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.

Tummy Tuck: 3 essential things you must know!

  1. Before a tummy tuck

When you continually gain and lose weight, the excess tissue composed of skin and fat in the lower part of the tummy becomes a real problem for some people. This excess tissue along with the underlying lax muscles can be dealt with by a surgical procedure known as a tummy tuck, otherwise known as an abdominoplasty. Removing the “muffin top” (the tissues between the belly button and pubis), then re-draping the skin from above the belly button to meet the skin on the pubis and repositioning the belly button, are the basis of all tummy tucks.

One of the keys to a tummy tuck is finding out how much excess skin and fat, as well as, muscle laxity you have in your tummy, is to bend over at the waist and “let it all hang out.” The next step is to pinch these tissues and tighten the tummy muscles, which will give you an idea of how much of the tissues need to be removed.x

Also, you will notice that most of the tissue bulk is in the midline and fades out at the sides. If you imagine this excess tissue as an ellipse on the lower tummy, it will give you an indication of how long the scar will be from one side of the hip to the other. I tell all my patients that the resulting scar can be concealed, that it will generally fade with time, but will always be there.

 

  1. Tummy tuck operation

Just prior to beginning the tummy tuck, I mark the tummy while the patient is standing up. I mark the midline from the xiphoid (“breast bone”) to the pubis. This enables me to realign the midline after removing the excess tissues and to place the belly button in the midline. A second line indicates the position of the lower-tummy incision. This usually lies quite low in the tummy since the most common garment worn by women today is jeans. Finally, areas for liposuction are marked in the upper tummy, the hips and lower flanks (liposuction thins the tissues and allows them to re-drape better).

Our anaesthetists use a laryngeal-mask airway (a breathing tube that sits at the back of the throat) and do not paralyse the patient, allowing them to breathe independently during the entire operation. I begin the tummy tuck operation with liposuction to the tummy, hips and lower flanks.  Then, I incise the skin around the belly button which is still attached to the underlying muscle wall. After making the lower tummy incision, I widely undermine the tissue up to the level of the belly button. I continue the dissection above the belly button to the level of the xiphoid process (lower part of the sternum), making a central tunnel (about the size of a hands width). I then “lace-up” the separated muscles of the midline from above and below the belly button.

Next, the patient is bent at the waist to 45 degrees, and the excess tissues removed so that the two skin edges may be closed without tension. Two drains are brought out below the pubic hairline to capture any excess fluid that may build-up in the tissues. These usually are taken out between day 3 to 5 when the drainage is less than 30 ml’s or so. Lastly, I bring out the belly button at the midline, usually 12 to 15 cm above the lower tummy incision and place a tummy binder on the patient at this time and adjust it to allow for moderate compression.

The patient is kept in a bent position at the waist and knees as they are transferred to the recovery bed.

 

  1. After tummy tuck surgery

After a tummy tuck, the patient will continue to wear TED (compression) stockings and automated calf compressors for 24-48 hours and be commenced on blood thinning agents the following day to lessen the chance of deep vein thrombosis (clots in the legs) or pulmonary embolism (when these clots break away from the legs and migrate through the venous system to the lungs causing a “lung attack”).

The patient is instructed to sleep with several pillows behind her back and a pillow beneath their knees.

They are encouraged to walk to the bathroom the following day, have showers and to undergo regular chest physiotherapy. Patients are advised to wear the tummy binder continuously for the first 4 weeks after surgery, except when they wash themselves or the binder. After this period, I allow them to wear it only at night if they wish, but many choose to wear it longer. I also advise patients that it takes 4 weeks to get back to normal activities of daily living and 6 weeks to resume aerobics exercises.

 

Question: What questions do you have about tummy tuck surgery? You can leave a comment below.

Can Breast Implants Raise a Low Nipple Areola Complex?

A youthful, cosmetically ideal breast has a nipple areola complex diameter of about 38-42mm.  Some breasts have large areolas from the time that they develop during puberty, and some enlarge later in life with pregnancy and breastfeeding. A large areola tends to make a breast look ’matronly’ even if it is not sagging. Nipple-areola complex diameter can definitely be reduced or enlarged, and this can be performed as a stand-alone procedure or as part of any breast enhancement procedure such as a lift, augmentation or reduction.

An attractive, well-positioned, and proportionate nipple areola complex is an important goal for many women looking to achieve a beautiful breast appearance. This small area of a woman’s anatomy can have a big impact on her satisfaction with her breasts. Women who are unhappy with the appearance of their nipple areola complexes, can have them corrected either alone or in combination with any breast enhancement procedure.

Breast augmentation with breast implants will not necessarily raise the nipple areola complex position in sagging breasts and in fact in some cases may make the areola larger. There are techniques to allow the implant to fall into the lower pole of the breast to create the illusion of lifting with more of the breast volume sitting lower on the chest. This is where using a tear drop (anatomical) breast implant can help as it creates a” bucket-handle” effect on the nipple areola complex.

The submuscular (below the muscle) breast implants are” innocent bystanders” to whatever happens to the breasts, as they are really chest wall implants that simply push the breasts forward. The submuscular breast implants are supported by the overlying pectoralis major muscles. In contrast, subglandular (above the muscle) breast implants are more likely to fall with pregnancy or weight loss, as they are supported only by the overlying breast tissues.

A periareolar (around the areola) or circumvertical (lollipop type) breast lifts are reasonable choices to reduce the nipple areola complex size and raise its position on the breast. These techniques reliably elevate the breast while keeping scars to a minimum. These breast lifts are desirable because of the nipple position (usually at or below the breast fold) and because of breast sagging. Neither nipple areola complex position nor breast sagging would be corrected with breast implants alone. “Blowing up the balloon” with larger breast implants will only create excessively large, still very saggy breasts. Reshaping the breast and elevating the nipple areola complex and breast back up onto the chest will play an important role in helping one achieve a cosmetically pleasing result.

Most plastic surgeons have a clear policy defining the financial responsibility of the surgeon and the patient in case of complications involving breast lifts, both short and long term. The policy should be made clear to each patient before surgery. It may differ from surgeon to surgeon with the majority of surgeons not charging their fee for reoperating on the patient but the patient having to pay the facility and anaesthesia costs.

Many women feel uncomfortable with their breasts their whole life because they had ’droopy’ or enlarged nipples or areolas that looked abnormal. A small surgical procedure to enhance the nipple areola complex can be extremely important for a woman’s self-esteem and self-image.

Question: Does it matter to you whether the nipple areola complex is proportionate to the remaining breast? You can leave a comment below.

Breast Augmentation with VECTRA 3D Imaging: ”try before you buy”

For every woman who has breast augmentation, there are just over 100 women who wished they had larger breasts but were hesitant to proceed with surgery. Whilst there are many factors contributing to the decision-making process, one of the biggest causes of patients’ hesitation is the inability to visualise the end result of their implant choices. So, if you find it hard to imagine how you will look after your breast augmentation procedure you are not alone.

At CosmeticCulture we spend a great deal of time going over appropriate implant size choices with patients and allow them to visualise their new look with implant sizers in front of a mirror using tight T-shirts (black which makes you look slimmer and white which makes you look bigger). Despite all of this effort, there still seems to be size choice issues in which the patients agonise over. The good news is that you can now “try before you buy”. There is a tool we use to assist our patients in visualising their result, and it is called VECTRA 3D imaging.

This technology has been around for quite some time, and it finally evolved into a user-friendly system that can be used in a time efficient manner in a busy clinical practice. Capturing the photo only takes about a second and the data is then processed by a computer, and in no time, the images are ready to simulate and can be reviewed with the patient. The real benefit of this system is that it has all of the commercially available breast implant sizes loaded in so that with the click of a button, a patient can see not only how she looks currently, but how she will appear after her augmentation. Furthermore, VECTRA 3D imaging system is designed to show patients all possible outcomes of their breast augmentation surgeries.  After the 3D image is created, women are able to choose different cup sizes to view how each will look on their bodies and ultimately decide which one is best for them. The VECTRA 3D visual allows a realistic view from all angles, while virtual clothing helps show how bikini tops and other clothes will fit. This interactive technique for sharing post-operative information is invaluable in showcasing numerous breast-size options and simplifying the decision-making process, as well as putting patients at ease about actual surgical outcomes. Many studies have validated its accuracy and patient satisfaction is around 95%! In addition, many of the patients who would have been reluctant to proceed with an operation were able to do so because of this technology.

The VECTRA  3D imaging for breast augmentation, may in a few short years, be required for the offices of plastic surgeons practicing state of the art breast and body contouring surgery. In addition, the more discriminating and tech-savvy patient will demand it and seek out those practice locations for their breast augmentation surgery.

For additional information please call 13000DRTIM or email info@cosmeticculture.com.au

Question:  Do you feel that having 3D Imaging to simulate breast size makes a difference in your decision on having breast augmentation?  You can leave a comment below or share this post with family and friends.

How Do You Repair Torn Earlobes?

The earlobes are the lowest part of the ears made of skin and a small amount of fatty tissue in between. There are large variations in size, form, and shape. The earlobes serve women (and men) as popular locations for placing jewellery. Often, the earlobes are pierced to fit various forms of ear ornaments ranging from studs to earrings which can occasionally set them up for trouble.

Excessive weight or trauma can easily overcome the strength of the earlobe tissues leading to a tear, which if complete, results in a split ear. Some people with rather thin earlobes who favour wearing heavy earrings, experience a gradual elongation of the ear-piercing tract such that it becomes slit-like and often too large. Another problem is that the earlobes can be torn by accidental trauma. This split may be unattractive and renders the earlobe unusable for most jewellery. Sometimes, clip-on earrings can still be fitted and are used to camouflage the earlobe tear.

The repair of torn earlobes is relatively simple. The procedure is routinely performed in the office under local anaesthesia with an optional sedative. After planning and marking, a small amount of lignocaine numbing solution is deposited. I favour a three-layer repair done under loupe magnification. But it is very important to remove the damaged ear-piercing tract or to trim the edges of the split if the earlobe has been torn through completely.

Then the three-layer closure consists of closing the outer layer of skin, the fatty tissue between the two layers of the skin and finally the skin in the back of the earlobe. Typically, the surgeon must take great pains to avoid any notching at the bottom of the earlobe. The fine sutures on the skin are usually removed within 7 days. Small amounts of antibiotic ointment are applied at home for a few days ensuring cleanliness. The healed earlobe has usually a barely visible pencil-fine straight or zigzag scar line.

People often ask if the ears can be pierced again. They can but typically you should wait three months after the earlobe has been repaired. Preferably piercing should not be done within the scar, as this can stretch and inevitably result in another clot.

Thanks for reading!

Dr. Tim – Sydney Cosmetic Plastic Surgeon

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

Laser Hair Removal Mythconceptions

There is no such thing as a single “best” laser for hair removal on all patients.  The best laser for laser hair removal for each person really depends on his or her skin colour. Thus, multiple lasers exist for hair removal. Different laser types, which emit distinct wavelengths of light, are better for treating different skin types. There are a number of manufacturers that make these laser types:

  • Alexandrite lasers. These emit laser light at 755 nm. These lasers work best on lighter skin. In my opinion,  it has been the most impressive laser for hair removal for light to olive skin types.
  • Diode Lasers.  These emit light at a wavelength of 810  nm.  Lighter skin types do well with this type of laser, as do some darker skin types.
  • Nd: YAG lasers.  These emit a 1064 nm wavelength.  This laser is best for darker skin types, as the higher wavelength reaches deeper into the skin.  This helps to avoid superficial skin melanin,  which pigments our skin.
  • IPL or  Intense  Pulsed  Light. It has been used for hair removal.  Lasers emit light at one wavelength (like laser pointers in PowerPoint presentations).  IPL machines produce a range of wavelengths  (like the cone of light from a torch one sees in cartoons) and are not lasers.  So,  there  is  no  such  thing  as  an  “IPL  laser”  or  “IPL laser  hair  removal”-  it’s  a  marketing  ploy  for  businesses  that  have  IPL  machines  and  not  hair  removal  lasers (the  only  exception  to  the  rule  are  the  few  machines  out  there  that  have  both  lasers  and  IPL  machines  in them).  Several studies have shown that  IPL is not as effective as dedicated hair removal lasers, and carry a higher risk of burns, blisters, and changes in pigment.

In my experience,  the Alexandrite laser is the most effective laser for removing hair on the lighter skin, whereas the Nd: YAG is the safest and best laser for more darkly pigmented skin.  Remember,  every laser  has  a  “target.”  For hair removal lasers, the goal is to selectively target the pigment (in other words colour) which in this case is called melanin found in hair follicles.  Melanin is the reason why we have black or brown hair or shades in between.  The hair follicles are living cells which make hair below the surface of the skin.  When the melanin is selectively heated, this destroys the hair follicle cells.  The lighter the hair, the less melanin the hair follicles will have in them.  As a result, hair that is blonde, white or grey does not improve with laser hair removal.  In my practice,  I have actually seen some patients notice a decrease in lighter hairs,  but it ’s the exception and not the rule.

Melanin is also present in skin and is the cause for dark skin and suntans.  It is the same target that the hair removal laser is trying to reach in hair follicles.  Hair removal lasers may target the melanin in the skin as well as in the hair follicles which sometimes results in burns,  blisters, and change in skin pigmentation.  As a result,  lower settings and longer laser pulse times must be used for darker skin to avoid damage.  As a consequence, more overall treatment sessions will usually be necessary.

Remember, laser hair removal is a medical procedure and you should always consult with a doctor who has extensive experience in lasers and laser hair removal.  This will maximize your chances of a great result.

Thanks for reading!

Dr.  Tim  –  Sydney  Cosmetic  Plastic  Surgeon

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