Breast Augmentation: What’s Recovery Like?

BAM Gallery2.002

During each breast augmentation operation, a long-acting local anaesthetic is placed around the implant so that patients will feel only minimal discomfort following surgery. Most of my breast augmentation patients take only a few days off from work to recover whilst others take up to a week. Patients may ease back into their normal exercise routine beginning several weeks after surgery.

 

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

Breast reduction: What are the symptoms?

Untitled 3.002

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 Implants & Anaplastic Large Cell Lymphoma (ALCL)- No Cause For Alarm

Breast Implant & ALCL

Only recently described, breast implant–associated anaplastic large cell lymphoma (ALCL) usually presents as an effusion-associated fibrous capsule surrounding the implant and less frequently as a mass. Little is known about the natural history and long-term outcomes of such disease. It is estimated that between 5 and 10 million women have breast implants. Due to the rarity of a diagnosis of ALCL (3 in 100 million per year in the USA diagnosed with ALCL in the breast) a worldwide collaboration is required to provide robust data to investigate this possible link.

ALCL is a lymphoma and not cancer of the breast tissue. When breast implants are placed in the body, they are inserted behind the breast tissue or under the chest muscle. Over time, a fibrous scar called a capsule develops around the implant, separating it from the rest of the breast. In women with breast implants, the ALCL was generally found adjacent to the implant itself and contained within the fibrous capsule. ALCL is a lymphoma which is a type of cancer involving cells of the immune system. It is not cancer of the breast tissue.

The most recent clinical studies state that it is not possible to confirm with any certainty whether breast implants have any relation to an increased likelihood of developing ALCL, and particularly whether any one type of implant can create a higher or lower risk than another of developing the disease. It should be noted that ALCL is extremely rare and treatable. This is evidenced in particular by three recent papers:

  1. A Danish nationwide study – ‘Breast implants and anaplastic large-cell lymphoma: a Danish population-based cohort study’– concluded that in a nationwide cohort of 19,885 women who underwent breast implant surgery between 1973 and 2010, no cases of ALCL were identified
  2. A review of cases within another recent comprehensive article, ‘Breast implant-associated anaplastic large-cell lymphoma: long-term follow-up of 60 patients’ concluded that: “most patients with breast implant-associated ALCL who had disease confined within the fibrous capsule achieved complete remission. Proper management for these patients may be limited to capsulectomy and implant removal. Patients who present with a mass have a more aggressive clinical course that may be fatal, justifying cytotoxic chemotherapy in addition to removal of implants.”
  3. In a study reported in the Journal of Clinical Oncology, Roberto N. Miranda, MD, Associate Professor in the Department of Hematopathology at The University of Texas MD Anderson Cancer Center, and colleagues assessed disease characteristics, treatment, and outcomes in 60 cases. They found that outcomes are better in women with effusion confined by the fibrous capsule, whereas disease presenting as a mass has a more aggressive clinical course.Patients should be advised that ALCL is a very rare condition and until any further evidence is presented there is no need to remove breast implants as a matter of course.

 

These data suggest that there are two patient subsets. Most patients who present with an effusion around the implant, without a tumour mass, achieve complete remission and excellent disease-free survival. A smaller subset of patients presents with a tumour mass associated with the fibrous capsule and are more likely to have clinically aggressive disease. We suggest that patients without a mass may benefit from a conservative therapeutic approach, perhaps removal of the implant with capsulectomy alone, whereas patients with a tumour mass may need removal of the implants and systemic therapy that still needs to be defined.

 

We continue to advise that any women with breast implants who experience any sudden unexplained changes, lumps or swelling should speak to their GP or their surgeon.

Untitled 3.005

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 

The Facts on Male Breast Reduction

Enlarged male breasts (also called gynaecomastia) are the butt of many jokes, which explains why people suffering from this condition often feel embarrassed, humiliated, and insecure about their bodies. Understandably, many men suffering from this condition often have a lower self-esteem and some will not be caught dead without their shirts on. Male breast reduction surgery will help you get a flatter chest that most men can only dream of having.

Male Breast Reduction.jpg.002

What Causes Enlarged Male Breasts?

Gynaecomastia is usually the result of excessive fat tissue in the chest area, which results in the appearance of a man having breasts. Loose skin can also result in this condition. Consequently, surgery is performed depending on whether excess fat tissue is the problem or the loose skin is the cause breast-like appearances. Fat tissue in the chest area can be due to excess body fat, hormonal imbalances, diet problems, or the use of certain kinds of drugs (marijuana and steroids being the most common). When the enlarged breasts are the result of loose hanging skin, it is usually because the individual has lost a considerable amounts of weight.

 

What Techniques are used for Male Breast Reduction?

The good thing about male breast reduction surgery is that it is a minimally invasive form of surgery. Below are a couple of surgical techniques used to ensure that you get a flatter chest:

  1. Liposuction: This is an effective technique for men who have relatively good skin elasticity. In this case, a small incision is made and the excess fat is removed using a cannula (a small hollow surgical tube). After this procedure, the chest assumes a normal masculine appearance without the need for further surgical intervention.
  2. Breast Tissue Removal: This procedure may be necessary in more severe cases of gynaecoamastia. Breast tissue removal can also be used in addition to liposuction, when removal of excess fat using a cannula does not suffice. However, this technique may also be used on its own.
  3. Skin Removal: Skin removal may be necessary in cases where there has been a massive weight loss prior to surgery. Skin removal can also be accompanied by breast tissue removal or liposuction.

 

Who Can Undergo Breast Reduction Surgery?

Generally, if you are a healthy man of any age, you can benefit from a male breast reduction surgery if you suffer from enlarged male breasts. Ideal candidates are those with elastic skin that will naturally reshape itself after the excessive fat or breast tissue is removed.

 

How Long Does Recovery Take?

Recovery from male breast reduction surgery takes about a week, although you will be discharged from the hospital on the day of surgery. The surgery is performed under general anaesthesia. Slight discomfort and pain is normal after the surgery. However, this can be managed using some pain medications. A chest garment is usually worn afterwards for up to six weeks to aid in reducing swelling and developing a collection (seroma or haematoma).

 

What are the Possible Risks of Male Breast Reduction Surgery?

Most risks associated with this surgery are usually very rare. Nevertheless, they are easily manageable and include bleeding, seroma, haematoma and infection. Proper post-operative care can effectively handle these problems if they do occur.

 

There is no reason to go through life suffering the embarrassment of enlarged male breasts. A simple male breast reduction surgery can help you achieve a flatter but muscular look that makes you look forward to removing your shirt the next time you are on the beach having some fun. This procedure poses few risks and you are usually back to your normal routine in just a couple of days.

 

Question: What is the most difficult thing you experience with having enlarged male breasts? You can leave a comment below.

Untitled 3.004

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 

Breast Augmentation Part 3 of 4: The Plastic Surgeon

BAM.003

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.

Breast Implants: Things to Know Before Getting Them

Untitled.003

There are two main reasons why women get breast implants. The first one is for reconstructive purposes. This is to bring the breast back to its original form after it has been damaged by an injury or by a disease such as cancer.

The second reason has to do with cosmetic or aesthetic reasons. They may want to have fuller breast or breasts that are more symmetrical with one another. It is also a way to boost confidence in their bodies.

The cost of doing such a procedure will vary. Depending on the location, the doctor who will be doing the operation and the type of implant used the cost can run to a couple of thousand dollars.

BAM Gallery2.003

Most plastic surgeons favour the infra-mammary incision location for most breast implants. The peri-areolar incision is made as a semicircle at the lower border of the pigmented areola. It does heal beautifully in most cases and uses the interface of the darker and lighter pigmented skin to camouflage the incision. For patients with small areolae, it may be preferable to use the infra-mammary incision, located underneath the breast. This incision also heals very well, and is especially useful for women with well defined creases under their breasts.

The axillary incision (in the armpit) is another option, but it’s better suited for saline implants than silicone gel. Because this access incision is a greater distance from the implant pocket, it’s less precise than the peri-areolar and infra-mammary approaches. Studies have confirmed that there is a higher implant revision rate using the axillary approach. Usually the axillary scars heal well, but they may still be visible when the patient wears sleeveless outfits. There is also a higher rate of breast implant infections with the peri-areolar and axillary approaches.

Patients frequently ask what effect the incision location has on maintaining nipple sensation after surgery. The answer is that the access incision usually has little effect on nipple sensation. Rather, it’s the size of the implant pocket that has the largest impact on nipple sensation. Large implants may require a pocket that stretches the nerves to the point that they do not function well, increasing the odds of impaired nipple sensation. Even so, the vast majority of my patients maintain normal nipple sensation.

Breast implants may be placed over or under the pectoralis major muscle. In the early days of breast augmentation, all implants were placed on top of the muscle. However, in recent decades, it has become more common to place implants underneath the pectoralis major muscle. The muscle covers the top half of the implant, providing additional thickness of coverage over the implant in the critical cleavage area. This makes it less likely that the implant edges or ripples will be visible when wearing a bra or swimsuit. Studies have also shown that the rate of capsular contracture is lower when the implants are placed under the muscle. Breast imaging to screen for breast cancer is more accurate when the implants are placed behind the muscle. For these reasons, I prefer to place implants underneath the muscle for most of my breast implant patients.

 

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 1 of 4: The Patient

BAM.001

There are generally three groups of women who frequently consider breast augmentation:

1) Nature ”missed a beat” during breast development

This usually occurs during puberty where the breasts may not develop at all or slightly, resulting in a ”bowling pin” type of a look. Apart from making one feel inadequate because their is a disconnect between the narrower chest to the wider hips, it also makes it difficult buying clothes that fit. Some people revert to using fillers and enhancers but they can never seem to compensate, are temporary measures, and they never feel a natural part of you like breast augmentation. Breasts can also develop unevenly during puberty, causing both difficulty in buying and wearing clothes, as well as, making one feel abnormal or a ”freak”.

2) Nature ”took a toll” during pregnancy and breast feeding

During these times, the breast enlarges and deflates repeatedly. This cycle stretches the breast skin especially in the lower pole, resulting in stretch marks. After breast feeding, the breast tissue itself may ”melt away” (especially in the upper pole), sometimes to a size less than before pregnancy. However, the skin never shrinks back to its original size, therefore, the breasts will appear saggy (think of the skin like an overstretched elastic band which frays at the edges). This is where a breast augmentation and/or a breast lift (mastopexy) can be of great benefit to restore the shape, size and contour of the breasts to the pre-pregnancy state.

3) Nature ”didn’t match desires” of women who want to enhance the shape and appearance of their breasts

Some women want to be the best they can be. Others have developed unattractive breasts or have uneven breasts that makes buying clothes difficult. Still others want to ”marry” or improve the balance between their chest with their hips. Breast augmentation to enhance the chest further or balance the hips can make an enormous difference to ones’ body shape and self-esteem.

Women who fall into any one of the above groups have every right to want to optimise any aspect of their breast appearance. If this involves breast augmentation, then she needs to also think about:

  1. The Procedure
  2. The Surgeon
  3. The Facility

These factors will be individually discussed in subsequent blog posts. Remember that no choice(s) is perfect and that every choice has trade-offs (you need to know them) as well as benefits. Therefore, choose carefully.

Question: What are your reasons for wanting to have breast augmentation? You can leave a comment below.