Breast reduction and the nipple areola complex

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The position and size of the areola are important considerations when evaluating a patient for a breast reduction. Typically it’s necessary to raise the nipple to a more youthful position. Often the areola is made smaller to achieve optimal proportions with the newly tight and perky breast.

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

Breast reduction: Are there different techniques and can it be combined with breast lift?

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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 

Breast reduction: Does your health fund cover it?

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Breast reduction surgery is considered to be medically necessary if a patient suffers from symptomatic macromastia. The typical criteria for health fund coverage of a breast reduction include: bothersome symptoms detrimental to quality of life, failure of medical therapy prescribed by another doctor, 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. The best way to determine if your procedure is medically indicated is in a consultation with me at the clinic.

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

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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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 

What Is a Mummy Makeover?

Many of today’s mums don’t feel they should sacrifice the way they look just because they’ve had children. After multiple pregnancies and breastfeeding, many women find it impossible for diet and exercise alone to restore their figures. These women usually want their tummies and breasts back the way they looked before pregnancy.

These so-called “Mummy Makeovers” are usually performed on women in their 30s or early 40s. There are multiple variations of the Mummy Makeover, of course, and I individualise the plan for each patient depending on their needs. Many women will not need or desire all of these procedures. Each patient determines what her personal Mummy Makeover will involve after we discuss her concerns and options in a thorough consultation.

A Mummy Makeover may be performed in one or more stages. Age, health, needs, and desires are all considered carefully when I formulate a plan for each patient. The majority of my patients choose to do more than one procedure at a time. I’ve had a great deal of experience performing these combined surgeries over the past decade. We take many steps to assure both minimal pain and maximum safety during our procedures:

  1. TUMMY TUCK: The tummy tends to experience the greatest change following pregnancy with stretch marks, loose skin and lower tummy fat being the most common complaints. The tummy muscles may also be stretched to the point that they remain separated in the midline, accentuating the patient’s lower tummy bulge. To treat these problems, I perform a tummy tuck where I remove the excess skin and fat from the tummy and tighten the muscles. Whenever we do a tummy tuck as part of the Mummy Makeover, we perform liposuction and pay special on to the belly button to help create a nice looking midriff.
  2. LIPOSUCTION: After having children, fat tends to redistribute to new areas on the body where it may be unwanted. This is frequently true even if women are successful at losing their baby weight. Most often, bulges of fat accumulated around the waist and on the thighs. On these areas, I frequently perform liposuction as part of a Mummy Makeover.
  3. BREAST SURGERY: The breasts go through dramatic changes with pregnancy and breastfeeding. Patient concerns about their breasts vary greatly, but the most common breast procedures I perform as part of a Mummy Makeover include:

Many of our patients for the Mummy Makeover travel from places outside of Sydney. Our staff can help with the planning of these sorts of trips through our CosmeticCulture Makeover Vacation Program, which makes travel for cosmetic surgery quite easy. More information is available on our website www.cosmeticculture.com.au, including descriptions of tummy tuck and breast augmentation or breast lifts as well as liposuction. You can also email us for more information at info@drtim.com.au or call us at 13000DRTIM.

Question:  Which parts of your post-childbirth body would you like to change with a Mummy Makeover? You can leave a comment below.

Breast Augmentation Part 2 of 4: The Procedure

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 issues you bring him. If you want the best result, you have to balance what you want with what your breast tissue will allow you to have and what it 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. Women tend to buy a bra that they can fill (or that pushes their 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 (i.e. the bigger the breast augmentation), the worse it will look over time. 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:

a) Implant pocket location

Implants can be placed in front of, or behind the muscle. There are 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, one can see the contours of your body a lot better than if you were to be covered by a doona cover, where 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, your best option would be to go 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 times. Electrocautery dissection techniques use an electric current to seal blood vessels and are thus, less traumatic and have shorter recovery times.

b) Implant Shape

Shapes of implants can either be round or teardrop (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 a 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 teardrop 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 teardrop implants may be better in women who have oddly 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. Tear drop implants have a “bucket-handle” effect on the nipple, elevating them to a higher position on the breast.

c) 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.

d) 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. Its biggest disadvantage is rippling and that it takes up the ambient temperature, meaning if you went to the beach for a swim, when you got out, your implants would 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”.

e) Implant size

Remember, the larger the implant, the more tradeoffs and risks you’ll encounter, especially long term.

f) 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 commonest type used by far. The periareolar incision (around the nipple-areola) usually heals well because it’s located in the 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, and 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 tradeoffs 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 in six weeks.

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

Teenage Cosmetic Surgery: Why So Much Pressure?

 

There has been a storm brewing for some me now regarding teenage cosmetic surgery.  A concoction made up of quick fixes,  a society obsessed with beauty, and the commercialisation and overexposure of cosmetic surgery. This has all lent themselves to the growth of cosmetic surgery for  Generation  X and younger.  This has been further compounded by the increasing number of medical specialists entering the cosmetic arena.

My worry is that this Generation X and their successors wanting teenage cosmetic surgery may become an abused marketplace.  It would appear that they have it a little easier, in the sense that, they have parents or relatives who have had cosmetic surgery and are approving of it, in an economy that has been both buoyant and robust for some time now.  This takes away from the fact, that teenage cosmetic surgery needs much more scrutiny because it can play on people’s insecurities and promises of an instantly better life.

Most plastic surgeons I believe are responsible individuals with a conscience who try and counsel teenagers, usually in front of their parents, of the risks, benefits, and outcomes of procedures, as well as whether they are appropriate or not. They try very hard to show that TV programs like Extreme Makeover,  Dr.  90210  and  The Swan trivialise and glamourise cosmetic surgery and that glossy magazines like Teen Vogue or Teen Cosmo display airbrushed photos of models and celebrities that are in reality unachievable.

Now teenagers who want to have cosmetic surgery usually have different motivations and goals than adults.  They too have cosmetic surgery to improve physical characteristics they feel are awkward or flawed,  that if left uncorrected, may affect them well into adulthood.  Teens tend to have cosmetic surgery to fit in with peers, to look similar.  Adults tend to have cosmetic surgery to stand out from others.  Teenagers frequently gain self-esteem and confidence when their physical problems are corrected.  In fact, successful teenage cosmetic surgery may reverse the social withdrawal that generally accompanies teenagers who feel different.  Not every teenager seeking cosmetic surgery is well suited for an operation.  Teenagers must demonstrate emotional maturity and an understanding of the limitations of cosmetic surgery.

I would caution teenagers and parents to keep in mind that cosmetic surgery is real surgery, with great benefits, but also carries some risks. Teenagers should have realistic expectations about cosmetic surgery and what it can do for them. In addition, certain milestones in growth and physical maturity must be achieved before undergoing cosmetic surgery. The most rewarding outcomes are expected when the following exist:

  1. The teenager initiates the request.
    The young person must appreciate both the benefits and limitations of cosmetic surgery, avoiding unrealistic expectations about life changes that will occur as a result of the procedure.
  2. The teenager has realistic goals.
    While parental support isn’t lessened at all, the teenager’s own desire for cosmetic surgery must be clearly expressed and repeated over a period of time.
  3.  The teenager has sufficient maturity.
    Teenagers must be able to tolerate the discomfort and temporary disfigurement of a surgical procedure.  Cosmetic surgery is not recommended for teens who are prone to mood swings or erratic behavior, who are abusing drugs and/ or alcohol, or who are being treated for clinical depression or other mental illness.

Some of the commonest teenage cosmetic surgery procedures include:

  1. Rhinoplasty (nose reshaping)

Cosmetic surgery may be performed on the nose to straighten the bridge, remove an unsightly hump, reshape the point or open breathing passages. Ordinarily, this is not performed until the nose reaches its adult size –  about age 15 or 16 in girls and a year later in boys. The procedure accounted for nearly 50 percent of all cosmetic surgical procedures performed on this age group.

2.Otoplasty (ear surgery)

Surgical correction of protruding ears, in which the ears are pinned back, may be performed any time after the age of five. Otoplasty made up 11 percent of all cosmetic surgical procedures performed on this age group.

3. Correction of Breast Asymmetry

When one breast grows to a much larger size than the other, an operation may correct the difference by reducing the larger breast, augmenting the smaller, or both. Many teenagers who want breast augmentation tend to have one breast that is larger than the other – sometimes a full cup size or more in difference. This condition is called breast asymmetry. Using a breast implant in the smaller breast allows the patient to have breasts of the same size. Although waiting may prolong the physical awkwardness, it is advisable to delay surgery until breast growth ceases in order to achieve the best result.

4. Breast Augmentation

Breast implants can be used for breast augmentation in women 18-years or older and for breast reconstruction.

Many teenagers who want breast augmentation to have one breast that is larger than the other -sometimes a full cup size or more in difference. This condition is called breast asymmetry. Using a breast implant in the smaller breast allows the patient to have breasts of the same size. Although waiting may prolong the physical awkwardness, it is advisable to delay surgery until breast growth ceases in order to achieve the best result.

5. Breast Reduction

Surgical reduction of very large breasts can overcome both physical and psychological burdens for a teenage girl.

In fact, many teenagers suffer ongoing back pain due to overly large breasts. Although waiting may prolong the psychological awkwardness, it is advisable to delay surgery until breast growth ceases in order to achieve the best result.

6. Acne and Acne Scar Treatment

Acne eruptions may be controlled by the proper use of modern prescription drugs. In addition to supervising the use of these medications, plastic surgeons may improve acne scars by smoothing or “refinishing” the skin with a laser or with a fine sanding technique called microdermabrasion. Other treatments for acne related skin problems include laser skin resurfacing, dermabrasion, and chemical peels.

7. Male Breast Reduction (Gynaecomastia)

Teenage boys with large breasts, known as gynecomastia, are often eager to undergo plastic surgery. Surgical correction can be accomplished in a variety of ways including liposuction and/or surgical excision of the breast tissue.

As a plastic surgeon, I am an advocate for the right teenage cosmetic surgery, at the right time, and for the right reason. Things like correction of prominent ears, breast reduction in adolescent boys or breast reconstruction in young girls with an underdeveloped breast can truly advance the person’s quality of life. It is our responsibility as plastic surgeons to guide teenagers (and their parents) in the right direction and to educate them that cosmetic surgery is not a panacea for the everyday pressures that teenagers’ face. Cosmetic surgery can make you more attractive but not necessarily happier!

Question: What do you think is the commonest reason teenagers want cosmetic surgery? You can leave a comment below.

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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 Lift and Augmentation: The facts you need to know!

The goals of breast lift with or without breast augmentation are to restore shape, volume, and nipple-areola position. However, simultaneous breast lift and augmentation present multiple problems, specifically because it becomes harder to control all of the variables affecting the outcome when combining the two procedures. No single method is best to treat all types of sagging (ptosis), and maintaining a good blood supply to the nipple-areola complex is of paramount importance, so a staged procedure may be necessary at times.

Why is combining a breast lift and breast augmentation the most difficult of all cosmetic breast surgery procedures? The surgery involves manoeuvres that can be counterproductive to each other since the skin is being removed and when closed back up again, pushes the breast in and upwards, whilst an implant stretches the skin in an out and in a downwards direction. These conflicting tensions can adversely affect the blood supply to the breast and skin which may affect wound healing, scar quality etc. Positioning of both the nipple and breast fold also becomes more challenging during simultaneous lift and augmentation. Secondly, no two breasts are the same, and each patient is seeking a different endpoint, sometimes with unrealistic expectations.

The first thing that I do when evaluating a patient for a breast lift is to ask them if they are happy with their present breast volume. You can simply do this by pinching the skin below the breast and pushing it up where it belongs. Most women are amazed at how little of breast volume they actually have. If that is the case, then volume enhancement, usually with an implant, is necessary along with a lift. If the volume is satisfactory, then a breast lift will suffice.

The second thing to do is grade the amount of breast sagging. This is done by using Regnault’s classification which looks at the position of the nipple as follows:

1)  Grade 1 (minor): nipple at breast fold
2)  Grade 2 (moderate): nipple is below the fold but above the lower breast contour
3)  Grade 3 (major): nipple is below the fold and below breast contour
4)  Pseudoptosis (“false sagging”): nipple lies above the fold, there is little breast volume, some of which lies below the fold

Other characteristics that one looks out for are:

1) Skin: elasticity and excess;
2)  Breast tissue:  firm and fibrous or soft and fatty; and
3)  Skin-breast tissue relationship: firm and adherent or loosely adherent and is the breast full or empty. Skin quality and the skin-breast tissue relationship are the key factors in determining the breast lift procedure and the quality and longevity of the final result.

As a general rule, if the skin elasticity is normal, the breast envelope is full, and the skin is adherent to the underlying breast tissue, then the scars would be limited, and vice versa. In other words, one progresses from limited scars such as periareolar scars (scars around the nipple-areola complex) to periareolar-vertical scars (scars that run down the front of the breast below the nipple-areola complex) to more extensive, full-length inverted-T or anchor scars.

For the patient with “pseudoptosis,” inserting a breast implant alone, usually tear-dropped shaped, is typically all that is needed. For Grade I sagging, an implant alone or a lift plus an implant may be required.

Depending on a number of factors, the lift may be performed via a crescent, periareolar, or vertical approach. A vertical approach is preferred if there is significant looseness below the nipple. However, the periareolar incision is generally used in just a few specific situations. Since this skin-only incision is unable to lift much weight, it is an option in women with small breasts who need only a small amount of nipple repositioning, usually < 2 cm.

In addition, it is considered advantageous in women with pointed, conical or tubular breasts, because it causes areolar flattening and eliminates the tubular nature. The main issue I have with performing a periareolar breast lift is its tendency to cause areolar flattening and leave the areola more prone to stretching.

In Grade 2 sagging, especially where the breasts are large and heavy, a vertical breast lift is often required because it will effectively lift the breast tissue to achieve increased projection. However, a periareolar incision may still be considered for women with light breasts. When performing a vertical breast lift, the procedure may be converted into a short inverted-T lift if a difficulty is encountered controlling the nipple-to-breast fold distance.

With Grade 3 sagging, the lift technique depends on the nipple-to-breast fold distance. If it is > 10 cm, most surgeons perform an inverted-T breast lift. Otherwise, vertical breast lift remains an option that will enable control of the nipple-to-breast fold distance, as the vertical scar tends to shorten in the post-operative period with scar contraction.

Thanks for reading!

Dr. Tim – Sydney Cosmetic Plastic Surgeon

www.cosmeticculture.com.au
www.drtim.com.au