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Patients usually take at least 3-4 weeks off from work following a body lift. I encourage patients to ambulate shortly after surgery. They may resume full exercise approximately 6 weeks following surgery.

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

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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 

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There are many reasons why women seek breast augmentation. Some women feel that increasing their breast size will give them greater self-confidence. Others would like to feel more proportional between their top and bottom so they fit better into their clothing. Mothers frequently seek breast augmentation to restore what was lost with breastfeeding and ageing. Supporting loose skin and giving upper breast fullness are also common reasons for choosing breast enlargement.

Good communication with patients in breast augmentation is key. There’s a need to review their medical histories and ask patients what their goals are for breast augmentation. In some cases, it is a modest increase in size to fit better in their clothing. Other times it’s a significant increase in volume to change their look. A patient may desire an improved breast shape or, possibly, better symmetry is their goal. Still others may want to restore their pre-pregnancy figure and may choose to combine their augmentation with a breast lift or other procedures.

On examining the patient, one needs to consider many features including breast volume, width, height, nipple position, areola size, ribcage curvature, skin tone, droopiness, asymmetry, and crease position. Breasts are highly variable, and I help the patient understand what their best options are based on their physical characteristics. We then come to a common agreement about what our goal will be. Remember, that “breast are sisters, not twins” so more often than not there is quite some variation between the two breasts so you can’t expect a perfect match following breast augmentation.

When the patient returns for their pre-operative visit, typically 1-3 weeks before surgery, I have them look through many digital photographs of breasts to show me their desired result. If there is a discrepancy between what we have discussed and what the patient is showing me with pictures, I’ll identify the difference and sort out what they really want, often using the 3D VECTRA which can simulate what the breasts may look like after augmentation. At the end of our meeting, I’m fairly confident that I understand what the patient desires. Likewise, the patient feels comfortable with our communication and our plan.

The photographs are then brought with me to the operating room. When the patient is asleep, I create the pockets for the implants on each of the breasts, and I occasionally use implant sizers to confirm the volume and shape of the optimal breast implants for the patient. Most patients are back to work and most of their usual routine in several days or up to a week. Strenuous exercise should be avoided for several weeks.

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

Beware! Women With Funnel Chested Having Breast Augmentation!

Funnel chest (pectus excavatum) is an abnormal development of the rib cage where the breastbone (sternum) caves in, resulting in a sunken chest wall deformity. Funnel chest is a deformity often present at birth (congenital) that can be mild or severe. The cause of funnel chest is not well understood. Yet, researchers believe that the deformity is caused by excessive growth of the connective tissue (cartilage) that joins the ribs to the breastbone (also known as the costochondral region), which causes an inward defect of the sternum.

While the vast majority of funnel chest cases are not associated with any other condition, some disorders may include the sunken chest feature include:

  1. Marfan syndrome: A connective tissue disorder, which causes skeletal defects typically recognised by long limbs and ‘spider-like’ fingers, chest abnormalities, curvature of the spine and certain facial features including a highly arched palate, and crowded teeth.
  2. Rickets: A deficiency disease occurring primarily in children, Rickets results from a lack of vitamin D or calcium and from insufficient exposure to sunlight, which disturbs normal bone growth.
  3. Scoliosis: A curvature of the spine.

Although the condition of funnel chest is relatively uncommon, it presents its own unique problems for women requesting breast augmentation. The commonest question asked is, “Which pocket is best to place the implants?”

In women with funnel chest deformity, I have tended to place the breast implants under the muscle because the breast and skin can be very thin over the midline of the chest and can make the implants more visible with a higher chance of rippling.

I also inform my funnel chest patients that the breast implants tend to slide towards the middle of the chest creating a very pronounced cleavage with nipples that tend to face inward (“cross-eyed” appearance). Because the patient with a funnel chest has a deeper midline, they will generate much more cleavage faster than patients with a flat chest wall. In worse case scenarios, the breast implants can slide towards the midline and “kiss each other” creating the “figure-of-8” or “bread loaf” deformity. Consequently, the experienced plastic surgeon will use a slightly smaller breast implant and will go under the muscle and make sure to leave enough tissue intact along the midline to prevent the implants from coming too close together.

As you can tell, this is a more difficult operation than regular breast augmentations. In my experience, the breast implants tend to improve the appearance of the “funnelling,” in that the indented area of the chest wall is less noticeable.

Question: Have any women with funnel chest experienced problems after breast augmentation? You can leave a comment below.

Tummy Tuck (Abdominoplasty ) for a Contoured Waistline

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Loose skin, stretch marks and abdominal fat are among the most common reasons patients seek help from a plastic surgeon. In some cases, patients have excess skin and fat on the abdomen due to weight loss. In other cases, age or pregnancy has changed the contour of the abdomen. Many people get frustrated about diet and exercise being unable to tighten their lower abdominal skin. Some even lose the motivation to exercise because they can’t see any improvement. For many patients, abdominoplasty (tummy tuck) is their best option to reclaim a youthful figure.

Candidates For A Tummy Tuck

Candidates for a tummy tuck have some (or all) of the following problems:

  • Loose skin on the lower abdomen
  • Stretch marks on the lower abdomen
  • Abdominal muscle laxity
  • Pubic laxity

Good abdominoplasty candidates should be healthy non-smokers. Although it’s better for patients to be close to their ideal weight, many patients who are overweight are still good candidates for the procedure.

Mommy Makeover

During pregnancy, skin may be stretched to the point that microscopic fractures form in the skin, or dermis, resulting in stretch marks. Caesarean section scars may accentuate fatty bulges by tethering the skin to the underlying muscles, causing the fat and loose skin to fold over the scar. The rectus abdominis (“six-pack”) muscles on the abdomen may become separated in the midline, creating a potbelly appearance. Fat also redistributes with age, becoming concentrated in the lower abdomen. The hourglass waistline of youth gives way to a larger midsection. That’s why many women choose abdominoplasty as part of their “Mommy Makeover“.

Although tummy tucks can achieve dramatic improvements, it’s important to also consider adjacent areas of the body for optimal results. For many patients, liposuction around the waist and thighs will provide more comprehensive results. Mothers will frequently choose breast surgery as well. This combination of procedures completes their transformation back to the hourglass figure they once had.

The Procedure

The tummy tuck procedure involves the following steps:

  • Removing a large amount of lower abdominal skin (and stretch marks)
  • Removing a large amount of lower abdominal fat
  • Tightening the rectus abdominis muscles of the abdomen
  • Redistributing the upper abdominal skin over the entire abdomen
  • Creating a new belly button within the tightened abdominal skin
  • Tightening the pubic area

Tummy tuck procedures (and results) vary substantially. Tummy tuck techniques have evolved significantly over the last decade in an attempt to achieve the best possible results for patients.

Recovery

Following a tummy tuck, patients should take at least 2 weeks to recover before returning to work. Normal exercise routines may be resumed approximately 6 weeks following surgery.

Take the first step toward restoring your body with a tummy tuck. Request a consultation online or call our office at 13000DRTIM.

Cosmetic Surgery Tip #13: You can try on different boob sizes before deciding on one

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Using “sizers” in the form of  breast implants or a rice-filled stockings, you can stuff your bra to give you an idea of the size you might like.

Photo Credit: Saul Steinberg “Masquerade”

Cosmetic Surgery tip #30: Supplement with a natural stool softener

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After surgery, many patients find that they are very constipated for several days which can cause discomfort.  Dehydration, narcotics and anaesthetic agents used during surgery all contribute to the digestive issue.  You can prevent this problem by eating a few prunes each day just prior to and after your surgery.  You can also take medical stool softeners like oral Dulcolax® or Microlax® enema for post-op constipation.

Photo Credit: Saul Steinberg “Masquerade”

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.

Cosmetic Surgery Tip #20: Any breast surgery can have a small effect on breast cancer screening in the future

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Breast health is important. Before the surgery, have a proper breast exam with your GP or gynaecologist. If you’re of age, get a mammogram. Most mammographers don’t have an issue if the implant is placed behind the muscle, but it is important to discuss this with your plastic surgeon. The x-rays used for mammographic imaging of the breasts cannot penetrate silicone or saline implants well enough to image the overlying or underlying breast tissue. Therefore, some breast tissue (approximately 25%) will not be seen on the mammogram, as it will be covered up by the implant. In order to visualise as much breast tissue as possible, women with implants undergo additional views as well as the standard images taken during diagnostic mammography. In these additional x-ray pictures, called Eklund technique or implant displacement (ID) views, the implant is pushed back against the chest wall and the breast is pulled forward over it. This allows better imaging of the forward most part of each breast. Sometimes it is more difficult to perform the Eklund technique in women who have severe scar tissue or capsular contracture and women who have very dense or fibrous breasts. Implants placed above the muscle can also make it more difficult to determine microcalcifications. Scar tissue around the capsule can be difficult to differentiate from calcification, which could be associated with cancer and thereby require an actual biopsy. The ID views are easiest to obtain in a women whose implants are placed underneath (behind) the chest muscle.

Photo Credit: Saul Steinberg “Masquerade”