Breast Augmentation: What Happens During a Consultation?

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There are many reasons why women seek breast augmentation. Some women feel that increasing their breast size will give them greater self-confidence. Others would like to feel more proportional between their top and bottom so they fit better into their clothing. Mothers frequently seek breast augmentation to restore what was lost with breastfeeding and ageing. Supporting loose skin and giving upper breast fullness are also common reasons for choosing breast enlargement.

Good communication with patients in breast augmentation is key. There’s a need to review their medical histories and ask patients what their goals are for breast augmentation. In some cases, it is a modest increase in size to fit better in their clothing. Other times it’s a significant increase in volume to change their look. A patient may desire an improved breast shape or, possibly, better symmetry is their goal. Still others may want to restore their pre-pregnancy figure and may choose to combine their augmentation with a breast lift or other procedures.

On examining the patient, one needs to consider many features including breast volume, width, height, nipple position, areola size, ribcage curvature, skin tone, droopiness, asymmetry, and crease position. Breasts are highly variable, and I help the patient understand what their best options are based on their physical characteristics. We then come to a common agreement about what our goal will be. Remember, that “breast are sisters, not twins” so more often than not there is quite some variation between the two breasts so you can’t expect a perfect match following breast augmentation.

When the patient returns for their pre-operative visit, typically 1-3 weeks before surgery, I have them look through many digital photographs of breasts to show me their desired result. If there is a discrepancy between what we have discussed and what the patient is showing me with pictures, I’ll identify the difference and sort out what they really want, often using the 3D VECTRA which can simulate what the breasts may look like after augmentation. At the end of our meeting, I’m fairly confident that I understand what the patient desires. Likewise, the patient feels comfortable with our communication and our plan.

The photographs are then brought with me to the operating room. When the patient is asleep, I create the pockets for the implants on each of the breasts, and I occasionally use implant sizers to confirm the volume and shape of the optimal breast implants for the patient. Most patients are back to work and most of their usual routine in several days or up to a week. Strenuous exercise should be avoided for several weeks.

To learn more about breast augmentations, request a consultation by contacting us at 13000DRTIM or emailing us at info@drtim.com.au 

Breast Augmentation Part 3 of 4: The Plastic Surgeon

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I am amazed how many patients spend more time shopping for a TV or washing machine than they spend selecting a plastic surgeon. Selecting your surgeon should be the single most important thing that you can do to assure an optimal result.

You should have a checklist of essential things to look for in a plastic surgeon:

  1. Be a Fellow of the Royal Australasian College Of Surgeons (RACS), the only college recognised by the Australian Medical Council that can train surgeons in Australia
  2. Be a Member of the Australasian Society Of Aesthetic Plastic Surgery (ASAPS)and the Australian Society of Plastic Surgeons (ASPS)
  3. Has hospital privileges to do breast augmentation at an accredited hospital or day surgery facility
  4. Subspecialises in cosmetic surgery
  5. Superspecialises in breast augmentation
  6. Recommended by a knowledgeable friend or doctor
  7. Curriculum vitae documents scientific presentations and publications

There are also a few less reliable points that I would like to address when choosing a plastic surgeon. Advertisements and media coverage are paid for by the plastic surgeon and does not necessarily reflect how knowledgeable, competent or experienced they are. Your local doctor may not be in the know of who is best to do breast augmentation and may not have an interest in cosmetic surgery to find out either. Some just refer to surgeons who are their friends from medical school, are in the local area and thus convenient or who may be paid for by the surgeon to refer you. Never listen to recommendations from anyone who is an “armchair expert” or who has no in-depth knowledge of breast augmentation. At the end of the day, look at the plastic surgeon’s results to see how good they are. Be very careful with “glamour shots” that can deceive because of lighting, patient positioning and camera angle. They may even be “photoshopped” or airbrushed. Some plastic surgeons may have models as patients that they have operated on their face but not their breasts (which was performed by another surgeon) and use them for advertising breast augmentation.

There are a further number of “red flags” that you should take notice of. These are:

  1. Completed training in a specialty other than plastic surgery
  2. Certified in an unrelated college
  3. Not a member of ASAPS and ASPS
  4. No hospital privileges
  5. If you are given false or misleading information- claims that are too good to be true.
  6. Unwilling to provide you answers to questions regarding credentials or curriculum vitae
  7. When the office staff are not courteous, knowledgeable or don’t spend enough time with you and don’t tell you what you need to know. Beware of staff who give you all fluff, but no substance and don’t offer to send you any information. Always insist that the price be broken down into the following categories: surgeon fees, anaesthetist fees, costs of implants, operating room fees, hospital stay fees, laboratory fees, mammogram or ultrasound fees, any other fees. Ask how long the prices on the quote last for. Remember, there is no such thing as bargain surgery. Have you ever seen top-quality surgery for bargain price? How is the bargain surgeon able to offer such a good price? When visiting the plastic surgeons rooms, look around and take notice of the little things. It should be a quiet, comfortable and modern, an atmosphere that reflects the good taste of the plastic surgeon. The organisation, function and flow of the plastic surgeon’s office is a reflection of the surgeon’s personality and habits. Think about it. If the office looks messy and unclean, doesn’t it reflect badly on the surgeon who accepts this scenario? Most of the time, you will recognise a good plastic surgeon without the surgeon having to tell you. If they have integrity, are caring and thorough, then this will definitely contribute to what you will get in the operating room and after.

Question: What factors do you consider important when choosing a plastic surgeon to perform a breast augmentation? You can leave a comment below.

Discover the Amazing Benefits of Breast Lift Surgery

We live in a world and age where more and more women want to feel appreciated, adored and loved. But unfortunately over time, their self-esteem and confidence can can be challenged when their breasts droop and lose their upper pole volume. A breast lift, also called mastopexy, can help, allowing women to regain the youthful aspect of their breasts.

 

An Annoying Process

Over time, the internal ligaments and the skin of your breasts lose its elasticity, making your breasts drop to a lower position. Aging, pregnancy, weight loss or weight gain are some of the causes that trigger this annoying and sometimes painful process. Instead of enjoying those perky and round breasts, you will have to be content with flat and broad breasts. The problem arises when you want to wear a bra. Instead of supporting your breasts, the bra will only accentuate the skin wrinkles. In the end, the only viable option you have to deal with this annoying problem is breast lift surgery.

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Benefits of Breast Lift Surgery

 

Your breasts have their own ‘personality’. In time, they lose their youthful aspect, becoming flat. This can lead to serious self-esteem problems and may affect your confidence and even relationships.

The first benefit of breast lift is that your breasts become firmer and uplifted. The position of the nipples and areolas is also enhanced. Even though the breasts are not symmetrical, they can be made more even in size and shape. Remember that your breasts are “sisters, not twins’ and there will always be a slight difference between the two sides. Although this procedure does not increase the size of your breasts, they will certainly appear perkier because they are firmer and lifted. If you combine breast lift with breast augmentation, your breasts can gain one or two cup sizes usually.

Another huge benefit of mastopexy is that it dramatically increases your self-esteem and self-confidence. Of course, this procedure won’t turn you into a celebrity, but will definitely improve your appearance, enabling you to live each day at its fullest and enjoy life again.

A breast lift procedure is relatively safe, especially when performed properly by a professional and experienced plastic surgeon and the side effects are quite uncommon. However, some women could experience scarring, infections, bleeding or loss of sensation in the nipples. Overall, more than 95% of patients who undergo a breast lift are extremely happy with the results.

 

Breast Lift Options

Because each of us is different and breast shapes vary greatly, you need an individualised plan in order to enjoy optimal breast lift results. Your plastic surgeon should be able to refine their technique and become well versed in breast lift with or without breast augmentation. They will help you choose the right surgical option for your needs. Generally speaking, you will have to decide between using an implant (augmentation mastopexy) vs no implant (breast lift only) and full incision (‘lollipop’ or ‘anchor’) vs short incision (within the breast fold).

 

Areola and Nipples

Breast lift is aimed to relocate your nipples to a higher position, restoring the original breast projection. The breast shape and contour are therefore enhanced. When evaluating your breast, your plastic surgeon will takes into account the position and size of the areola. The areola is usually altered in size in order to achieve optimal proportions with the new raised nipples and to maintain the youthful aspect of your breasts.

 

Short Recovery Period

Recovery is generally swift for a breast lift. Most women need less than a week to recover before returning to work and 2 weeks for the incision to heal. The scars fade away to a pencil thin, white line in about 12 to 18 months.

 

Get a Consultation

The best way to understand how a breast lift works and to grasp its benefits is to have a consultation with your plastic surgeon. They can explain the difference between various treatment options and can offer you precious insights on how to make sure you enjoy a short recovery period.

 Question: What is the most challenging aspect of having droop breasts? You can leave a comment below. 

Breast Reduction for Symptomatic Macromastia

Breast reduction surgery patients are among the happiest  because they both look and feel better following surgery. When women have large, burdensome breasts, they frequently suffer from a condition called symptomatic macromastia which may include the following symptoms:

  1. Pain in the neck, shoulders, breasts, and upper or lower back
  2. Bra strap indentations
  3. Rashes underneath the breasts (intertrigo)
  4. Little finger numbness
  5. Difficultly exercising, fitting into clothing or examining the breasts

Breast reduction surgery is designed to make the breasts smaller and lighter to alleviate the problems of symptomatic macromastia. However, the plastic surgeon performing the breast reduction is the most important determinant of the quality of the result. There are many different techniques for breast reduction, and each surgeon has their own preferences based on experience and patient needs. Often, breast reduction is combined with a breast lift on the other side.

Techniques

There are basically 2 types of techniques used commonly throughout the world:

  1. Wise Pattern (also known as the “Inverted T” or Anchor Scar) describe a technique with a scar around the areola with a vertical scar extending downwards to a horizontal scar in the breast fold.
  2. Vertical (also known as the Circumvertical or “Lollipop” Scar) describe a technique with a scar around the areola with a vertical scar extending downwards to meet the breast fold.

The choice depends on the extent of ptosis (sagging) and the surgeon’s experience. Liposuction is commonly used with the Vertical techniques and less frequently with the Wise pattern except to remove unwanted fatty tissue from the armpit regions.

Medicare & Health funds

Breast reduction surgery is considered to be medically necessary if a patient suffers from symptomatic macromastia. The typical criteria for Medicare Item no. coverage of a breast reduction include: bothersome symptoms detrimental to quality of life, failure of medical therapy prescribed by another doctor, physiotherapist or chiropractor, and removal of a minimum estimated weight of breast tissue.

Most health funds  will cover this procedure for patients with these symptoms if they have attempted conservative medical treatment without success. Most commonly, this conservative medical treatment is provided by a GP, physiotherapist or chiropractor. Typically, there is a minimum weight of breast tissue that must be removed from each breast to qualify as a medically necessary breast reduction for health fund coverage. The best way to determine if your procedure is medically indicated is in a consultation with me at the clinic.

Recovery

One of the best things about recovering from breast reduction surgery is how quickly patients experience relief from their symptoms. The morning after surgery many patients already feel symptomatic relief, even though their recovery has just begun. Many comment that they even breathe easier when they no longer have so much weight on their chests.

Recovery from a breast reduction tends to be quick because it does not involve the underlying muscles, bones or internal organs. Most women will need a few days to recover before returning to work, up to 2 weeks for the incisions to heal before resuming exercise and 12-18 months for the scars to fade to a subtle colour.

To learn more about your breast reduction options and whether or not you are a candidate, email us at info@drtim.com.au or call our clinic at 13000DRTIM .

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Breast reduction surgery patients are among the happiest of all plastic surgery patients because they both look better and feel better following surgery. When women have large, burdensome breasts, they frequently suffer from a condition called symptomatic macromastia. Symptomatic macromastia is considered to be a medical problem that may include the following symptoms:

  1. Pain in the neck, shoulders, breasts, and upper or lower back
  2. Bra strap indentations
  3. Rashes underneath the breasts
  4. Finger or hand numbness
  5. Difficultly exercising, fitting into clothing or examining the breasts

To learn more about breast reduction, request a consultation by contacting us at 13000DRTIM or emailing us at info@drtim.com.au 

Breast Augmentation Part 2 of 4: The Procedure

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The things you need to know to make better choices regarding breast augmentation are the following:

1) Match your desires with reality

The surgeon can only work with the tissues you bring him. If you want the best result, you have to balance what you want with what the tissues will allow you to have and what they can support over time. Also, no woman has two breasts that are the same, and no surgeon can create two breasts exactly the same. Cup size is extremely variable and inconsistent from one brand of bra to another and women buy a bra that they can fill (or to push breast tissue where they want it to go to create a specific appearance), not necessarily a bra that fits. Last of all, the bigger the breast you request (ie. the bigger the breast augmentation), the worse it will look over time and you can’t pick out a breast from a book or magazine and expect the same result unless the woman in the picture looked exactly like you before surgery.

2) Know about the implants

Breast implants are not perfect, don’t last forever, and require some maintenance. If you can’t accept these facts, don’t have a breast augmentation. If you do, then you need to think about:

  1. Implant pocket location. Implants can be placed in front of, or behind muscle. There is less capsular contracture rates when the implant is placed behind the muscle and you can obtain better or more accurate mammograms too. Also, in thin women, behind the muscle is preferable because adequate tissue coverage is most important. Think when you lie in bed, if you are covered by a bed sheet only, then one can see the contours of your body a lot beer, than if you were to be covered by a doona, they are less distinct. Having said that, an implant placed in front of the muscle will always more predictably control breast shape. How do you decide whether to go in front or behind the muscle? If you pinch the breast tissue in the upper pole and it’s < 2 cm, consider going beneath the muscle, otherwise, you run risks of seeing the edges of the implant. One aspect that often gets overlooked is the way the pocket is created. Blunt dissection techniques are fast and efficient but create more tissue trauma, tear tissues, create more bleeding, and result in longer recovery time. Electrocautery dissection techniques use an electric current to seal blood vessels and are thus, less traumatic and have shorter recovery times.
  2. Implant shape. Shapes of implants can either be round or tear drop (anatomical). There is a trend today of women wanting more upper pole fullness and therefore opting for round implants. Given that the breast is constantly evolving and that over time there is loss of upper pole fullness as the breast tissue ”melts away”, breast augmentation with round implants may be a good option for maintaining upper pole fullness in the long term. The other added advantage is that if it rotates, it doesn’t affect the shape of the breast. In contrast, a tear drop implant which is fuller at the bottom and tapers at the top, will give an odd shape to the breast if it does rotate. However, breast augmentation with tear drop implants may be better in women who have odd shaped chests (either long or wide for example) because you can tailor the dimensions of the implant more specifically to fit the breast ”foot print” on the chest. Tear drop implants may also be beneficial in women with mild sagging breasts who do not want scars on their breast from elevating the nipple. The tear drop implants have a ”bucket-handle” effect on the nipple, elevating them to a higher position on the breast.
  3. Implant surface (or shell)The surface of the implant is made of a silicone rubber and can be textured or smooth. Textured implants have a lower risk of capsular contracture than smooth implants.
  4. Implant ”stuffing”. The stuffing or filler of the implant can be silicone or saline. Saline is salt-water and is harmless if the implant ruptures. It’s biggest disadvantage is rippling and that it takes up the ambient temperature, so that if you went to the beach for a swim, when you get out, your implants will feel cold. Silicone gel filler on the other hand is more natural, more predictable and it is safe. There are grades of silicone gel that range from ”jelly” consistency to that of ”gummy bears”.
  5. Implant size. Remember, the larger the implant, the more tradeoffs and risks you’ll encounter, especially long term.
  6. Incision location. The scar can be placed in three areas. The breast fold incision offers the best degree of control for the wide range of breast types and is the the commonest type used by far. The periareolar incision (around the nipple-areola) usually heals well because it’s located in thinner skin but is limited and can’t be used if the areola is not large enough for access. The biggest problem is the increased exposure of the implant to bacteria if any of the breast ducts were to be cut. The armpit (axillary) incision places no scar on the breast but takes longer to perform and harder to control the position of the breast fold.

3) Get well acquainted with the tradeoffs, problems and risks

Tradeoffs always depend on the details of each specific case, the characteristics of your tissues , the experience of your surgeon with different options. Every breast augmentation operation carries inherent risks and medical complications are not totally preventable by you or your surgeon. Remember, don’t have a breast augmentation unless you thoroughly understand and accept the potential risks and trade-offs of the procedure.

4) Know about the recovery

The more tissue trauma caused by your surgery, the longer and more difficult your recovery. That is why it takes longer to recover from a pocket created behind the muscle. Excessively large implants can produce excessive stretch marks that cause more discomfort and temporary or permanent sensory loss. Most women return back to normal duties within four weeks and athletic activities by six weeks.

 

Question: Do you think that the benefits far outweigh the trade-offs for breast augmentation? You can leave a comment below.

 

Breast Augmentation Part 4 of 4: The Facility

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Your safety is of paramount importance when undergoing breast augmentation. Always have your surgery in an accredited hospital or day surgery facility. If you are young and healthy, then a day surgery facility is fine. If you are older and have health problems, then a hospital would be a beer place to have the procedure performed because of the availability and back-up of an intensive care and other highly specialised health staff.

Accredited means that the surgical facility has passed a set of rigorous examinations to assure that the equipment and procedures meet standards for optimal safety. The hospital or day surgery facility should be fully accredited by the Australian Council on Healthcare Standards (ACHS) or a set of ISO standards that provide the highest standards of service. Patient health, safety and comfort should be the surgical facilities main concerns and they should continually monitor and evaluate their performance to achieve this outcome. Another requirement of accreditation is to assure that personnel are trained, experienced and skilled health care professionals and procedures and equipment are in place to deal with any emergency from a power outage to cardiac arrest.

Sometimes it’s reassuring to visit the accredited facility yourself. If you’re not comfortable with a surgical facility, don’t have the breast augmentation surgery there. What you want to see is modern, comfortable surroundings and caring and warm personnel. The operating room should appear state-of-the-art, spotlessly clean and equipped with the most up-to-date equipment. The recovery area should be immediately adjacent to the operating rooms. Some surgical facilities provide overnight accommodations with one-on-one nursing care especially for patients who need overnight care for more extensive procedures.

The following checklist should help you “tie things up” when organising your breast augmentation:

  1. Check date of surgery and pay scheduling deposit if required
  2. Review surgeon’s financial policies and policies for refunds
  3. Sign informed consent and operative consent forms for breast augmentation
  4. Schedule laboratory tests and mammography/ultrasound if required
  5. Review medications to avoid and ones to take before surgery
  6. Review post-operative instructions the night before surgery
  7. On the day of surgery wear comfortable clothes, get someone to drive you home and be with you overnight, wear no make-up, and leave your jewellery and valuables at home

 

Question: What things do you consider important in the surgical facility when having a breast augmentation? You can leave a comment below.

The Benefits of Breast Asymmetry Correction

Almost every woman on the planet has one breast that is fairly different from the other. For some women though, the discrepancy can be extreme with noticeable differences in size and shape between the two breasts.

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Breast asymmetry will come in different shapes and sizes, but what remains constant is the problems they cause. Breast asymmetry will not only make finding bras that fit and clothes that hide the asymmetry a hassle, but will also impact negatively on a woman’s self-esteem and confidence.

Breast asymmetry correction is one the most recurring problems I face as a plastic surgeon specialising in breasts. During initial consultations, I often find that some patients are not even aware of their own breasts being asymmetrical. To facilitate proper planning so as to improve the outcome of surgery, these differences have to be identified early in the procedure.

Breast asymmetry types

1. Congenital Breast Asymmetry.

This means that the difference in the size of your breast is innate: it is as old as your breasts and has been becoming more conspicuous with their growth and development. There are several reasons why patients have these preexisting differences between their breasts. They include:
– Differences in breast volume
– Differences in areola size and/or position
– Rib cage (chest wall) asymmetries, as in pectus excavatum or scoliosis
– Differences in the positioning of the breast fold crease.

2. Post Surgical Breast Asymmetry

There are several conditions that would lead to development of breast asymmetry several years after a breast surgery procedure has been done on a patient; an example of such an operation is breast augmentation. This conditions include:
– Capsule contracture
– The breast tissue may be drooping
– Implant position movement
– Areolas getting stretched.

Breast asymmetry correction

There are several techniques that can be used to correct this problem and help you feel comfortable and more confident in how you look.  The first and most important step in breast asymmetry corrections is the determination of the ideal breast size for you. I work very closely with my patients to help them make this essential decision. Important questions asked at this stage are; whether smaller breasts need to be enlarged with implants, or whether larger breasts should be reduced in size for example.

In some cases, the best results can be achieved by doing the same thing to both breasts. For example; a patient with very large breasts can have both reduced with one breast being reduced more than the other to make up the difference. Where the patient has small breasts, augmentation can be done on both with one being augmented more than the other. The important thing here is to make sure that the final breasts have roughly the same amount of implant volume or breast tissue after the procedure. It’s only then that you will be able to enjoy relatively same sized breasts.

Customised treatment plan

Unlike other breast cosmetic surgeries, breast asymmetry is a more difficult procedure to perform. It thus requires careful planning, thought and consideration well in advance before the procedure. This is where the surgeons experience is crucial as they will help the patient make the smallest of decisions that will together determine the overall success of the procedure. As they say: ‘the devil is in the detail.’

Since patients have several options to choose from, I take the time to go through each option with my patients. I will help the patient make the best decision by outlining the best available options for their particular condition so as to achieve the best results. Being a trusted adviser, it’s my goal to make sure that all my patients fully understand the implications their decisions will have on their well-being and to help them choose wisely.

Implant options

If we do decide that the implant method is the best solution for your problem, you will be able to get access to a wide range of implants that are guaranteed to suit your needs. We have access to the newest generation of implants available in different styles and sizes at my patients’ disposal.

Breast asymmetry surgery is one of the most challenging breast procedures. Diligence, communication and surgeon experience are all crucial ingredients for the best results.

 

Question: What do you find are the most difficult challenges with breast asymmetry? You can leave a comment below.

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One of the amazing things about recovering from breast reduction surgery is how quickly patients experience relief from their symptoms. The morning after surgery many patients already feel symptomatic relief, even though their recovery has just begun. Many comment that they even breathe easier when they no longer have so much weight on their chests.

Recovery from a breast reduction tends to be quick because it does not involve the underlying muscles, bones or internal organs. Most women will need:

  1. A few days to recover before returning to work
  2. A month for the incisions to heal before resuming exercise
  3. A year to 18 months for the scars to fade to a subtle colour

To learn more about breast reduction, request a consultation by contacting us at 13000DRTIM or emailing us at info@drtim.com.au 

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Breast reduction surgery is designed to make the breasts smaller and lighter to alleviate the problems of symptomatic macromastia. However, the surgeon performing the breast reduction is the most important determinant of the quality of the result. There are many different techniques for breast reduction, and each surgeon has his or her own preferences based on experience and patient needs. Often, breast reduction is combined with a breast lift.

To learn more about breast reduction, request a consultation by contacting us at 13000DRTIM or emailing us at info@drtim.com.au