PORTRAIT
Since 2012, the Swiss Society for Aesthetic Surgery has been comprised of physicians with certified (FMH) training in plastic reconstructive and aesthetic surgery. The members of this society have a special interest in aesthetic surgery, representing the majority of their surgical activity. The role of the Swiss Aesthetic Surgery Society is to ensure the continuing education of aesthetic surgery in Switzerland, to promote patient safety, to provide objective information and to maintain a level of excellence in aesthetic surgery in our country.
CHOOSE YOUR SURGEON
Unfortunately, we find that a large number of physicians in Switzerland perform cosmetic
surgical procedures without having completed the necessary training. From a legal point of view, this is still allowed for the time being, as any doctor who has a medical degree and has completed two years of postgraduate training can theoretically perform all procedures, provided that he or she feels capable of doing so. In view of this legal vacuum, it is essential to choose a doctor who has completed postgraduate training and holds the title of specialist in plastic, reconstructive and aesthetic surgery.
1
Make sure that you are dealing with a real specialist in Plastic, Reconstructive and
Aesthetic Surgery.
2
The plastic surgeon you choose must inspire confidence in you.
3
The information gathered must seem clear and understandable to you.
4
The surgeon must talk to you about the techniques, the type of anesthesia, the risks and the possible complications.
5
The plastic surgeon must give you an estimate (it is mandatory!) and discuss it with you.
6
The systematic proposal of a reflection period and a second consultation before
proceeding to surgery is a guarantee of good professional ethics.
7
The plastic surgeon must give you an information document about your operation to read and have you sign an informed consent.
8
A second opinion may be useful in case of doubt.
LIST OF MEMBERS
Dr Helen Aghahosseini
VAUD / WAADT (VD)
17, rue de la Dôle
1005 Lausanne
Dr Kouroche Amini
GENÈVE/ GENF (GE)
Chemin de Beau-Soleil 12
1206 Genève
Dr Thierry Bezzola
GENÈVE/ GENF (GE)
57, rue du Rhône
1204 Genève
Dr Yves Brühlmann
BERN (BE)
90 Brunnmattstrasse 22
3007 Bern
Dr Nicolas Chami
VAUD / WAADT (VD)
50 Rue du Midi 12
1003 Lausanne
Dr Alexandre Cheretakis
GENÈVE/ GENF (GE)
30 Route de Chêne 112
1224 Chêne-Bougeries
Dr Mihai A. Constantinescu
BERN (BE)
3010 Bern
Dr Simone Eggli
BERN (BE)
Christoffelgasse 6
3011 Bern
Dr Jean-François Emeri
VAUD / WAADT (VD)
Ch. Des Croix-Rouges 9
1007 Lausanne
Dr Dominique Erni
SCHWYZ (SZ)
Küferweg 9
6403 Küssnacht
Dr Daniel P. Espinoza
GENÈVE/ GENF (GE)
1, rue Emile-Yung
1205 Genève
Dr Philipp Fallscheer
TICINO / TESSIN (TI)
Riva Antonio Caccia 1A
6900 Lugano
Dr Dominik L. Feinendegen
ZÜRICH (ZH)
Dufourstrasse 38
8702 Zollikon
Dr Thomas Fischer
BERN (BE)
Hirschengraben 7
3011 Bern
Dr Marie Christine Gailloud Matthieu
VAUD / WAADT (VD)
Rue du Valentin 61
1004 Lausanne
Pr Yves Harder
VAUD / WAADT (VD)
Rue du Bugnon 46
1004 Lausanne
Dr Hans Peter Kern
ZÜRICH (ZH)
Dufourstrasse 31
8008 Zürich
Dr Daniel A. Knutti
BERN (BE)
Bahnhofstrasse 39
2502 Biel
Dr Serge Lê Huu
VAUD / WAADT (VD)
Chemin des Allinges 16 bis
1006 Lausanne
Dr Lucas Leu
ZÜRICH (ZH)
Dammstrasse 29
8702 Zollikon
Dr Martino Meoli
TICINO / TESSIN (TI)
Via Peri 4
6900 Lugano
Dr Ali Modarressi
GENÈVE/ GENF (GE)
Avenue de Champel 24
1206 Genève
Dr Eva Neuenschwander Fürer
ZÜRICH (ZH)
Forchstrasse 4
8008 Zürich
Dr Sophie Nordback
VAUD / WAADT (VD)
Voie du Chariot 6
1003 Lausanne
Dr Pierre-Olivier Parvex
GENÈVE/ GENF (GE)
110, route de Chêne
1224 Genève
Dr Michel E.Pfulg
VAUD / WAADT (VD)
43, avenue de Collonge
1820 Montreux-Territet
In Reben 19
8315 Lindau
Dr Jan G. Poëll
ST. GALLEN (SG)
Schönbühlstrasse 8
9402 Mörschwil
Dr Pierre Quinodoz
GENÈVE/ GENF (GE)
1bis, avenue J.D. Maillard
1217 Genève
Dr Wassim Raffoul
VAUD / WAADT (VD)
Rue Bugnons 46
1011 Lausanne
Dr Patricia Roggero
VAUD / WAADT (VD)
24, chemin de Porchat
1004 Lausanne
Dr Kai-Uwe Schlaudraff
GENÈVE/ GENF (GE)
24, bd. des Philosophes
1205 Genève
Dr Dominik W. Schmid
ST. GALLEN (SG)
Sonnenstrasse 6
9000 St. Gallen
Dr Mathias Tremp
ZUG (ZG)
Dorfplatz 1
6330 Cham
Dr Andreas Tschopp
BERN (BE)
Bellevuestrasse 15
3095 Spiegel bei Bern
Dr Raphael Wirt
BERN (BE)
General-Dufour-Strasse 17
2502 Biel
Dr Michele Zanzi
Dr Michele Zanzi
VAUD / WAADT (VD)
Place Bel-Air 1
1003 Lausanne
Dr Christian Zuber
VAUD / WAADT (VD)
25, rue de Lausanne
1950 Sion
Dr Jacques Alexandre Zufferey
VAUD / WAADT (VD)
30, rue de Lausanne
1950 Sion
THE INTERVENTIONS
Reconstructive or reconstructive surgery deals with birth defects or deformities, skin and other anatomical losses caused by tumors, diseases (leprosy, noma) or accidents. In certain cases, it can correct malfunctions. It also includes burn surgery. Aesthetic surgery (cosmetic surgery) includes the correction of cosmetic defects that cannot be classified as congenital defects or deformities; but it also includes rejuvenation surgery (anti-aging – rejuvenation) and surgery to improve the outer contours.
​
Breast surgery
Breast augmentation with implants and fat injection
Breast reduction
Mastopexy (breast lift)
​
Figure surgery
Liposuction
Abdominoplasty (belly lift)
Bodylift (circular waist lift)
Arm and thigh lift
​
Facial surgery
Face and neck lift
Upper and lower blepharoplasty (eyelid surgery)
Lipofilling or lipostructure (Correction of facial volume by injection of fat)
Correction of protruding ears
Rhinoplasty (nose correction)
chin correction
Facial implants
Hair loss surgery
Lasers, peels, dermabrasion
Facial injections (hyaluronic acid and botulinum toxin)
​
Intimate surgery
Nymphoplasty (labia minora surgery)
Vaginoplasty (narrowing of the vaginal canal)
Penoplasty (penile surgery)
PLASTIC SURGERY PRICES
Prices for aesthetic procedures such as breast augmentation, eyelid lifts, liposuction, intimate surgery and tummy tucks vary between providers, sometimes by a factor of two. From the information on the website, it is usually not possible to understand how the prices are made up. Therefore, we list here factors that explain the price differences:
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Geographic location: providers in urban centers are usually in the upper price segment due to higher rental and personnel costs. Procedures performed abroad are significantly below the Swiss price level due to generally lower cost of living.
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Specialization and experience of the doctor: In Switzerland, the name 'cosmetic surgeon' or 'specialist in aesthetic surgery' is not protected and can be used by any doctor regardless of the underlying training or experience. Only the title 'Specialist in Plastic, Reconstructive and Aesthetic Surgery' guarantees a controlled, professional career with regulated quality requirements. Specialists with this title have a long training, are more experienced and the operations are accordingly in a higher price segment, as with cheap providers. Experience in aesthetic surgery plays an extremely important role, because the more regularly and often operations are performed, the more consistent are good surgical results.
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Where does the surgery take place: Private clinics are usually more expensive than outpatient surgery centers. In outpatient facilities, prices depend on the standard of the operating room. A room in which surgery is performed is clearly cheaper than a real operating room, with laminar flow (low turbulence air flow with filters), hygienic standards in the construction and controlled procedures for the preparation of sterile instruments and the necessary material.
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Material used: especially in breast augmentation, the price range for implants is very wide: the cost of a round silicone implant with a smooth surface is significantly lower than that of a teardrop-shaped implant with highly cross-linked silicone content and a rough surface.
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Surgical technique used: especially in eyelid lifts, intimate surgery and tummy tucks, certain techniques require a longer surgical time, which is beneficial for the healing process and for the result achieved. Longer surgery times are associated with higher costs.
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Type of anesthesia: Will the surgery be performed under local anesthesia or general or sedation? Local anesthesia is performed by the surgeon and does not require another medical person and does not cause additional costs. General anesthesia, on the other hand, require the presence of a specialist in anesthesiology, who is usually assisted by a specialist in anesthesiology.
ABC OF BREAST IMPLANTS
In our daily work as surgeons, we are confronted with the question of the right technique and the optimal implant when discussing and performing reconstruction and augmentation of the female breast. Breast implants have been available in various forms for over 50 years. They have been constantly improved. Surgical techniques have been refined. Despite the new developments, the question of the advantages and disadvantages of breast implants still arises for every patient. Should I have breast implants? What alternatives do I have? How do I choose my surgeon? Which implants, which size and shape? What surface finish? What is the best approach for me? In which tissue layer will the implant be placed?
Weighing the benefits and risks and choosing the right implant is a difficult personal process. In 1995, the Federal Office of Public Health, together with experts from patient organizations and the medical profession, developed a brochure to answer the most important questions. The information brochure was revised in 2001 and served as the basis for the present brochure. It was revised and updated by a group of specialists from the Swiss Society for Plastic, Reconstructive and Aesthetic Surgery and the Swiss Society for Aesthetic Surgery. Its usefulness has been verified by patient organizations.
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With this brochure we want to provide women with basic information about breast implants and thus reduce their fears.
A
for Acceptance
The decision to get an implant is neither easy nor quick. You should only decide for or against an implant after a detailed explanation and sufficient time for reflection. If necessary, you should seek a second opinion. The goal of the consultation is achieved when you are aware of the possible side effects of the procedure and are prepared for regular follow-up examinations and, if necessary, follow-up operations.
Breast corrections may be necessary for a variety of reasons. The consequences of accidents, breast cancer operations or psychological problems caused by subjectively unsatisfactory or missing breasts can be a major stress for the women concerned.
Silicone implants are used, among other things, for reconstruction after breast removal and for reconstruction of a missing breast. Procedures should only be performed if medically and psychologically justifiable. The aim is to offer help to the women concerned. Patients generally feel more confident after the operation and experience less inhibition and feelings of inferiority.
B
for Balance
The female breast is considered a sign of female identity and has an important function in a woman's life. However, it is precisely the social emphasis placed on the breast that stylizes it into a central symbol. The loss of a breast or deviations from the ideal can cause great problems for the women concerned. Plastic surgery has always helped to solve breast-related problems.
C
for Capsulitis or Shell
Any implant inserted into the body causes a so-called "foreign body" reaction. Such a reaction, which consists of the formation of a capsule around the implant, is normal and always occurs. In some cases, this capsule may thicken and shrink (capsular fibrosis) and eventually lead to calcium deposits. These can lead to painful hardening and changes in shape, which necessitate removal of the capsule and possibly replacement of the implant.
This procedure is covered by basic health insurance.
D
for Day of the surgery
The operation can be performed on an outpatient basis, i.e. one day of surveillance at the surgical establishment and then a return home at the end of the day, or with an overnight hospital stay.
The operation is performed under general anesthesia or local anesthesia under sedation and usually lasts from one to two hours.
E
as Everyday life
In principle, all activities are allowed as before the operation. Seat belts can be worn without hesitation. For extreme sports, you should consult your doctor.
As a rule, the ability to breastfeed is not affected by the implant. However, it may be affected by certain surgical procedures.
F
for Form of implant
The shape of the breast is defined by the volume, diameter, projection and the shape of the implant itself.
A breast prosthesis therefore has 4 parameters:
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the shape of the shell
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the volume in cc
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the projection in cm
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diameter in cm
The most common shapes are: the anatomical or drop-shaped prostheses which have a major projection in the lower pole in order to give a more natural curve, and the round prostheses which have the same projection on the whole diameter and give a more rounded curve.
Currently, there are round prostheses that behave like anatomical prostheses thanks to a silicone gel that can be shaped more easily.
Once the volume is chosen (which is expressed in cc), the ideal diameter is defined according to the patient's original breast and the projection. All these parameters will give different types of breasts.
G
for Gel
The shell of the prosthesis is almost always made of silicone. The inside of the prosthesis is made of gel. In most cases it is a silicone gel.
On the market, there are different alternatives: water gel, saline solution, etc...
Currently, silicone gels are cohesive for safety reasons.
In case of rupture, the gelatinous mass remains compact and does not come out of the capsule of the prosthesis. Silicone gel can also be ergonomic. This gel gives a more natural look and feel to the breast.
H
for History
Plastic surgery has always helped to solve breast problems. Silicone gel-filled implants were first inserted in the United States in 1962. In 1963, the first implantation with a saline filler took place in France. The shell was always made of silicone. Silicone implants are also used for other purposes, for example to augment the chin or to replace testicles or joints. After 1980, individual cases were described in which a link between silicone implants and diseases such as breast cancer or autoimmune diseases was suspected. The US Food and Drug Administration (FDA) ordered expert consultation. Because there was insufficient data on the safety of silicone-filled implants, the FDA decided in 1992 to ban their use. One exception was implantation in controlled scientific studies. Saline-filled implants remain approved. In Europe, silicone implants could continue to be used. In 1999, the Institute of Medicine (IOM) published a report on the safety of breast implants. It clearly showed that problems with breast implants are local and that there is no evidence of systemic diseases such as cancer or autoimmune diseases according to recent studies. In 2001, the German TÜV introduced a quality label for breast implants. In the United States, silicone implants were approved again in 2006. This was followed in 2010 by the PIP implant scandal, which contained substandard silicone as a filler, and in 2015 by the recommendation to stop using implants from the Brazilian company Silimed. These incidents occurred under strict regulatory requirements. They show us that we are dependent on strict quality control by the authorities and that we must constantly document and follow up on patient histories.
I
for Incision
There are several options for inserting the prosthesis: using existing scars on the breasts, making a 5 cm long peri-areolar incision, a 5 cm incision in the infra-mammary fold or a 5 cm incision in the axilla.
L
for Lymphoma
In 1997, a case of ALCL (anaplastic large cell lymphoma) was described for the first time in a person who received a breast implant. It is a malignant tumor that is associated with an accumulation of fluid around the implant. The occurrence of this complication is very rare. However, if breast swelling occurs one year after implantation, this complication should be ruled out. Complete removal of the implant capsule is the treatment of choice.
Until now, only implants with a textured surface have been affected by this problem, and as of 2019 these are no longer available on the market.
M
for Mammography
In the context of an aesthetic breast augmentation, it is possible, in most cases, to carry out cancer screening checks by mammography. It is necessary to inform the radiologists of your situation. In other cases, a sonogram can be performed.
O
for Operator
An operation of this kind should only be performed by a specialist who has received appropriate training. You should ask about the qualifications of the specialist during the consultation.
In Switzerland, the surgeon must have a title of specialist in plastic, reconstructive and aesthetic surgery. This title is associated with the term FMH which stands for Federation of Swiss Physicians, the only official body recognized.
Q
for Quality
It is essential that you request an operation report as well as the information attached to each implant regarding the type, brand, expiration date, filling and envelope material of the implant. This information should be included in the medical history and in your personal file.
In Switzerland, there is an anonymous breast registry that collects all the information about the prostheses implanted by all the accredited Swiss surgeons. Only the operating physician knows the identity of the patient. This registry allows, in case of a problem, to immediately inform the doctor and to have statistics on the quality, the life span and possible complications.
R
for Rupture
Finally, specific body reactions that can be attributed to silicone are described. Direct contact of liquid or gel silicone with the surrounding tissue can cause a reversible inflammatory reaction. The body's defense system (immune system) is also involved. Experts believe that the possibility of a so-called generalized immune system reaction is very unlikely and not scientifically proven.
A defective implant should be replaced if there are symptoms.
All implants after 2000 have a cohesive silicone gel so that it does not leak out of the capsule and infiltrate the tissue. For previous implants, it is possible that the filler material has infiltrated the tissue and should be removed.
S
for Surface
The surface of the denture capsule is smooth. In the past, there were several surface options: smooth, micro-textured, textured (rough surface). For medical reasons already described, textured prostheses are no longer in commerce.
T
for Traceability
It is essential that you request an operation report and the information attached to each implant concerning the type, brand, expiration date, filling material and envelope of the implant. This information should be included in the medical history as well as in your personal records.
All Swiss physicians should enter the data of anonymous prostheses into a national breast registry for quality control.
U
as Use another solution
Lipofilling. Lipofilling allows to give volume to the breast with injections of its own fat.
V
for Viability
Breast implants age and wear out. They also have a limited lifespan, but this cannot be predicted exactly. The silicone shell can tear (rupture) and the filler material can seep into the surrounding tissue. Even through an intact shell, a small amount of filler can leak out (bleeding). For this reason, patients with breast implants should ideally be checked regularly, at one or two year intervals.
Women who have undergone surgery at a young age in particular should expect to have one or more implant replacements during their lifetime. However, some new generation implants have a lifetime guarantee.
W
for Who pay ?
If the patnxdhnient wishes to undergo a breast augmentation for aesthetic reasons, she usually has to bear the costs of the operation, the implants, the hospital stay and the loss of working hours herself. The additional costs resulting from possible immediate complications (such as post-operative bleeding, infections, removal of implants) are covered by the insurance. If the operation is performed for medical reasons (e.g. reconstruction after a cancer operation) the health insurance will cover all costs.
In any case, prior consultation with the operating physician and the health insurance company is necessary. It is also necessary to clarify whether the costs of periodic check-ups will be covered.