Breast Augmentation revisions: 3 facts you must know!

Designing a surgical plan that can deliver a satisfactory result for women seeking surgical revision after breast augmentation can be quite difficult.  It still requires the plastic surgeon to obtain a good history, perform a careful clinical examination and identify the woman’s concerns and goals.

Revisional surgery after breast augmentation is typically more complex, because of the diversity of presentations and the interval elapsed since their primary surgery.  Additional surgery may be required because of anatomical changes caused by the previous procedure or that have occurred over me.  This information must be explained to and understood by women who may be expecting an easy fix. Furthermore, plastic surgeons may face the challenge of communicating with a dissatisfied and angry patient and therefore, in-depth and honest discussions outlining the risks, benefits, and costs of the various options remain paramount for achieving success.

There are 3 key facts women seeking revisional surgery after breast augmentation need to consider:

1)  Your plastic surgeon needs to listen carefully to what you’re saying.  They must find out what’s motivating you in order to satisfy your goals.  If your problem, however, is imperceptible to them, or you’re seeking an outcome they consider unattainable, they may not be able to help you reach your goals.

2)  Use visuals to enhance your consultation.  Visuals are extremely useful in helping you to understand all your options.  Your plastic surgeon should draw schematic diagrams to explain the various techniques and present you with lots of pictures of previous patients, which should be catalogued by physical attributes, rather than by implant volume or bra size.

3)  Make sure all your options are given to you in detail.  Your plastic surgeon should take a systematic approach to counseling you about your surgical options, beginning by describing the simplest, least-expensive procedure and moving up in terms of complexity and cost. Outlining all of the information so that you understand the basis for your recommendations and the likely outcomes should help you reach an informed decision and choose an operation that will deliver a satisfactory result.

If you have cost in mind and are dissatisfied after your recent primary surgery, then try and rectify the situation by returning to your previous surgeon. If this is not an option because of poor surgeon-patient communication, then you should seek another surgeon.

Thanks for reading!

 

Dr Tim – Sydney Cosmetic Plastic Surgeon

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

 

Breast Augmentation vs. Breast Lift – Know it all!

Like many women, you may find yourself choosing between these two procedures or choosing both. Each has its own unique goals, and the procedures are often combined to achieve an even more attractive curvature.

Breast Augmentation Goals
The goal of breast augmentation surgery is to make your breasts bigger and/or fuller (more projected). Women differ so vastly in shape, size, and frame that a number of options have been developed that offer something for everyone. You can choose from:

  1. Silicone gel or saline implants
  2. Textured or smooth surfaced implants
  3. Implant placement behind the breast tissue or behind the pectoralis muscle
  4. Round or tear-drop (anatomical) implants
  5. Various sizes of implants
  6. Different sites for the incision (breast fold, armpit or nipple areola complex)

Breast Lift Goals
Breast lift surgery is designed to elevate sagging breasts and restore their youthful, perky stature. Gravity, pregnancy and weight gain have a way of stretching even smaller breasts over time. Weight loss may leave breasts less firm and a bit saggy. Breast lift surgery involves elevating the nipples and lightening the breast skin to restore breasts to an attractive shape.

Breast Lift with Breast Augmentation Goals
The lift removes the excess skin and reduces sagging (pushes things “up and in”). The implant fills the remaining breast skin, adding contour and fullness where minimal breast tissue is insufficient (pushes things “out and down”). As you can see, the forces are opposing, and for that reason, there is a 20 % revision rate for this procedure.

What Makes the Difference?
What makes the biggest difference in outcomes is that the most successful plastic surgeons use the following techniques and protocols:

  1. Minimal blood loss, bruising and swelling by using electrocautery for dissection of the pocket, as well as, gentle manipulation of the tissues
  2. Smaller incisions
  3. No sutures for removal
  4. Specialised instruments for accurate placement of an implant
  5. Adequate pain relief postoperatively
  6. No drains or wraps to manage
  7. Avoidance of blood thinning agents perioperatively (cease multi-vitamins, aspirin, NSAIDs etc.)

 

Thanks for reading!

Dr. Tim – Sydney Cosmetic Plastic Surgeon

www.cosmeticculture.com.au
www.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.

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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.

Breast Augmentation Part 3 of 4: The Plastic Surgeon

I am amazed at 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)  Certified by the Royal Australasian College of Surgeons, the only college recognised by the Australian Medical Council that can train surgeons in Australia

2)  Be a Member of the Australian Society of Plastic Surgeons (ASPS) and the Australasian Society of Aesthetic Plastic Surgery (ASAPS)

3)  Has hospital privileges to do breast augmentation at an accredited hospital or day surgery facility

4)  Subspecialises in cosmetic surgery

5)  Super specialises in breast augmentation

6)  Recommended by a knowledgeable friend or doctor

7)  Has a curriculum vitae that 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 is 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 “photo-shopped” 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 ASPS and ASAPS

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 their 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 is 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 a bargain price? How is the bargain surgeon able to offer such a good price?

When visiting the plastic surgeon’s 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 that 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.

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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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 

Correction of inverted nipples: the facts that you need to know!

As many as 3% of Australian women have at least 1 inverted nipple but the subject of nipple inversion is seldom discussed amongst family, friends or the media. Clearly, nipples are an integral part of the breast, playing a role in appearance, in sexuality, and in motherhood. Therefore, many women who have inverted nipples, feel that it affects their self-esteem and body image.

Most cases of inverted nipples are just born that way (congenital). However, some nipples become inverted after breastfeeding when scar tissue builds in the milk ducts. Nipples that become inverted after birth are usually caused by one of three things: not enough skin at the base of the nipple, constricted milk ducts, or scarring of the milk ducts due to breastfeeding. There are 2 types of inverted nipples: shy and densely inverted.

  1. Shy inverted nipples– can be drawn out with physical stimulation, either sexually or for breastfeeding. Shy inverted nipples may only cause cosmetic and psychological problems.
  2. Densely inverted nipples– this is where the nipples never come out, even when aroused or in very cold water. Densely inverted nipples also have functional repercussions, such as the inability to breastfeed, infection or irritation of the nipple when natural secretions become trapped.While a procedure to correct inverted nipples can have a great impact on the patient’s psyche and correct irritation problems, the ability to breastfeed cannot be guaranteed, as some or all of the ducts may need to be divided in order to free the nipple so that it is drawn out completely. The particular technique I use to correct inverted nipples was taught to me by my colleague and friend Dr. Grant Stevens, a plastic surgeon in Los Angeles, who is a pioneer in new techniques for procedures in breast surgery. The technique is safe, effective, has a short downtime, and the results are long-lasting. Before the procedure begins, the nipple and areola are numbed with an ice cube or pack, and a local anaesthetic given using a tiny needle the size of a hair. This means the patient experiences little or no pain, despite the sensitivity of the area.

The surgery itself is broken into 3 stages:

Stage 1: an incision measuring 4 to 5 mm is made in the lower portion of the nipple. The fibres or ducts are then released that are pulling the nipple down. The nipple is drawn out with much care in order to preserve the ability to breastfeed.

Stage 2: involves a series of stitches around the nipple.  If the nipple is imagined like a clock, the stitches run from 12 to 6 o’clock, then again from 3 to 9 o’clock.  By bunching up the tissue around the nipple, these stitches create a new pedestal for the nipple to rest on. A dissolving “purse-string” stitch is made around the base of the nipple, weaving in and out of the skin, which tightens the base of the nipple.

Stage 3: a small plastic “stent” – like a tiny medicine cup – is placed over the newly extracted nipple. This stent actually holds the nipple in place and ensures that the nipple heals in an outward position. Not only does it help with the nipples’ projection, but it also protects the nipple in the healing stages. This stent is kept on for 1 to 3 days. The patient then returns for a follow-up visit to remove the stent and the process is complete.

Post-operatively, there is little care needed. While the stent is on, patients cannot get the area wet and sexual contact is discouraged for the first week after surgery. Occasionally, the patient may need an ointment to aid the healing, although this is rare. The wound heals very quickly – to the point where the scar is usually invisible by the time the patient returns to have the stent removed (the stitches dissolve within 10 to 14 days). Possible complications include the retraction of the nipple or a local infection.

Although the correction of inverted nipples is a procedure that can greatly assist both the self-esteem of the sufferer and the function of the breast, more and more women are coming to my practice seeking nipple surgery for repair, correction, and enhancement of other conditions too:

  1. Enlarged nipples can be corrected with simple outpatient surgery reducing the length or diameter of one or both nipples.
  2. Reducing enlarged areolas is a quick fix as the areola can impact the appearance of the breasts more than any other feature.
  3. “Puffy” areolas put a cone-like cap on the breasts that some people find unattractive. A simple surgery can flatten the areola and beautify the breasts.

So despite the fact that nipples are usually hidden, women still want them to look attractive. Many women suffer with nipple and areola abnormalities such as inverted nipples, enlarged nipples, and puffy, enlarged or discoloured areolas.  Many of these conditions can impact breast function, but they all impact the way women feel about their bodies. The nipple can be repaired during outpatient surgery or during breast enhancement surgery.

Question:  Do women feel inverted nipples is such a big issue to warrant surgery?  You can leave a comment below.

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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 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.

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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