[Conciliatory proceedings of a German mediation center after breast augmentations]. / Schlichtungsverfahren nach Mammaaugmentationen ­ eine Analyse der Eingriffe mit Behandlungsfehler und Haftungsanspruch der Norddeutschen Schlichtungsstelle.

Introduction The requested by the "Norddeutsche Schlichtungsstelle ["North German Mediation Centre"] reveal the complications and problems of breast augmentation. The North German Mediation Centre is responsible for ten federal states in Germany (Berlin, Brandenburg, Bremen, Hamburg, Mecklenburg-Western Pomerania, Lower Saxony, Saarland, Saxony-Anhalt, Schleswig-Holstein and Thuringia) and is thus the largest mediation centre in Germany Material and Methods We analysed requests from patients, expert reports ordered by the North German Mediation Centre and the final verdicts of mediations after breast augmentations between 2000 and 2007. This approach has the advantage that it addresses the topic from different viewpoints. Furthermore we analysed the statistical data provided by the mediation centre. Results In 44 % of the patient´s requests, a causal relationship was confirmed between the damage caused to the patient's health and malpractice. This is much greater than the overall figure for the mediation centre, which is that a causal relationship was confirmed in only 24 % of cases. The 66 patient requests after breast augmentations included 29 cases with liability. In 86 % of the cases, the expert opinions concluded that mistakes were made during planning (72 %). Most frequently, surgical incisions were incorrect (45 %), followed by the preparation of the pocket (28 %), the surgical approach (31 %) and the implant size (17 %). The patients mainly complained about asymmetry (79 %) and the position of the implants (62 %) or the size of the breasts after surgery (38 %). Discussion The greater frequency of a causal relationship between the damage caused to patient health and malpractice - in comparison to the general statistics - may be due to the greater complexity of breast augmentation than generally expected. Not only the surgery itself, but - to an even greater extent - adequate planning and aftercare are of predominant importance in satisfying the patient. All these factors and the high expectations of the patients lead to a higher request rate.