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 

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.

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.

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.

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 .

Breast Implants: Things to Know Before Getting Them

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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.

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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