Cosmetic Surgeon Brisbane Dr Raymond Goh | Plastic Surgeon | Specialising in Cosmetic, Reconstructive and Hand Surgery Brisbane » Breast Surgery

Breast Implants or Breast Lift?

admin2 — Mon, 27 Jun 2016 07:15:42 +0000

Many patients present for breast enhancement, but are unsure if what they require are breast implants or if they require a lift (mastopexy) procedure, with or without implants. Of course, to be entirely sure, a complete assessment by a fully qualified plastic surgeon experienced in breast enhancement surgery is necessary. However, there are a few tips that patients can apply to get a fairly close idea as to which procedure is required to give them the result they are looking for.

The “look in the mirror” assessment:

Patients can gain a quick assessment just by looking at the mirror (with arms down by your side) or at photographs taken of them.

Try to avoid “selfies” of breasts as these are often taken at incorrect angles and distances, rendering them distorted and inaccurate.

When you look at the mirror, make a note of where you inframammary fold or breast crease is. The folds on each side may be at different levels, and this factor in breast asymmetry is common and can be considered normal.

Once you have determined where your breast fold is, take note of the following:

The NIPPLE position: is this ABOVE the fold, AT the fold, or BELOW the fold.
The bulk of your BREAST TISSUE: is this ABOVE the fold, AT the fold, or BELOW the fold.

Once the above questions have been answered, we have most of the necessary information required to determine which is the best operation to perform; this however has to be balanced with what result we’re aiming for, as there are sometimes limitations caused by the patient’s anatomy.

In general, if your nipple and most of your breast tissue lies above the breast fold, then you should get a very good and long-lasting result with implants alone. On the flip side, if your nipple and most of your breast tissue lies below the fold, then you will NOT be able to get a good result with implants alone, no matter how large they are. You will in this case require a breast lift, with or without implants (depending on what volume you wish to achieve).

The tricky judgement call arises when the nipple AND/OR the bulk of the breast tissue lies AT around the breast fold level. These “borderline” situations demand one other important question to be answered: What size or volume increase are you looking for?

In cases of borderline droopiness, the patient MAY be able to get away with a reasonable result with an implant alone; however, the caveat is that implant must be of a large enough size that will allow the loose lower skin to be filled. The result of such an approach may give a satisfactory result, but it certainly won’t be as “perky” a result when compared with a lift or the result gained with implants in a non-droopy patient. If you are a borderline case and only looking for a small increase in size/volume, then a lift is often advised.

The trade off with a lift (with or without implants) is, of course, the inevitable scarring. A breast lift (or mastopexy) involves elevating the nipple areolar complex to a higher, more desirable position, removal of lax breast tissue, and tightening of the breast skin envelope. This will result in circular scar around the nipple areola, a vertical scar down the centre of the breast, and often a horizontal scar across the breast fold. This scarring in most patient will fade with time and become quite inconspicuous.

So there you have it. A quick and simple analytical process that enables you a fairly good idea to see if you are a good candidate for breast implants alone or if you require a breast lift. Remember, nothing beats a comprehensive assessment with an experienced surgeon. Know what kind of result you are looking for in terms of SHAPE and SIZE. Discuss these with your surgeon to see if they are achievable. There are many other factors (such as skin quality, breast tissue composition, tubular deformity etc) that play a part in the decision making process, and your pre-existing anatomy may also limit what can be achieved.

The ideal breasts, with a full rounded lower pole contour and the nipple areolar complex positioned at the apex of the breast. Both nipple and bulk of breast tissue lies above the breast crease.

Severe breast ptosis (droopiness) where both the nipple and bulk of breast tissue lies below the breast crease. This will definitely require a lift procedure, with or without an implant.

Breast asymmetry with pseudo-ptosis (nipple ok, breast tissue droop) on the left side. The right side will do fine with an implant alone. The left side however, with the nipple above the fold, but with the bulk of the breast tissue starting to fall below the fold, will either need an implant large enough to fill out the lax lower breast tissue or a smaller implant together with a lift.

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BREAST AUGMENTATION COMPLICATIONS

shairao — Wed, 30 Sep 2015 09:17:24 +0000

Breast Augmentation Surgery: Potential Risks

Breast augmentation and breast lift (mastopexy) procedures can dramatically improve the femininity and self confidence of women seeking enhancement of their breasts. The majority of women having breast augmentation will travel through their procedure uneventfully. There are certain things after the operation that should be expected, such as swelling, mild to moderate discomfort, and temporary numbness – these should be communicated to the patient prior to surgery. The benefits of having a breast augmentation or lift should also be balanced with comprehensive discussion on the potential risks and complications of undergoing the procedure.

As common as it is, and as much as it is promoted, discussed, and popularised in social and popular media, the potential risks of breast augmentation and lift should never be trivialised. It is still a surgical procedure, and all surgical procedures carry potential risks. The list of possible complications of breast augmentation and lift is exhaustive, but the important ones include:

Bleeding. If bleeding is significant enough, this may warrant a return to the operating theatre, and evacuation of the haematoma (collection of blood) and identification and cessation of the source of bleeding. The signs of bleeding include an increase in pain and swelling/size of the breast. If this occurs, you should immediately contact your surgeon or hospital emergency department.
Infection. This is rare. However, if an infection develops around the implant becomes severe enough, it may be necessary to remove the implant and clean out the wound.
Numbness. This usually recovers after several weeks, but may persist for longer in some women.
Capsular Contracture. This is scarring around the implant which may be severe enough to cause symptoms. It can occur in the short term or many years after placement of the silicone implants. The body will naturally form a layer of scar tissue around the silicone implant – this is expected, normal, and is called a capsule. A capsular contracture occurs when the scar tissue becomes thick and firm enough to cause discomfort, palpable hardness, and visible deformity. A surgical procedure may be required (capsulectomy) to remove the capsule if symptoms are severe enough.
Asymmetry. There can be many reasons why breast may appear not exactly symmetrical after an augmentation or lift procedure. It may be related swelling, capsular contracture, or due to technical aspects of the pocket creation, pectorals muscle release, nipple positioning, degree of skin adjustment, and establishing the inframammary fold. The implants may take several weeks to settle into their final position whilst the swelling dissipates, and it is important during this time that you diligently wear the supportive garment provided.
Complications related to the general anaesthesia. These include blood clots, chemical imbalances, and heart and lung related issues.

Whilst complications after breast augmentation and lift surgery are not common, when they do occur, they can impact upon the patient’s physical and emotional wellbeing, and cause a significant setback in their overall expectation. It is important at this time that the patient is fully informed of and understands what is occurring and the possible reasons behind it. Sometimes, however, a complication can occur without any clear reason and even after the most perfectly executed surgery. Whatever may be the case, it is important that the surgeon communicates to the patient how the problem can be fixed (if a secondary procedure is indicated) and what is to be expected.

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WHICH INCISION?

shairao — Tue, 29 Sep 2015 09:11:17 +0000

Effect of Incision Choice on Outcomes in Primary Breast Augmentation

If you are thinking about having breast augmentation, one of the factors that needs consideration is the site of the incision (where the cut in the skin will be created to place the implant through).

The options for the incision in breast augmentation are:

1. inframammary (in the fold underneath the breast)

2. peri-areolar (around the nipple)

3. trans-axillary (arm-pit)

4. trans-umbilical

The trans-umbilical approach has many drawbacks and is seldom performed. The trans-axillary approach has a scar that’s well hidden; however, this approach does not allow the surgeon as good an access to the breast when compared with the inframammary or peri-areolar approach.

In my practice, the inframammary and peri-areolar incisions are the most commonly used approaches for breast augmentation. They each have their pros and cons, and I would discuss these with the patient during our consultation, taking into consideration the patient’s personal preference. Both incisions give good access to the breast, both for primary as well as secondary procedures if they are ever required. Both incisions can heal up to become almost indistinguishable.

A study conducted in 2011 by Professor Scott Spears showed that the incidence of capsular contracture, which is scarring around an implant that can contract and cause symptoms, is highest with the transaxillary approach and lowest with the inframammary approach. One theory behind the cause of capsular contracture is bacterial contamination. The lower rate of capsular contracture with the inframammary approach may be related to the possible reduction in contamination by bacteria (theoretically, the the nipple or armpit can be a source of bacteria). The occurrence of capsular contracture can be unpredictable, and further studies on this condition are been carried out to determine ways of minimising their occurrence.

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DO I NEED A LIFT?

admin2 — Tue, 15 Sep 2015 00:45:01 +0000

That’s one of the most common questions that a women considering breast augmentation asks herself and her surgeon, and is particularly relevant when a woman has some degree of ptosis (droopiness) of the breasts. It is a very valid question, as not performing a lift (mastopexy) with an augmentation where it’s indicated can result in displeasing results. The flip side to doing a lift of course is the associated scarring – this is unavoidable, as a mastopexy requires removal and tightening of breast tissue and skin.

When we analyse ptosis, we must consider it in two parts: 1. nipple ptosis and 2. glandular ptosis.

Nipple ptosis refers to where the nipple lies in relation to the inframammary fold. Glandular ptosis refers to where the majority of the underlying breast tissue lies in relation to the fold. When the nipple is below the fold, it generally means that a lift is required. When the nipple is above the fold, a lift is generally not required. A more difficult decision arises when the nipple is at the fold. This is when the pros and cons of a lift versus implants alone need to be discussed. With glandular ptosis an implant of sufficient size may occasionally be used to fill and push out the breast.

With the newer generation of anatomical highly cohesive silicone implants, there are now some situations whereby a patient who has borderline ptosis may get away with having implants alone. In these situations, one would always caution the possible downsides to having implants alone, such as early recurrent ptosis and the requirement to do a secondary lift some time down the tract.

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Which Plane?

admin2 — Tue, 15 Sep 2015 00:40:32 +0000

Breast Augmentation pocket planes explained:

A lot of women considering and researching breast augmentation are still confused about what the different pocket planes into which breast implants can be placed and, in particular, which pocket plane will best suit their body.

In essence, there are two pocket planes that a breast implant can be put into: OVER the muscle (sub-glandular, sub-fascial) and UNDER the muscle (sub-pectoral, sub-muscular). A further refinement of the under-the-muscle pocket plane is the DUAL-PLANE technique. The over-the-muscle technique involves creating a pocket under the breast tissue so that the only thing covering the implant is breast and skin. The under-the-musclel technique, on the other hand, has the implant placed under the pectoralis muscle, such that the implant is covered by muscle as well as breast and skin. The dual-plane technique is a modifiable and customised method by which we create a pocket in which the top portion of the implant is positioned under the muscle whilst the lower part of the implant is positioned under breast and skin.

There are advantages and disadvantages to each pocket plane, and indications for each are dependent on the patient’s body type and clinical findings. In general however, most patients seeking breast augmentation are best suited to having their implants placed under the muscle in a dual-plane fashion.

The dual-plane technique is a refinement of the under-the-muscle pocket in breast augmentation. In this technique, the pectoralis muscle is released from its attachments such that the “roof” of the pocket (and tissue which will cover the front part of the implant) is made up of muscle in the upper portion and breast tissue in the lower portion. The advantage of having the upper part of the implant under the muscle is that this is where having extra tissue coverage and protection can be beneficial, especially in the long term, when breast tissue gets thinner in the upper pole. In the dual-plane technique, having breast and skin over the lower part of the implant allows the implant to more effectively expand out the lower pole of the breast, thus creating a more pleasing aesthetic result. A customised dual-plane technique allows the surgeon to tailor the areas of the implant we want to be covered by muscle, and also define the areas where we want the breast and skin to be expanded by the implant.

There is no one standard technique in terms of pocket plane that will qualify for every patient seeking breast augmentation. In order to achieve the desired result, one must develop a customised approach taking into consideration the patient’s existing anatomy, and selecting the most appropriate size, shape, and type of implant.

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