Plastic surgery - Clinic for Trauma Surgery, Orthopaedics and Plastic Surgery

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Clinic for Trauma Surgery, Orthopaedics and
Plastic Surgery

Plastic surgery

We have two areas of focus when it comes to plastic surgery: firstly, correcting the body’s contours, and secondly, restoring function as much as possible for patients with a congenital malformation or patients who have suffered from an accident or tumour removal. The treatments we provide range from reconstructive and aesthetic surgery through to burn and hand surgery. Our operations are performed using innovative technology and are in line with the latest standards.

An overview of our services is available if you would like to know more about them. The links provided in the table of contents lead to detailed descriptions of their respective topics.

If you would like to schedule an appointment during our consultation hour, please click here!

Range of services

Overview

Click on any one of the terms to get a detailed description of that term. If you would like more information, please e-mail us at This email address is being protected from spambots. You need JavaScript enabled to view it..

Reconstructive surgery

Accidents often cause significant soft tissue damage, which can be surgically reconstructed depending on the type and severity of the injury. For example, it is possible to restore muscle function even if the affected muscles have not functioned for years. Damaged nerves and vessels can regain function as well. Here at our clinic, we offer the full range of modern microsurgery procedures, including free tissue transfer, which involves using incredibly fine threads to attach free grafts to the regional blood vessel system under a surgical microscope.

Muscle transfer surgery

If muscle groups fail or paralyses occur, we can relocate muscles from the surrounding area of the body, restoring loss of function almost completely in many cases. The success rate of this procedure depends on the motivation of the patient and the strength of the muscles that have been transferred. It is particularly important to ensure that the muscles being transferred receive intensive training beforehand.

In our consultation hour, we will discuss in detail which surgical procedure is best suited for you. 

Lymphatic surgery

Overview of surgical treatment for lymphoedema

Surgery for lymphoedema

Many cases of lymphoedema can be treated effectively with conservative therapy in the form of lymphatic drainage and compression. Most cases of oedema will recede after six months. For some patients, however, the lymphoedema will not go away. The issue: Swollen limbs can severely restrict movement and put a huge strain on patients in their everyday life.

Here at our clinic, we offer the full range of surgical and conservative options that are available for treating chronic lymphoedema. You are more than welcome to schedule an appointment during our consultation hour. 

Lymph node transplantation

With some diseases, lymph nodes will need to be removed and may need to be replaced with lymph nodes from other areas of the body. Possible donor regions are the groin, the neck, the lateral thoracic region and the area underneath the hips.

Before removing any nodes, we first check to make sure lymph flow at the donor site is normal. When lymph nodes are removed from the groin, the risk of a leg lymphoedema developing as a result is relatively high. When it comes to the side of the neck, on the other hand, several nodes can usually be removed without causing any issues. This is the procedure with which we have had the best results so far.

The technique was developed by Corinne Becker, a Belgian doctor who practised in Paris in the 1980s. What is special about this technique is that the lymph nodes are removed together with the surrounding fatty tissue as well as an artery and a vein. The incisions that need to be made to carry out this technique are only five to eight centimetres in length. The "vascularised" (from the Latin Vasculum, meaning "small vessel") lymph nodes are then immediately inserted into the recipient site. Under a surgical microscope, the artery and vein, which are only about half a millimetre thick, are sutured to an artery and a vein at the recipient site, using threads that are thinner than a human hair. The reason the lymph nodes are transplanted along with their surrounding fatty layer is due to the “lymphangiogenic” quality of this fatty tissue. This “lymphangiogenic” quality means that it can form new lymphatic vessels and sprout into the surrounding tissue, thus connecting the transferred nodes to the lymphatic system. But before the vascularised lymph nodes are inserted, the tissue that has been scarred by the radiation therapy must first be removed completely, as it will otherwise prevent new lymphatic channels from forming.

Almost all patients who have the procedure say that they feel less pain, that they regain function quickly, and that the tissue has gotten softer. However, depending on how many lymph nodes have been transferred, it may take longer for the extremity to return to its normal size.

Conservative treatment (lymphatic drainage, compression) can be resumed after about three weeks. Around a third of those treated will no long require conservative treatment, and a further third will only require it to a lesser extent than they did before. The remaining patients, however, will still require the exact same level of conservative treatment they were receiving before.

Lymph node transplantation is a medically necessary procedure. Therefore, it is covered by the statutory health insurance. In relation to the lymph node transplantation procedure described above, you will find an interesting review article on "Repairing lymphoedema" in the journal “Lymphe und Gesundheit” (“Lymph and Health”), Issue 01-2013.

Lymphatic vessel transplantation

Lymphoedema occurs in some patients after they have had tumour surgery or been in an accident. If the tissue has not yet changed permanently and the remaining lymphatic vessels do not display signs of atrophy, scarring or sclerosis, then there is a good chance that the patient can be returned to their oedema-free condition by means of a lymphatic vessel transplant. In many cases, the transplant improves the patient’s condition considerably, especially if the procedure is carried out early – ideally half a year to a year after the oedema arose.

The transplanted lymphatic vessels will bypass the blockage – similar to bypasses concerning the heart or leg – and enable the lymph to flow. Two or three lymphatic channels up to 30 cm long are removed from the inside of a thigh, but only if the lymphatic system is still working properly in this area of the body. These channels are then used in other parts of the body, usually in the armpit or groin, to help decongest the arms or legs. This method has been tried and tested since 1985, and between then and now, it has also been used successfully in some cases to treat secondary head lymphoedema caused by cancer surgery ("neck dissection") and irradiation of lymph nodes in the neck area.

As lymphatic vessel transplantation is a medically necessary intervention, its costs are covered by the statutory health insurance. If you would like to read more on this topic, there is an interesting review article on “Repairing lymphoedema” in the journal “Lymphe und Gesundheit” (“Lymph and Health”), Issue 01-2013.

Lymphaticovenous anastomosis (LV shunts)

In medical terms, an anastomosis is an artificial connection, created either naturally or surgically, between blood vessels and/or lymphatic vessels. In this sense, the lymphatic vessel transplantation can be described as a lympho-lymphatic anastomosis. A lympho-venous anastomosis, on the other hand, is a connection between lymphatic vessels and venules (small veins). This connection serves to feed the lymph into the veins before it reaches the defective area of the lymphatic system. In principle, this is what the intact lymphatic system does anyways, just closer to the heart. A lympho-venous anastomosis involves early introduction of the lymph into the bloodstream, near to the lymphoedema.

This procedure has been in use for over 35 years, particularly in Italy (C. Campisi), India and China. In Germany, it is used to treat patients with issues such as genital lymphoedema or arm/leg lymphoedema with significant impairment of the hand/foot. Lymphatic channels must be present in the patient for them to have this procedure. The presence of lymphatic channels can be determined through a lymphangiography, but sometimes a surgeon will only be able to determine whether these channels are present during the operation itself.

The advantages of performing a lympho-venous anastomosis instead of a transplant are that we only have to make small incisions and do not have to remove lymphatic vessels or nodes from an unaffected part of the body. The disadvantage of this procedure, however, is that the decongestive effect is limited to a small area around the anastomosis. This means that we will often have to use many anastomoses over a larger area.

Lympho-venous anastomosis installation is also a medically necessary intervention and is therefore covered by statutory health insurance. Further information regarding this topic can be found in the review article “Repairing lymphoedema” in the journal “Lymphe und Gesundheit” (“Lymph and Health”), Issue 01-2013.

Lymphatic surgery to treat genital lymphoedema

Women

Chronic genital lymphoedema is usually very stressful for women who are affected by the condition, with lymph cysts often being entry points for bacteria and therefore regularly causing erysipelas to manifest. More severe forms can have a negative impact on sexual intercourse.

Conservative therapy is sometimes unable to put a halt to the long-term effects, and bandaging the region can prove difficult. An operation, on the other hand, can improve the situation on a lasting basis.

Lymph cysts and lymphoedema mainly form in the areas of the body that are covered with a particularly thin layer of skin. For women, these include the outer labia; in men, the skin of the scrotum. Removing parts of the skin ensures that the oedema is less severe if it reoccurs in the future. Lymph cysts or pronounced swellings will mainly appear on the labia majora. They can also occur on the labia minora / inner labia, but this is less common.

The corrective procedure involves removing the lymph cysts and reducing the size of the outer and/or inner labia. The labia will take on a very youthful appearance to begin with. After a few months, they should start looking age appropriate again. Scarring is rarely a problem with this procedure. We can ensure optimal wound healing and scar formation through special plastic surgery suturing techniques that use dissolving suture material.

Men

Genital lymphoedema can be a heavy burden on men affected by the condition. Pain when urinating, running and having intercourse are the main problems and can affect a sufferer’s quality of life. Since genital lymphoedema often occurs in conjunction with limb oedema, the therapy needs to be tailored with this in mind. For most patients suffering with lymphoedema, the most promising therapeutic method available to them is “Complex Decongestive Physiotherapy (CDP)”, which can be performed on either an inpatient or outpatient basis. The first step of this therapy involves repairing the skin. This is followed by manual lymphatic drainage, the application of special compression bandages, and physiotherapy exercises that help with decongestion.

After intensive decongestion of the genital lymphoedema and the leg lymphoedema that often accompanies it, we can then remove any pathologically altered tissue. Reconstruction of the genital region is necessary in cases displaying pronounced genital lymphoedema in combination with mons pubis oedema (swelling of the pubic mound region) and a buried penis. This procedure involves removing diseased tissue from the pubic area and repositioning the root of the penis.

After the operation, the frequency of erysipelas and the use of antibiotics will be significantly reduced, although we cannot guarantee that a lymphoedema or lymph cysts will never occur again in the patient’s genital region. If they do reoccur, however, they will be much less pronounced than they were before the operation and can be removed via a minor procedure. All in all, the operation can significantly improve your quality of life. 

Lymphangiomas

These rare congenital lymphoedema malformations can cause disfigurement to the body’s surface. Occasionally, they can also cause disability. After a precise diagnostic work-up, often carried out using magnetic resonance imaging, we can determine with certainty whether an intervention is advisable. This will depend on how accessible the lymphangiomas are. Even if we find that an operation is not advisable, we can still provide you with a comprehensive consultation or refer you to a specialised lymphology clinic for further treatment. 

Body contouring and skin tightening / tissue reduction surgery

Overview of tissue reduction procedures

Skin tightening surgery

Nowadays, a person can achieve sustainable weight loss through modern, so-called bariatric operations. These interventions are carried out at our Clinic for General and Visceral Surgery, as well as at other general surgery centres. Over time, these operations will lead to significant weight loss, which in turn can result in folds of loose skin all over the body. 

Upper body lift

We offer the full range of skin tightening operations, including the latest skin tightening procedures such as the total body lift. This procedure involves tightening and lifting the upper arms, chest and both breasts. For women who are having this procedure, excess tissue on the lateral chest wall can also be used to augment the breasts, without the need for silicone implants. For men, this procedure can help them achieve a flatter chest for the long term. We can also permanently remove sagging, unsightly folds on the front of a man’s chest.

Upper arm lift surgery

An upper arm lift involves permanently removing excess tissue or sagging skin. Surgical scars will appear on the inside of the arm and can be easily concealed. In some cases, the incision will need to be extended over the armpit. Thanks to our unique expertise in the field of lymphology, we perform a special treatment of the armpit to prevent the formation of postoperative lymphoedema. In many cases, we can simultaneously also reduce sweat glands and remove the amount of hair-bearing skin. This means that we are able to remove excess tissue of the upper arm and armpit, permanently get rid of unwanted armpit hair, and fix any issues with unpleasant excess sweating all in one single operation. 

Breast lift / breast reduction

Heavily enlarged breasts will often place a great strain on patients. Shoulder sores, back pain and intertrigo are a constraint on their everyday life. A breast reduction can help with these issues and bring relief. When performing this operation, we utilise modern surgical procedures and employ techniques that prevent scar formation. In some cases, your health insurance may cover the costs of the procedure. Please speak to us about this – we can help you prepare a report for the purposes of clarifying whether your insurance company should meet the costs. 

Lower body lift

After significant weight loss, or when the lower parts of the body sag due to age or genetic predisposition, we can help your appearance return to normal by means of an operation. By employing one or more procedures, we can tighten both thighs, the abdominal wall, the flanks and the buttocks region. The aim of the procedure is to distribute and tighten the excess skin in all directions in an optimal way. The scarring from these procedures is kept within the bikini area and can therefore be easily concealed.

This surgery is not intended as a treatment for obesity. As part of this procedure, however, we do collaborate with specialised departments within the University Medical Centre Göttingen’s interdisciplinary obesity centre. Furthermore, if you are planning on losing weight, we are happy to advise you about skin tightening operations that may follow.

Thigh lift

Thanks to an adapted line of incision and a special preparation technique in the depth of the tissue, we are able to protect deep-lying lymph vessels within the thigh. Following the operation, special conservative lymphatic therapy, including compression tights and manual lymphatic drainage, helps to keep leg swelling to a minimum.

Breast surgery

Breast surgery overview

Breast reconstruction

Breast amputation, i.e. mastectomy, is a rarity nowadays. Thanks to modern surgical procedures and corresponding supportive treatments such as chemotherapy and radiation, most breast cancer patients are now able to have breast-conserving surgery. Some cases, however, require so much breast tissue removal that a skin/soft tissue defect will still be present after the patient’s surgery. But even in these cases, there is the possibility of rebuilding the breast with the help of modern microsurgical techniques using tissue from the patient’s own abdomen.

Here at our clinic, we employ the most commonly used procedures – the so-called DIEP flap (DIEP = Deep Inferior Epigastric Perforator, a perforating flap of the inferior epigastric artery) or the TRAM flap (TRAM = Transverse Rectus Abdominis Musculocutaneous flap, a muscle/subcutaneous tissue flap that includes the straight abdominal muscle). This operation involves using excess tissue from the lower abdomen to form a breast. Blood flow can be provided to the skin/soft tissue flap by connecting fine blood vessels under a microscope. This complex microsurgical procedure can eliminate the need for a silicone implant in the majority of cases. The scar on the lower abdomen can easily be concealed in the bikini area, and at the same time, the patient will benefit from a flatter stomach thanks to the abdominoplasty performed as part of the procedure.

Breast reconstruction for patients with chronic arm lymphoedema

Breast reconstruction can be risky in cases of chronic arm lymphoedema – there is a chance the lymphoedema will deteriorate if the line of incision is an unfavourable one. In addition, a postoperative infection after breast reconstruction can lead to swelling of the arm. We employ specialised techniques and use particular connecting blood vessels that can be accessed in a lymph-friendly way; this helps to avoid unwanted, increased swelling of the arm after the operation. We recommend that the patients concerned undergo decongestive therapy at a specialised lymphology clinic before the operation. We can also arrange for patients to receive postoperative follow-up treatment at a lymphology clinic. In many cases we can organise this in advance, so please don’t hesitate to contact us.

We advise patients with arm lymphoedema to not have their breasts reconstructed using their own back tissue. This is because incisions made to the back can negatively impact the lymphatic drainage system of the associated quadrant. In many cases, this can then lead to the arm lymphoedema becoming worse. For patients with lymphoedema, an example of a more suitable procedure would be the use of their own lower abdomen tissue via a TRAM flap or DIEP flap.

Breast lift / breast reduction

Heavily enlarged breasts will often place a great strain on patients. Shoulder sores, back pain and intertrigo are a constraint on their everyday life A breast reduction can help with these issues and bring relief. When performing this surgery, we employ modern surgical methods and scar-saving techniques. In some cases, your health insurance may cover the costs of the procedure. Please speak to us about this – we can help you prepare a report for the purposes of clarifying whether your insurance company should meet the costs.

Breast augmentation

Very flat or asymmetrical, uneven-looking breasts can often make a woman feel very negative about herself. We can help in these cases by permanently enlarging the breast. We do this by using silicone gel-filled implants of the highest quality and operating under the highest standards of safety. Thanks to our specialised adjustment system and trial external prostheses, you will be able to get a good idea of what you might look like after the operation from your very first appointment at our outpatient clinic. Nowadays, breast implants are available in all different shapes and sizes, which enables us to choose an implant that is perfectly suited to your physique. 

Nipple reconstruction

Once the breast has been successfully reconstructed, we can then restore the nipple – either during the same procedure or in a second operation at a later date. There are various surgical techniques we can use to do this. Which technique we use will depend on both our medical findings and your personal wishes. After the nipple has been restored, the areola can then also be remodelled by using medical breast pigmentation to get it to match up with the colouring of the opposite, healthy areola.

Surgical lipoedema treatment (liposuction / tissue reduction in cases of lipoedema)

Overview – range of treatments for lipoedema / obesity

  • Conservative treatment methods (manual lymphatic drainage, compression therapy)
  • Possibility of referral to our interdisciplinary obesity centre if desired
  • Liposuction, after conservative therapy measures have been exhausted

Lipoedema is a congenital increase and disease of the adipose tissue. It almost exclusively affects women, and can cause the legs and buttocks to greatly increase in size, even if the upper body of the person affected is slim. Patients occasionally suffer from a dragging pain, the tissue is often dimpled, and patients have a tendency to bruise incredibly easily. The ankle and instep are always left unaffected by this condition: The excess fatty tissue stops abruptly at the bottom of the lower leg, creating a sharp contrast between the enlarged leg and slim foot. Lipoedema is the result of a congenital weakness of the connective tissue and thus damage to the smallest blood vessels. This causes fatty tissue to accumulate in the lower half of the body.

While the symptoms of this condition can be improved through conservative therapies and compression treatment in combination with manual lymphatic drainage and movement therapy, this treatment method will rarely result in the fatty deposits regressing completely. For patients who have been treated using conservative therapy without success and whose general health is good, liposuction may be an option. Through this procedure, we will be able to greatly improve a patient’s appearance.

Liposuction should not, however, be performed on a patient with chronic lymphoedema or whose legs have a particular tendency to swell. Patients with lymphoedema will have swelling to their ankles and insteps, displaying a pitting oedema (when a finger is pressed into the area, the indentation will remain). However, an occasional tendency to swell, especially when stressed, is not considered an exclusion criterion for the operation. Extremely obese patients are unsuitable for liposuction surgery, as liposuction is not a replacement for a heathy diet. Any varicose veins that are present should ideally be removed at least six months before the desired operation. You won’t need to go far for this, as we also carry out vein stripping / varicose vein removal via small incisions in our clinic. The would be beneficial for you, as the same lines of incision can be used later on to perform the liposuction surgery, especially if it is the same surgeon carrying out both the varicose vein stripping and the liposuction. We do not recommend liposuction of the legs if the venous system is severely damaged, especially if this damage is in conjunction with an occlusion of the leg’s deep venous system. We will be happy to arrange a duplex ultrasound for you so that the condition of your venous system can be examined in detail.

We will usually put a patient under general anaesthesia when performing this procedure. We monitor patients at our clinic for one to two nights after the operation, so that we are able to act immediately should any circulatory changes occur. We start mobilising patients on the same day as their operation – provided their circulatory function allows this. Patients are often only required to physically rest for a few days, and you will very likely be able to return to work after about a week. Despite this, you should still wear compression tights for six weeks to three months after the operation to help with lymph drainage.

Liposuction can greatly improve the aesthetic appearance of patients suffering from lipoedema. In some cases, however, skin tightening surgery will be required at some point after the operation, especially if the skin was overstretched before the liposuction due to the accumulation of larger fatty deposits. In these cases, the excess skin can be removed via tissue reduction surgery. In relation to this, we offer the full range of skin tightening / tissue reduction procedures for body contouring (see section “Body contouring and skin tightening / tissue reduction surgery”).

Aesthetic surgery

Aesthetic surgery overview

Upper/lower eyelid lift

The eye region plays an important role in interpersonal communication, which is why patients whose eyes have changed aesthetically with age can often feel very self-conscious and may turn to surgery – the so-called “lid lift” (blepharoplasty). The most common operation is the upper eyelid lift, which we perform in our clinic on an outpatient basis using local anaesthesia, meaning you can return home within just a few hours of a successful procedure. After surgery, you should avoid strenuous activities and apply a cold compress to the eye area at regular intervals. We offer the full range of aesthetic eyelid surgery options, all of which include comprehensive aftercare treatment provided by our medical team at the clinic.

Otoplasty

Protruding ears are relatively common, with both ears usually affected. For children of school age, protruding ears can be a burden that their parents may want to spare them from. We therefore recommend that the procedure is carried out before the child starts school at the age of five, in order prevent them from suffering any emotional stress as a result of their ears. Children at this age are sufficiently cooperative and their ears are well formed with a stable appearance.

As a general rule, we put children under general anaesthesia for this operation, which will be followed by a short inpatient stay. After the procedure, patients must wear a bandage over their ears for between seven and ten days. During this time, they should avoid sleeping on their side if possible. In addition, we recommend wearing a headband at night for two to three weeks to ensure that the operation is ultimately a success. The aftercare patients receive is of course provided by our medical team. 

Breast augmentation

Very flat or asymmetrical, uneven-looking breasts can often make a woman feel very negative about herself. We can help in these cases by permanently enlarging the breast. We do this by using silicone gel-filled implants of the highest quality and operating under the highest standards of safety. Thanks to our specialised adjustment system and trial external prostheses, you will be able to get a good idea of what you might look like after the operation from your very first appointment at our outpatient clinic. Nowadays, breast implants are available in all different shapes and sizes, which enables us to choose an implant that is perfectly suited to your physique. 

Tummy tuck

People who have lost a significant amount of weight or who have been pregnant will often have excess skin around their lower abdomen. In these cases, a tummy tuck (abdominoplasty) is a suitable and fairly atraumatic procedure for permanently removing excess tissue or sagging skin. We are also able to tighten the muscles of the abdominal wall, giving the waist a more defined shape. This procedure can also be performed in combination with abdominal liposuction. We put patients under general anaesthesia for this operation, which will be followed by an inpatient stay.

Post-accident scar corrections and burn scar corrections

Serious accidents can sometimes leave victims with bothersome, rubbery or indented scars. If conservative treatment methods, such as compression bandages with silicone or the injection of anti-inflammatory substances into the scar, have already been tried and have proven unsuccessful, we can correct these scars using modern plastic surgery procedures. If you are suffering from trapped skin nerves (neuroma) or nerve branches caused by scar shortening / scarred tissue, we can easily take care of this problem using microsurgical procedures. This will often help to eliminate pain – even in patients who have suffered with chronic discomfort for years.

Burn injuries create particularly extensive areas of scarring that can even hinder a victim’s range of motion. To treat these injuries, we use so-called tissue expanders, whereby a silicone balloon is inserted to stretch the healthy skin and soft tissue. The extra skin that’s produced as a result is then transferred to meet the scarred area in a later operation. In many cases, this procedure enables us to remove the majority of the scar. In addition, we also use local (regional) flap plasty techniques such as Z-plasty. We attach particular importance to proper aftercare and scar prevention. For patients with a tendency of developing rubbery and bulging scars, we can prevent scarring by applying a silicone sheet at an early stage.

Corrections of “visible” scars (face, hands) are covered by the statutory health insurance, as are scars that cause one to suffer from limited mobility. In other cases, you can clarify beforehand whether your insurance will cover the costs. During out initial consultation, we will be happy to write a letter for you to submit to your health insurance company in relation to this.

FAQ

Frequently asked questions about the use of liposuction to treat lipoedema

  1. Are the results permanent? Can the fatty deposits that were removed reaccumulate?

The results are usually permanent. The fatty tissue can grow back in rare cases, e.g., patients with hormonal disorders or a severe thyroid disorder. If you begin to put on significant amounts of weight again after the operation, this may result in the amount of fatty tissue in the treated area increasing as well. However, in our experience, patients who have liposuction will gain weight evenly across all parts of the body, as opposed to any weight gain being concentrated in the area of the body that was treated. 

  1. Will the procedure leave any visible scars or indentations?

By using gentle suction methods and specialised techniques, we can largely prevent indentations from forming. The resulting scars no longer than five millimetres long and are very inconspicuous. They will be slightly reddened immediately after the operation and barely visible within half a year to a year of you having the operation.

  1. At what age can or should liposuction be carried out at the earliest?

As a general rule, this type of procedure should only be performed on someone who has stopped growing. In very rare cases, e.g., for those suffering from congenital or hyperplastic obesity, we are able to perform liposuction earlier as well. Cases such as these will need to be scrutinised carefully, however.

  1. Is the procedure painful?

In the majority of cases, we put patients under general anaesthesia when performing liposuction, meaning you won’t feel any pain. Post-operative pain can be effectively managed with medication. 

  1. Can I go on holiday by aeroplane and stay out in the sun?

The tissue will take a few months to normalise. During this time, you may experience temporary swelling. As sun exposure and high temperatures can aggravate these swellings, we recommend that you do not sit in direct sunlight, visit the sauna, or use a tanning bed in the three months that follow your surgery.