe und Form bei.
Unter dem Muskel oder über dem Muskel?
Die wohl wichtigste Fragestellung widmet sich der richtigen Lage des Implantates. Das Implantat kann hierbei entweder direkt unter der Brustdrüse (subglandulär) unter die Muskelhaut (subfaszial) oder unter dem Muskel (submuskulär) platziert werden. Eine Kombination aus submuskulär und subfaszial stellt die dual-plane Variante dar. Hierbei liegt ein Teil des Implantates unter dem Muskel und ein Teil unter der Muskelhaut.
Die Auswahl der Platzierung richtet sich nach verschiedenen Faktoren:
Körperbau der Frau
Gewünschtes Aussehen (natürlich vs. künstlich)
Schmerztoleranz der Patientin
Stillwunsch der Patientin
Bei schlanken und zart gebauten Frauen, bei denen weniger Brust-Volumen vorhanden ist, tendiert man dazu, die Implantate submuskulär einzubringen. Dadurch ist das Implantat besser geschützt, es liegt mehr Gewebe über dem Implantat und das Risiko des Implantates, nach unten abzurutschen, wird durch diese Methode verringert. Durch das chirurgische Abheben des Muskels ist diese Variante jedoch auch die schmerzhafteste. Eine submuskuläre Lage hat außerdem den Vorteil, dass die Brustdrüse nahezu unberührt bleibt und das Risiko, dass man nicht mehr Stillen kann, stark minimiert wird. Die submuskuläre Lage bringt zugleich das natürlichste Ergebnis, der auch die längste Heilunsgzeit mit sich.

Platzierung der Brustimplantate


Wie wird das Implantat eingebracht?
Es gibt für die Einbringung grundätzlich 3 Zugangswege:
Submammär– hierbei liegt der Schnitt bzw. später die Narbe in der Unterbrustfalte und ist dadurch meistens nach der OP nicht mehr sichtbar.
Diese Methode ist die Standard-Methode und wird von den meisten Patientinnen gewählt.
Transaxillär- man geht hierbei über die Achsel und präperiert von der Seite weg, entweder unter dem Muskel oder über dem Muskel. Für eine sichere Präparation und um eine gute Blutstillung zu gewährleisten nimmt man hierfür meist eine kleine Kamera zu Hilfe.
Transareolär- hierbei wird der Schnitt an der Unterseite der Brustwarze gesetzt. Man muss durch die gesamte Brustdrüse präperieren. Wie man sich vorstellen kann, ist hier eine Platzierung des Implantates hinter dem Muskel nur schwierig möglich.
Diese Methode birgt das größte Risiko, dass die Stillfähigkeit beeinträchtigt wird.

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Gibt es Komplikationen?
Direkt nach der Operation kann es zu einer Blutung im Implantatgebiet kommen. Stärker werdende Schmerzen und eine zunehmende Schwellung bzw. Verhärtung einer Brust deuten auf eine Blutung hin. Hier heißt es möglichst schnell wieder zurück zum Arzt seines Vertrauens zu gehen. Ein Serom, das sich langsam nach der Operation bildet, wird in den Wochen nach der OP langsam vom Körper resorbiert. Die Einlage von Drainagen ist je nach Operateur beliebig- manche haben gute Erfahrungen, manche nicht.
Kapselfibrose
Die Kapselfibrose ist nicht nur die häufigste Komplikation bei dem Einsatz von Brustimplantaten, sondern stellt auch den häufigsten Grund für eine erneute Operation dar. Grundsätzlich ist es so, dass, wenn Fremdmaterialien in den Körper eingebracht werden, der Körper meistens versucht eine Hülle um diese zu bilden und diese damit abzukapseln. Diese Kapselbildung ist an sich nichts schlechtes, jedoch neigen diese Kapseln dazu sich im Laufe der Zeit zusammenzuziehen. Der Grund dafür ist nicht 100%ig bekannt, jedoch glaubt man, dass die Bindegewebszellen langsam zu Muskelzellen werden und sich dadurch zusammenziehen. Dadurch wird natürlich das Implantat langsam zusammengequetscht und verhärtet sich im Laufe der Zeit (ähnlich wie bei einer Presse). Manchmal kann es hierbei auch zu dem „Tennisball“-Phänomen kommen. (Das Implantat ist deutlich von der restlichen Brust abgrenzbar und schaut aus wie ein Tennisball).
Hierbei hilft nur ein Austausch des Implantates.
Implantat-Ruptur
Nach manchen Traumata bzw. selten auch spontan kommt es zu der Ruptur eines Implantates. Das heißt, dass die äußere härtere Silikon-Hülle einreißt und das flüssigere Silikon leicht hervortritt. Die Ruptur-Rate ist sehr gering. Das PIP- Implantat, welches vor einigen Jahren in den Medien war, hatte eine Ruptur-Rate von 35%. Grund hierfür war die Verwendung von minderwertigem Silikon. Dies führte zu einem leichten Einreißen auch schon bei geringem Druck. Auch zunehmendes Alter des Implantates stellt ein Risiko für vermehrte Rupturen dar.
Absinken des Implantates
Wie bei der normalen Brust, arbeitet auch bei Implantaten die Schwerkraft gegen uns. Zusätzlich wird das Gewebe im Alter schwächer und dadurch neigen Implantate im Laufe der Zeit abzusinken. Grundsätzlich heißt es: je mehr Gewebe ein Implantat bedeckt, desto schwieriger ist es für das Implantat nach unten abzurutschen.
Was muss ich nach der OP beachten?
Nach der OP ist das Gewebe ähnlich zu einer Hautwunde noch filigran und kann, wenn Druck auf das Gewebe kommt, wieder aufreißen. Deshalb ist in den ersten Wochen nach einer Brust OP von reißartigen Bewegungen, schwerem Heben, Tragen und von Sport Abstand zu nehmen. Zusätzlich dazu sollte man die ersten Wochen einen speziellen Stütz-BH tragen, der die Brust und das Gewebe unterstützt, das neue Gewicht zu tragen. Für kurze Perioden (Waschen des Stütz-BHs) kann man diesen auch durch einen straffen Sport-BH ersetzen.
DISCLAIMER
Dieser Artikel erhebt keinen Anspruch auf Vollständigkeit und liefert lediglich einen Anhaltspunkt. Bitte frage deinen betreuenden Arzt um eine belastbare Diagnose und die entsprechende Therapie zu erhalten.
Hwang, Kun, et al. „Myofibroblasts and capsular tissue tension in breast capsular contracture.“ Aesthetic plastic surgery 34.6 (2010): 716-721.
Heden P, Montemurro P, Adams WP, Jr., Germann G, Scheflan M, Maxwell GP. Anatomical and Round Breast Implants: How to Select and Indications for Use. Plastic and reconstructive surgery. 2015;136(2):263-72
Mallucci P, Branford OA. Concepts in aesthetic breast dimensions: analysis of the ideal breast. Journal of plastic, reconstructive & aesthetic surgery : JPRAS. 2012;65(1):8-16
Headon H, Kasem A, Mokbel K. Capsular Contracture after Breast Augmentation: An Update for Clinical Practice. Archives of Plastic Surgery. 2015;42(5):532-543. doi:10.5999/aps.2015.42.5.532.
Dian, D., and K. Friese. „Augmentation und Korrekturoperationen der Brust.“ Der Gynäkologe 41.12 (2008): 971-978.
Quaba, A. Quaba, PIP silicone breast implants: rupture rates based on the explantation of 676 implants in a single surgeon series, Journal of plastic, reconstructive & aesthetic surgery : JPRAS 66(9) (2013) 1182-7.
D.C. Hammond, M.M. Migliori, D.A. Caplin, M.E. Garcia, C.A. Phillips, Mentor Contour Profile Gel implants: clinical outcomes at 6 years, Plastic and reconstructive surgery 129(6) (2012) 1381-91.
M.G. Berry, J.J. Stanek, PIP implant biodurability: a post-publicity update, Journal of plastic, reconstructive & aesthetic surgery : JPRAS 66(9) (2013) 1174-81.

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